In the same amount of time it takes you to boil an egg, or answer an email, a new online video will show you how to end a pregnancy with pills.
Animated figures, accompanied by voice-over narration, take viewers through the process step by step: When to take the mifepristone, the first part of the two-part drug regimen for medication abortion; how long after that to take the misoprostol, how to place those pills under the tongue; and when to expect the cramping and bleeding, which signal that the passing of the pregnancy has begun. The 11-minute video also provides instructions on how to relieve pain or discomfort, and when to seek medical help. At the very beginning, it tells viewers how safe and effective this abortion method is, and how low the rate of complication.
The video is the product of a collaboration between Doctors Without Borders, the international humanitarian aid group, and HowToUseAbortionPill.org, a website with written guides for using abortion pills, and what to know about the laws regarding abortion and self-managed abortion, the practice of ending a pregnancy on one’s own. In the U.S., long-standing restrictions from the Food and Drug Administration make it illegal to sell mifepristone online or in pharmacies, and five states currently have laws in effect banning self-induced abortion.
The full online video series—which is 45 minutes and includes a broad overview of what medication abortion is and how it works, and instructions for pre- and post-abortion care—is intended as a training tool for the humanitarian healthcare workers who provide reproductive health services abroad; the videos address providers directly, rather than patients. But because the how-to videos are available to the general public in multiple languages, they can double as a complete guide to doing your own abortion, outside of medical supervision.
“We do not see this piece as an instructional guide for self-managed abortion,” the project manager at HowToUseAbortionPill.org told VICE. “However, we know that much of our online content (which goes up to an 11-week gestational limit) is used for self-managed abortion.”
“This course doesn’t use the phrase ‘self-managed abortion,’” added Manisha Kumar, the head of the task force for safe abortion care at Doctors Without Borders. “But it intentionally uses non-technical, simple language as much as possible because we want everyone to understand the basics about how a medication abortion or an abortion with pills works. I don’t think there should be any secrecy there.”
Kumar said the providers at Doctors Without Borders see the consequences of anti-abortion restrictions—coupled with a lack of information about safe and effective abortion methods—all the time. “Every day we’re treating women that come in with hemorrhage infections and uterine perforations,” Kumar said. “We see it firsthand.”
Though many of the patients who receive care from Doctors Without Borders live in countries where abortion is highly restricted on the national level, the landscape of abortion rights in the United States has put many patients in a similar position—needing abortion care and not knowing where to get it, or finding too many obstacles in their way to access it.
A recent study found that after a 2013 law shuttered more than half of Texas clinics, many women attempted to self-manage their abortions because in-clinic care was out of reach for them. The rate of self-managed abortions in Texas, one of the states with the most anti-abortion laws on the books, is three times that of other states.
Other research into self-managed abortion has yielded similar results: When Abigail Aiken, an assistant professor at the University of Texas at Austin, did an analysis of U.S. requests to Women on Web, a website that prescribes and sells abortion pills, she found that the highest rates of requests came from states that are hostile to abortion access, like Mississippi and Louisiana.
Most people looking for information about self-managed abortion and for a place to purchase pills are searching the internet. In the month-long period between May and June 2017, U.S.-based internet users ran more than 200,000 Google searches for information about self-managed abortion, according to analysis from Guttmacher Institute. And in recent years, more online resources have emerged to provide people with the information they’re searching for: In 2018, Rebecca Gomperts, the Dutch doctor behind Women on the Web, launched a sister site called Aid Access, intended solely for people in the U.S. looking for help ending their own pregnancies. Gomperts talks patients through the procedure herself, but the site also includes a page answering dozens of common questions about self-managed abortion.
Aid Access is just one of a handful of sites that sell abortion pills online, despite it being considered a violation of U.S. Food and Drug Administration regulations to do so. In order to provide pregnant people with the information about what to expect from each service, Elisa S. Wells created Plan C, a site that tests the products from abortion pill retailers and issues a “report card” based on their results. Plan C also lists multiple sites people can visit to learn how to take the pills, if they do end up purchasing them online. (HowToUseAbortionPill.org is among them.)
Though it may seem like there's already plenty of information out there for people interested in ending their pregnancies on their own, Wells said it’s still not as widely available as it should be, and many people still aren’t aware of how safe and effective medication abortion is when done properly—so having more credible online resources can’t hurt. The fact that Doctors Without Borders is a recognizable, reputable group also might make people more comfortable with the procedure.
“We know that people are buying pills online, or in bodegas and pharmacies,” Wells said. “In many parts of the world, they’re able to buy them off pharmacy shelves and they don’t always come with instructions.”
Crucially, Wells said, the more sites that provide information about medication abortion and self-managed abortion, the less stigmatized it will become.
Currently, that stigma means many people still may worry about the safety of the method, despite evidence to the contrary, and may have internalized the outdated imagery of the coat hanger, which suggests that abortion outside of a traditional clinic context must always be sketchy or dangerous.
The invention of the abortion pill means that’s no longer the case, and it will continue to be a method people turn to when barriers keep them from accessing in-clinic care. Though the pills themselves have a number of restrictions, Wells argues that medication abortion constitutes the one method of abortion that’s nearly impossible to ban or restrict. The pills are available on the internet, and so is the information on how to use them.
“It’s not going to be possible to [completely] restrict access to medication abortion because we do have these technologies,” she said. “We have the technology of the pill, first of all—and then we have the technology of information. It’s unstoppable.”
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