Advocates for Self-Managed Abortions Are Preparing for a Post-Roe World

Activists are trying to help women navigate the complicated legal landscape around misoprostol and mifepristone, "essential medicines" according to the World Health Organization.
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Eleanor Crossey Malone displays an abortion pill packet in Belfast, Ireland.

Eleanor Crossey Malone displays an abortion pill packet in Belfast, Ireland.

One evening last month, half a dozen people, mostly women, met at a suburban home in upstate New York for a remote workshop. Sitting on sofas and fold-out chairs in their host's living room, they enjoyed vegan snacks while waiting for the leader of the workshop to appear on the television above the mantle place. Bottles of wine sat to the side for drinks to follow.

"The atmosphere felt something like a radical Tupperware party," says Kate Krimsky, one of the participants.

The participants, all advocates for abortion access, were there to learn how specific medications can be taken at home to safely induce miscarriages. They believe that the knowledge to conduct such "self-managed abortions" will become essential should Roe v. Wade be overturned.

"Medical abortions," or those induced through the use of medication, rather than performed through surgery, are fairly routine. According to the latest statistics from the Centers for Disease Control and Prevention, medical abortions account for nearly a quarter of all abortions performed in the United States. Misoprostol and mifepristone, the "abortion pills" are both safe and effective enough to be the standards offered by Planned Parenthood up to 10 weeks into pregnancy. In some parts of the world, like Latin America, they are even available directly from pharmacies, and the World Health Organization includes them on its list of essential medicines.

How abortion pills are obtained and administered are the issues at the crux of self-managed abortions. In essence, a "medical abortion" becomes a "self-managed abortion" when the procurement and administration of the pills are in the hands of the patient, rather than anyone else.

In the U.S. today, misoprostol and mifepristone are controlled by a patchwork of often contradictory laws stipulating when, where, and by whom they can be administered. According to the Guttmacher Institute, which conducts research and advances policy regarding sexual and reproductive health, 34 states require abortion pills to be provided by licensed physicians. Throughout the country, they must be distributed by pre-registered clinics, medical officers, and hospitals, rather than pharmacies, and they are not necessarily covered by health insurance, even Medicaid. Attempts have also been made to ban the pills altogether, such as in Oklahoma, but these have been blocked by court orders.

"A self-managed abortion is the self-sourcing of abortion medicines followed by self-use of the medicines, including self-management of the abortion process outside of a clinical context," explains Susan Yanow, co-founder of Women Help Women, an international non-profit organization dedicated to improving abortion access. "The process of taking control of one's reproductive life can be empowering. Abortion pills are safe and effective, and the rare complication is the same as with a miscarriage—all doctors can treat it."

To help navigate the confusing legal landscape around abortion pills in the U.S., Women Help Women launched Self-Managed Abortion; Safe and Supported in 2017. The website not only provides users with access to basic information about the abortion pills, such as how they can be taken safely, but connects them with counselors who can assist them on a case-by-case basis. The hope is that, by making this knowledge more widely available, a degree of autonomy will be restored to those far from abortion clinics or constrained by anti-abortion laws.

Yanow also leads workshops on self-managed abortions, such as the one attended by Krimsky. As a volunteer clinic escort who helps patients avoid confrontations with anti-choice zealots, Krimsky was interested in learning more about self-managed abortions, especially following proposals for new abortion restrictions in six states earlier this year. It's been widely speculated that these laws are meant to inspire a challenge to Roe v. Wade in the Supreme Court, whose membership currently leans conservative.

"For the first time, many of us are beginning to consider what a post-Roe America might look like," Krimsky says. And, in that world, self-managed abortions might be the only options available.

A friend of Krimsky's had previously attended a formal, in-person workshop with Yanow and asked her to conduct a similar event remotely for those, like Krimsky, who were unable to make it. Over the course of two hours, Yanow shared the basics of menstruation, pregnancy, and the reproductive system, before moving on to the specifics of the abortion pills: necessary precautions such as proximity to a hospital and a companion; steps to safe administration; and signs to seek medical attention.

Because sharing information about self-managed abortions could be criminalized—people have been charged with murder for inducing their own miscarriages, so fear abounds that others involved may likewise be seen as complicit—much of the workshop was dedicated to roleplaying, with the participants attempting to walk the fine line of legality. A particularly sensitive subject was obtaining the pills themselves, which the group danced around by noting that the drugs were available over the counter in other countries and had relatively long shelf lives, thus could be stockpiled, or were available for other purposes, which could be had with or without a prescription.

A protester at a "Stop the Bans" rally in New York City.

A protester at a "Stop the Bans" rally in New York City.

"Sharing information about this procedure is far more dangerous than the procedure itself, which is among the safest of medical procedures—safer than a root canal and far safer than a pregnancy," Krimsky says.

After Yanow logged off, the attendees opened the wine, reviewed what they had learned, and discussed how they intended on spreading that information within their communities. Following the election of President Donald Trump, the confirmation of Supreme Court Justice Brett Kavanaugh, and the wave of proposed abortion restrictions, pro-choice advocates had been up against the wall for some time. Now at least they could take a new tact.

"When we talk about issues around reproductive health right now, it's usually in bleak terms—the gag orders, the funding cuts, and the bans—but everyone left thrumming with excitement," Krimsky says of the workshop. "We felt hopeful, and that hope is empowering."

Hope may become even more necessary as challenges to Roe v. Wade continue to mount. A month before Yanow's workshop, Krimsky had attended a "Stop the Bans" rally in New York City, where hundreds of people gathered to express their opposition to the recently proposed restrictions. During the rally, Krimsky noticed an older woman who was holding a sign that read, "I Survived an Illegal Abortion in Birmingham, Alabama, in 1969, #NeverAgain."

"A few moments later, she began to cry," Krimsky remembers. "I didn't realize I was crying too until a stranger touched my arm to comfort me."

"Now, as in the past, it will fall upon individuals to take charge of their own reproductive health," she continues. "The knowledge of these medicines can truly mean the difference between life and death for a pregnant person in a post-Roe America. That's our takeaway. That's the mission."

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