Nearly six months ago, Texas enacted the toughest abortion restriction in the nation. Now, with abortion clinics devastated, Texans are turning to at-home abortions.
During the first week of September, after Texas implemented a law that bans abortion as early as six weeks into pregnancy, an organization that helps people perform their own abortions saw requests for help from Texans spike by 1,180 percent, according to new research published Friday.
Before the Texas law took effect, Aid Access, an organization that ships abortion-inducing pills across the United States, received an average of 10.8 requests per day from Texans. But during that first September week, Aid Access received 137.7 requests per day.
Over the following three months, that frenzy calmed down somewhat, to an average of 29.5 requests per day. But that’s still an increase of 174 percent over pre-ban levels.
With the Supreme Court now deliberating over a case that could overturn Roe v. Wade, the 1973 decision that legalized abortion nationwide, Texas perhaps provides the clearest window into what a Roe-less future may look like. And it’s a future that may be more reliant on people finding ways to use pills to perform their own abortions, a method known as “self-managed abortion.”
“Self-management has, I think, stepped in to become an option for people when getting to a clinic is not going to be an option for them in Texas,” said Abigail Aiken, lead author on the study and associate professor of public affairs at the University of Texas at Austin. “Of course the need for abortion won’t go away just because it’s criminalized.”
The Texas ban flies in the face of Roe, but so far, legal attempts to freeze it have proved fruitless. Its endurance is due to a unique legal invention: Rather than rely on the state to enforce it, the ban deputizes ordinary Texans to sue if they suspect someone “aids or abets” in an illegal abortion.
In August 2021, before the ban took effect, Texas clinics performed more than 5,400 abortions. But in September 2021, after its implementation, clinics performed fewer than 2,200 abortions. That’s a drop of nearly 60 percent.
The Friday research suggests that Aid Access has stepped in to help close the gap. The organization, founded in 2018 by a Dutch physician named Rebecca Gomperts, sends Americans who are less than 10 weeks into their pregnancies drugs that will induce their own abortion. Unlike telemedicine abortion—which also involves people having abortions at home and was recently expanded in the United States—the self-managed abortion offered by Aid Access operates entirely outside of the U.S. healthcare system.
“Even though the model is actually pretty similar—it’s the same medications, they’re also used at home, there’s no ultrasound—we’re talking there about something that is happening outside of the formal healthcare setting,” Aiken said. “There’s no U.S.-based clinic. There’s no U.S.-based provider.”
Out of nearly 2,270 people who used the service between 2018 and 2019, more than 98 percent said they were satisfied with the experience, according to research released last week by a research team led by Aiken. No deaths were reported to Aid Access.
Aid Access, the research concluded, “may offer a safe and effective option for those who cannot access clinical care.”
The impact of the Texas ban has reverberated far beyond the state’s borders. On Thursday, Planned Parenthood announced that, between September 1 and December 31, its health centers in states that neighbor Texas saw an almost 800 percent increase in abortion patients from Texas. Oklahoma clinics, in particular, saw a nearly 2,500 percent increase in Texan patients, compared to the previous year.
The Friday research indicates that the ban has also led to surging interest in self-managed abortion in states beyond Texas: In the first week of September, Aid Access saw its requests for help from the 49 other states increase by 107 percent, to an average of 134.6 requests per day.
But medication abortions—whether self-managed or conducted with the aid of a clinic—can only be used up to a certain point in pregnancy. Current U.S. guidelines has cleared the use of abortion-inducing pills up to 10 weeks of pregnancy; the World Health Organization recognizes a self-managed abortion protocol that can be used up until 12 weeks of pregnancy, although it cautions that there’s less research on its efficacy past 10 weeks of pregnancy. People who want to end their pregnancies beyond that point and who aren’t able to get help in a brick-and-mortar clinic may be out of luck.
“For those people, options are really limited and it’s another reason why we need this full spectrum and not just one thing we can rely on,” Aiken said.
Relying on Aid Access also carries some legal risk. Self-managed abortion exists in a legal grey zone: Although only a handful of states explicitly outlaw the practice, experts say that if prosecutors want to charge someone for ending their own pregnancy, they’ll find a way to do so. Last year, in anticipation of Roe’s decay, the organization If/When/How created a first-of-its-kind legal defense fund to aid people who may face criminal probes for inducing their own abortions. (The fund will help anyone who performs their own abortion, regardless of method.) Since 1973, when Roe was decided, there had been at least 21 arrests for suspected self-induced abortions, according to an analysis by If/When/How.
If Roe falls, 26 states are certain or likely to ban abortion, according to research from the Guttmacher Institute, which tracks abortion restrictions. But lawmakers in conservative states, perhaps in part anticipating that the demise of in-clinic abortions will lead to a rise in self-managed abortions, have pushed for ways to limit medication abortion, which now account for more than half of all U.S. abortions, according to Guttmacher Institute research released Thursday.
Telemedicine abortion is already banned in 19 states. But Texas has also now banned the use of medication abortion past seven weeks of pregnancy, as well as imposed jail time and heavy fines on anybody who prescribes abortion-inducing pills through the mail—which is exactly what Aid Access does.
“They’re already in contravention of so many Texas state laws that if they were really worried about or feeling vulnerable to being punished for that,” Aiken said, “they probably wouldn’t still be doing what they’re doing.”