Abortions happened before it was legal to get one, and, should it ever become illegal again, they will happen then too—many of them outside of clinics, without direct medical supervision.
But doing your own abortion in 2020 looks a lot different than it did pre- Roe v. Wade. People who self-induced abortions in the decades before the landmark Supreme Court ruling sometimes resorted to drinking toxic chemicals, throwing themselves down the stairs, or using crude instruments like knitting needles or a coat hanger, the latter of which has become a universal symbol of the life-threatening consequences of restricting people’s access to abortion care. The hanger may still function as a powerful image, but it’s no longer accurate when it comes to representing what it means to self-induce an abortion: Self-inducing or self-managing an abortion is now synonymous with taking pills, a safe and effective method of ending a pregnancy.
Even with Roe v. Wade still in effect, more and more people are choosing to have their abortions this way. Some people choose it because, in fact, they have no other choice: The nearest clinic may be too far away, or the procedure itself may be too expensive, making it difficult to access a medication abortion or procedural abortion at a clinic. These obstacles can also be exacerbated by state restrictions on abortion, which can also play a role in people’s decisions to do their own abortion.
Other people prefer to end their pregnancies on their own because it can be more convenient than scheduling an appointment—or, in some states, multiple appointments—at a clinic, and because it can be done in the privacy of one’s home.
But even as self-managed abortion becomes more commonplace, how exactly it works is still largely misunderstood: A recent study from the Kaiser Family Foundation found that 62 percent of people think emergency contraceptive pills (like Plan B) can be used to end an early pregnancy, and just 36 percent of women of reproductive age had ever heard of medication abortion, or abortion with pills.
What is self-managed abortion?
“Self-managed abortion” is a term used to describe the method of self-inducing an abortion, typically using pills purchased on the internet.
Though it’s a violation of the Food and Drug Administration’s rules to sell abortion medication online—the agency’s restrictions on mifepristone require it to be administered in person at a hospital or clinic—there are several websites where people can buy the drugs online.
Any abortion with pills is “self-managed” to some degree. Patients who go to a clinic for a medication abortion will be sent home with a package of pills to take on their own, and pass the pregnancy without any medical supervision—just like the person who buys the pills on the internet.
Doctors screen patients to make sure they’re eligible for medication abortion and will counsel them on how to administer the pills properly, but “after that the whole process really takes place at home and is really self-managed by the patient,” said Daniel Grossman, an OBGYN and the director of Advancing New Standards in Reproductive Health, a program at the University of California, San Francisco.
How do you know if it’s the right method for you?
It’s important that people who are considering self-managed abortion make sure they’re a good candidate for the method, Grossman said. First, they need to determine how far along they are, since medication abortion is typically used in the first 10 weeks of pregnancy. (Some clinics have begun to provide medication abortions up to 11 weeks, but 10 is still standard.) People considering self-managed abortion may already know how far along they are from an in-clinic ultrasound; if not, they can calculate it by counting back to the first day of their last period.
People who got pregnant with an IUD can’t end their pregnancy with pills until the IUD is removed, and people who take blood thinners or have blood disorders shouldn’t use this method of abortion.
Where do you buy abortion pills online?
There are more than a half dozen sites currently selling abortion pills online. Plan C, a reproductive health advocacy group, has purchased and tested pills from each site and ranked them based on shipping time, product quality, and physician oversight; the results appear in a “report card” on Plan C’s website.
Aid Access continues to be the highest-scoring service: Though patients might have to wait up to two weeks to receive the pills, it’s the cheapest place to order from. Whereas pills can cost as much as $430 through other online services, at Aid Access they’re $90. The site is also the only abortion retailer run by a licensed physician—Rebecca Gomperts, a doctor based in the Netherlands—who writes a prescription for the pills herself, and provides consultation and counseling to people who request medication from her.
Aid Access, as well as other sites like Women on Web (a sister site to Aid Access), Safe2Choose.org, and AbortionPillInfo.org also provide instructions on how to administer the pills.
How do you give yourself an abortion?
The first step of the pill regimen is to swallow the mifepristone with water. The mifepristone is the drug that stops the embryo from developing. Then, after 24 to 48 hours, you follow it up with the misoprostol, which will initiate uterine contractions that eventually expel the pregnancy. Instead of swallowing the misoprostol, the pills are inserted under the tongue, where they must be left to dissolve for 30 minutes; after 30 minutes you can drink water and swallow whatever is remaining of the pills.
Usually, people start bleeding within the first couple of hours. Some people describe the process of passing the pregnancy as being no more severe than a “heavy period,” according to Grossman, but medication abortion usually involves more blood and more intense cramping.
Grossman said the pain can be managed with ibuprofen, or soothed with heating pads or a warm bath.
Is it legal to give yourself an abortion?
Currently there are five states that have laws explicitly criminalizing self-managed abortion: Arizona, Delaware, Idaho, Oklahoma, and South Carolina. But there are subtler ways states try to criminalize this method of abortion. Thirty-eight states have some version of a fetal protection law on the books, and though many of them were intended to protect pregnant people from harm—think: an abusive spouse who punches their partner in the stomach—prosecutors have tried to use them to criminalize people they suspect of self-managed abortion.
Usually, these cases don’t amount to much; historically, judges have dropped the charges, arguing that they constitute a misapplication of the law.
“Any attempt to criminalize or control self-managed abortion is illegitimate and unconstitutional,” said Farah Diaz-Tello, senior counsel at the reproductive justice legal group If/When/How. “The charges usually end up getting dropped because the law doesn’t apply.”
Other than the legal risks, is it dangerous to do your own abortion?
Research has shown that abortion with pills is overwhelmingly safe and effective, even when it’s done outside of medical supervision. Passing the pregnancy always involves some degree of bleeding and cramping, but can also include side effects like diarrhea, nausea, and vomiting. Serious complications like hemorrhaging or infection are extremely rare: If after taking the misoprostol you have a fever that won’t go away after 24 hours, or extreme bleeding—such that you soak through two maxi pads an hour for two hours—you should seek medical attention, Grossman advised.
Otherwise, reproductive health advocates attribute the lingering stigma surrounding self-managed abortion to the criminalization of it in parts of the country, as well as the FDA’s federal restrictions on mifepristone.
“There’s a lot of mythology around self-managed abortion,” said Robin Marty, the author of Handbook for a Post-Roe America. “But if we keep spreading information and resources as widely as possible, people will start to understand that there’s no danger in these pills—the only danger is the legal jeopardy, and that’s the problem.”
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Read more about medication abortion:
Almost 40 Percent of Abortions Are Now Done With Pills
The FDA Is Restricting Access to the Easiest, Safest Form of Abortion
Buying Abortion Pills Online Is Overwhelmingly Safe, But Maybe Illegal
This article originally appeared on VICE US.