COLUMBIA, Missouri — In the Columbia Public Library, just past a room where a Bible study was wrapping up, a group of people gathered in a conference room to learn how to have an abortion at home.
What happens when you self-induce an abortion? one woman asked the panelists, who sat at a table in the front of the room.
“It depends a little bit on how far along in pregnancy you are. The earlier in pregnancy, generally, the faster it works,” answered Colleen McNicholas, an OB-GYN who works at the last abortion clinic in Missouri. “I would say most people start bleeding within a couple hours of taking the medication.”
“It is very much, in fact, identical to having a miscarriage,” she added.
Abortion rights activists have long warned that overturning Roe v. Wade, the 1973 Supreme Court decision that legalized abortion nationwide, won’t stop people from trying to end their pregnancies — instead, it’ll just force them underground, to the so-called “back alleys.” Advocates spent decades trying to protect the nation’s dwindling supply of abortion clinics, often armed with the motto, “We won’t go back!”
But while Wednesday marks 47 years since Roe was decided, the landmark ruling's fall looks closer than ever. Over the past decade, states have enacted more than 500 restrictions on abortion, including, in 2019, a handful of bans that would essentially eliminate abortion if they ever went into effect. This March, the Supreme Court will hear arguments in its first abortion rights case since Brett Kavanaugh’s confirmation cemented its conservative majority. Fearing the possibility of a post-Roe United States, some advocates — including those who help run clinics — are working to exorcise the bloody specter of the coat hanger.
“Sometimes it’s just easier. That’s it.”
Americans can truly never “go back” to the days before Roe, advocates say, because they can now safely order abortion-inducing pills online and safely “self-manage” a first-trimester abortion. And they want to spread the word about how to do it.
Shortly after Donald Trump won the presidency in 2016, the reproductive justice group Reproaction decided to start hosting gatherings to teach people about self-managed abortion. So far, Reproaction has hosted 21 meetings across Arkansas, Missouri, Ohio, Texas, Virginia, and Washington, D.C. — including the one in Columbia — where activists tell attendees about a regimen recommended by the World Health Organization. That protocol details how a drug called misoprostol can induce an at-home abortion, right down to the number of doses you would need to take and when.
Pamela Merritt, Reproaction’s co-founder, told VICE News that she sees self-managed abortion not only as a kind of insurance policy if Roe goes under but also as a way to simply expand the menu of options for abortion.
“Just as we will never live in a world where people don’t need abortion — it will always, always be needed — we will never live in a world where everybody wants the same option or choice,” Merritt said. “We need to be pushing for that across the board and fighting for access in all of those forms, so that people can get the care that works best for them.”
Reproaction has activists all over the country but frequently focuses on Virginia, Missouri, Wisconsin, and D.C. As a progressive group, it lives in what Merritt calls the “left flank” of the American abortion rights movement, connecting reproductive health care to issues like mass incarceration, gun violence, and the Standing Rock protests. Its activists are also uncompromising about their support for abortion: The local organizer behind the Columbia forum wore a T-shirt emblazoned with the bright orange words “pro-abortion, pro-family, pro-justice” rather than the more traditional and euphemistic “pro-choice.”
Reproaction is an aberration among abortion rights activists. Even just a few years ago, some of the more mainstream reproductive rights groups tried to distance themselves from self-managed abortion.
In 2015, Planned Parenthood’s then-president, Cecile Richards, decried a survey from the Texas Policy Evaluation Project that found that up to 240,000 Texas women have tried to end a pregnancy on their own in their lifetime, calling their actions “desperate measures.” Researchers suggested that their discovery may be tied to Texas' severe regulations on abortion clinics, which have left them an endangered species in the state.
"Most people thought we were well past the days of women taking matters into their own hands,” Richards said, “but laws that make it impossible to get safe and legal abortion are taking us backwards.”
Farah Diaz-Tello, senior counsel for If/When/How, an organization that supports self-managed abortion, can see where opponents are coming from. She characterized their attitude as, “We worked really hard to get good, high-quality care for people who need abortions. And are we now saying that people are going to — we’re going to send them off into the wilds of the internet to receive their care? That is not the feminist ethic that has driven abortion care to this day.”
“I was 17 when Roe v. Wade passed, and I remember marching for it. And it makes me so angry that we’re here again.”
But Colleen McNicholas’ very presence on the Reproaction panel signaled how rapidly attitudes toward self-managed abortion have changed over the last few years: She’s the chief medical officer for Planned Parenthood of the St. Louis Region and Southwest Missouri.
During the panel, she told attendees, “Every kind of abortion you could get is safer than being pregnant. Especially in the state of Missouri.”
“So long as we have a safe option that can be accomplished outside of a clinical or medical setting, there’s no reason that shouldn’t also be available,” McNicholas added in an interview. “It doesn’t abdicate our responsibility to also find ways to make in-clinic or in-hospital or medicalized abortion available to these communities as well. We need to do that, too. But we can do both together.”
Diaz-Tello put it slightly differently.
“Self-determination is a part of the values that we’ve always worked with,” she said. “I think there’s a greater comfort with the idea — and even where there is discomfort, a greater understanding of the urgency that nobody goes to jail, nobody has to fear jail time for ending a pregnancy.”
While red states tighten abortion restrictions, the legality of procuring your own abortion remains murky. It’s explicitly outlawed in six states, though abortion rights advocates warn that an overzealous prosecutor can generally find a statute vague enough to fit the supposed crime. Since 1973, at least 21 people have been arrested over allegations they helped end a pregnancy.
The effort to normalize self-managed abortion in Columbia started as soon as people walked through the door, where they were greeted by a table covered in cutesy, neon-bright pamphlets.
“Abortion care on my own terms,” announced one postcard, above a drawing of a hand pulling an orange “Rx” package from a bathroom cabinet. “Abortion pills by mail? Yep!” proclaimed another, as a hand — its fingertips slicked with red polish — held a similar package in front of a row of mailboxes. In a third postcard, a couple cuddled on the couch beneath the words, “Home. Where life happens. Abortion care can happen here, too.”
At another forum hosted by Reproaction, this time in late October in McAllen, Texas, one panelist echoed those less-than-subtle messages as she spoke about her decision to skip the clinic and manage her own abortion.
“For me, it wasn’t about being restricted by any sort of thing, other than I wanted to be completely autonomous,” explained Nancy Cárdenas Peña, who works as the Texas associate director for state policy and advocacy at the National Latina Institute for Reproductive Health. The panel took place outside, on a wooden porch next to a brewery; string lights twinkled as the sun set over the course of the hourlong forum, and a Billie Eilish remix blared from the speakers as Cárdenas Peña spoke.
“We often talk about, well, like, ‘People have to drive to desperate means to get self-managed abortion,’” she went on. “No, sometimes it’s just easier. That’s it.”
Both of the panels seemed low-key, if not exactly relaxed, which wasn’t surprising — they were focused largely on how and why Americans frequently struggle to get legal abortions, and about the stigma often embedded in the procedure. But sometimes, a woman would suddenly speak up, her voice shaking with rage.
“I was 17 when Roe v. Wade passed, and I remember marching for it. And it makes me so angry that we’re here again,” Rosemary Feraldi, an audience member in Columbia, told the room toward the end of the panel.
“My maternal grandmother died of a self-induced abortion, which led to three very young orphans,” she continued. “I have family members that have experienced going through abortion, and it just makes me so angry that my daughters, my granddaughters, might have to — I’m just really appreciate for you guys to offer this.”
Because self-managed abortion is often at best secretive and at worst illegal, it’s difficult to tell just how many people might be doing it. But there is some evidence that it’s becoming more common. A September report from the Guttmacher Institute also found that in 2017, 18% of clinics reported seeing at least one patient who had attempted to end a pregnancy on their own. In 2014, just 12% of clinics said the same.
In interviews with 18 Texas women who’d tried to self-induce their abortions, researchers from the Texas Policy Evaluation Project reported that the women were mostly driven by their limited access to money, transportation, and clinics. (In 2012, the state had 41 clinics; as of 2019, it had just 24.) And while a 2014 nationwide survey from the Guttmacher Institute found that less than 3% of all abortion patients had attempted to end their pregnancies on their own, the researchers found that in 2012 and 2014, almost 7% of Texan patients tried to do so.
“We suspect that self-managed abortion may become more common if clinic-based abortion care becomes more difficult to access,” the researchers wrote in a January study, “especially among women in south Texas where misoprostol may be more accessible due to the proximity to Mexico, and among poor women — who make up more than half of all abortion patients and face barriers to accessing reproductive health care.”
Between March 2018 and August 2019, more than 37,000 women, in all 50 states and Washington, D.C., reached out to Aid Access, an initiative that directly ships abortion-inducing pills to American women who want to end their pregnancies.
“With clinics being shut down, with funding being pulled, with all of the legal and political forces that are trying to restrict access to abortion — like many other issues in our country, we’re seeing people rise up and saying, ‘Not here, no way.’ We’re too old for this. We’re too modern for this,” said Amy Merrill, digital director at Plan C, a website that grades purveyors of abortion-inducing pills on cost, shipping time, and quality. On the day Alabama passed a law to ban almost all abortions, Plan C had about 8,000 visits to their site — a 1,600% spike in traffic. “It’s resistance. It’s in response to what we’re seeing happen, which is that our rights are being taken away from us.”
After the forum, Feraldi told VICE News that, despite what happened to her grandmother, she has zero reservations about using pills to self-manage abortions. She wants to tell others what she’s learned.
“I think I’ll share it with young women that I know, that are close to me, my own kids,” she said. “Anybody who might be interested.”
Cover: Dr. Colleen McNicholas and Pamela Merritt listen to Evonnia Woods, the panel's moderator, introduce the forum on self-managed abortion. Photo by Carter Sherman.