Self-Managed Abortion Is a Nightmare in the Surveillance Age

In the wake of the leaked Supreme Court document that will overturn Roe v. Wade, I watched as the term “self-managed abortion” spiked on Google trends. As a self-managed abortion educator, I wasn’t surprised. Any time a news cycle is dominated by anti-abortion rhetoric, especially when anti-abortion laws pass like in Texas or Oklahoma, more and more people seeking abortions start looking for ways to take matters into their own hands—and for good reason. 

But now, as the very last federal protections for abortion slip away, I’m concerned with how mass data collection and new surveillance technologies have affected peoples’ ability to seek access to self-managed abortion safely and privately, as well as share information about it. 

Self-managed abortion (SMA) has a long history in America and around the world, and it will continue to be a critical tool for people seeking to terminate their pregnancies even if Roe is overturned. But in 2022, the stakes have gotten considerably higher.

Data brokers now freely sell access to private information on people seeking abortions, birth control, and other reproductive healthcare, including geolocation data taken from smartphones. Following a recent Motherboard report, one data broker was pressured to stop selling data on people who had visited abortion clinics run by Planned Parenthood.

The ubiquity of surveillance technologies like facial recognition also makes it far more likely that people taking steps to get abortions will be identified and targeted—especially if they are visiting abortion clinics in person. As the legality of abortion continues to slip in America, more and more people are turning away from brick and mortar clinics and towards self-managed solutions to terminate their pregnancies. 

Even outside mass data collection, hospitals and medical institutions have never guaranteed the privacy of many marginalized communities, especially when it comes to reproductive healthcare. 

While it is almost never required that hospital or ER staff report patients who they suspect are having miscarriages due to self-inducing their abortion, it continues to be a persistent problem, especially for women of color. This was true for Lizelle Herrera, a Texas woman who was charged with murder and spent time in jail after her nurse suspected her of inducing her miscarriage and reported her to the police. (Thankfully, the charges were ultimately dropped, and Herrera was freed.)

Avoiding these sites of hostility can be especially important for young people, BIPOC, those who are undocumented, and queer and trans people, who all have long histories of experiencing reproductive oppression and violence. Being able to circumnavigate those spaces while accessing an abortion can be a blessing for many people who are safer and more comfortable in the privacy of their own homes, instead of at brick-and-mortar clinics that are frequently targeted by anti-abortion extremists.

But self-managed abortion in a post-Roe world brings about a new set of problems to an already gray legal area. While only six states have laws that explicitly ban self-managed abortion, the past week has seen many state lawmakers introducing and threatening to introduce outright bans of SMA, abortion medications, and even contraception. Beyond this, many overzealous prosecutors use other legal loopholes to terrorize and criminalize those even suspected of inducing their abortion at home.  

These are all the things I keep in mind when people reach out to me to ask about self-managed abortion. As a SMA educator, I’ve practiced how to share information about how a person can self-manage their abortion at home using World Health Organization guidelines. And despite how it may sound, evidence shows that self-managed abortions are incredibly safe and effective, and the medications are safer than Tylenol. Recently, a collective of anarchists has even released instructions on how to synthesize the abortion pill misoprostol at home.

The true danger, advocates say, is a medical and legal system that forces abortion seekers to accept increasingly higher levels of legal risk. 

“The primary risk is legal, not medical,” Erin Matson, the Executive Director of Reproaction, a D.C.-based organization working to make self-managed abortion more accessible, told Motherboard. “Abortion with pills is safe and it works including outside of the medical system.” 

Reproaction is one of the few organizations that shares the abortion protocols set by the World Health Organization and trains folks on how to share this information in what they call House Parties. House Parties are held virtually through secure webinar formats, participation is closed, and attendees are screened ahead of time. 

“We know that there are abortion opponents who mean grave harm and will do anything they can to curtail access to self-managed abortion with pills and are only too gleeful to send more people to jail,” said Matson. 

So how can activists and abortion seekers keep ourselves safe when searching for and sharing this information? 

Matson has some practical advice. Send messages with encrypted apps like Signal, use Tor browsers when researching information relating to SMA, and, if you’re able, leave your phone at home if you’re going to a clinic or protest. 

She also advises people to delete menstrual tracking apps. As someone who has used period tracking apps since I was a teenager, I have long since stopped using certain apps. I switched to Euki, created by Ibis Reproductive Health, which doesn’t store any data on the cloud. It can delete the data that’s stored on your phone on a recurring basis, and also camouflage itself—any icon on the app can have its name changed so it won’t display words like “abortion” if you don’t want it to. 

For anyone using a period tracking app for any part of their fertility, it’s critical to understand how companies might be using your data. Bethany Corbin, a femtech lawyer who specializes in privacy and security, explained what consumers should know. 

“A lot of femtech companies, especially free femtech apps, will have some provision in their privacy policy that allows them to sell consumer data downstream,” Corbin told Motherboard. “They can sell that to people like data brokers who can then for $160 or however much, sell that data to anybody who wants it. They can also give it to the large, large companies like Facebook or Google to use that data. Once you've clicked on that little checkbox that says, ‘yes, I've read and consent to the Privacy Policy and Terms of Use,’ you're essentially giving a company the right to do whatever it is they want to with their data.”

Even still, comparing which apps are safe to use is a nightmare. Most privacy policies are intentionally dense and difficult for a layperson to comprehend. Understanding how different companies are using data is crucial, yet nearly impossible to achieve for the average user. 

It’s also important to note that none of these apps are bound by HIPAA privacy laws, which normally would be present if the data was shared with a doctor. So whether you’re using an app to track your ovulation, menstruation, basal temperature, or other aspects of your fertility, it’s up to the individual app to decide if they will sell your data.

Given the increasingly contentious environment around abortion rights, Corbin says that the possibility of hacks are also present.

“The concern that really worries me is that reproductive health and femtech companies are going to be a much larger target for hackers,” said Corbin. “Because right now, the value of data for healthcare is already very high. It’s $250 on the black web per medical record. Let's say that Roe falls and you've got 13 states with trigger laws ready to make abortion illegal. Now hackers have more of an incentive to target those reproductive health companies, because that value of the reproductive health data just skyrocketed.” (A 2019 report by cybersecurity firm Trustwave noted that certain leaked or hacked medical records can be worth up to $250 on the dark web.)

As we continue to exist in a world where the legal landscape is changing but the need for abortion care is not, it’s our duty to one another to be educated on the safety and privacy concerns around self-managed abortion. When looking for menstrual tracking or fertility apps, be aware of how a company is using your data. If you would like to self manage your abortion, consider how your search history or apps could be used against you. By being diligent about who has access to our personal data, we can keep ourselves and each other safe.