Abortion is still legal in all 50 states, but that doesn’t mean it’s accessible. As of 2017, 89 percent of U.S. counties had no abortion clinic, and about 40 percent of women of reproductive age live in one of those counties. An abortion with pills, or a medication abortion, costs an average of $535 (£414) in a clinic, similar to the cost of an aspiration abortion. Often, private insurance doesn’t cover the cost of the procedure.
Under these conditions, it’s not surprising that people who need abortions might consider doing it themselves, a method that no longer involves coat hangers or crude objects, but is now done with pills. People usually buy these pills online, and take them at home early in pregnancy to induce what is effectively a miscarriage. Over the last few years, we’ve gotten a better understanding of how many people are choosing this option, known as self-managed abortion, and why.
The Guttmacher Institute found that during a month-long period in 2017, shortly after President Donald Trump took office, people in the U.S. ran more than 200,000 Google searches for information on how to give yourself an abortion. More than a quarter of them said that information which included the term “abortion pill” best matched what they were looking for. And subsequent studies have also shown that rates of requests for abortion pills online are often higher in states that are hostile to abortion, where patients face the most barriers to accessing care. Factors like cost and distance to a clinic also play a huge role in people’s decisions to attempt their own abortions.
VICE spoke to three women in the U.S. who chose to do their own abortions with pills. They all said cost was the number-one reason why they self-managed their abortion rather than visit a clinic, but for some, ending their pregnancy in the comfort of their home was a preference. Some said this idea appealed to them because they wanted more privacy: Two women told VICE they hadn’t told anyone else they were pregnant and didn’t want anyone to know they were having an abortion. Some women also liked the convenience of the method because they either didn’t want to—or couldn’t—take time off work for an appointment at a clinic.
Each of the women VICE spoke to bought the pills from the same site: Aid Access, an online abortion pill retailer run by the Dutch doctor Rebecca Gomperts. The site is currently the only abortion pill service operated by a licensed physician who counsels patients and writes the prescription for the pills. Patients send the prescription to Aid Access’s overseas pharmacy, which ships the medication to the U.S.
The pills cost just $90 (£70); patients who can’t pay the full price pay what they can, or can get the pills for free.
The Food and Drug Administration’s restrictions on mifepristone—one of two drugs involved in the abortion pill regimen—make it illegal to sell abortion pills online, and some states have laws explicitly criminalizing self-managed abortion. For that reason, VICE has gone to lengths to protect our sources’ identities, using a first name, first initial, or a pseudonym to identify the women who shared their experiences. VICE has also removed the names of the online support groups where sources sought help, so as not to make those forums a target for shuttering by tech platforms.
Here are the women’s stories in their own words, edited for length and clarity:
“ I took the first pill about an hour after I got the package. I couldn’t miss another day of work so I took the second set of pills the next day around 6 pm, on the way to my son’s school.”
I found out I was pregnant on New Year’s Day . That first week after I found out, my mind was all over the place, like, what do I want to do? Do I want another kid? I just moved to Mississippi recently and I have a three-year-old.
But then I started feeling sick, my relationship was going haywire, and my finances were dropping. I was like, OK, this is not the time. But since I’m in Mississippi there’s only one place here that provides abortions. It was just way too expensive and it was also hard for me to schedule with work.
I got an advance on my tax returns that I could have used on the procedure, but I had promised my son that we would redecorate his bedroom for his birthday. It made me upset to think that [if I used the money for an in-clinic abortion] I wouldn’t be able to do that , but I knew I wouldn’t be able to raise another kid by myself.
Then I started getting really sick and wasn’t really able to eat anything. I found a support group [online] and asked for advice. There are a lot of women in the group, and they tell you to do what’s best for you and there’s no type of judgment or anything. One woman said, “Have you ever considered Aid Access?” They told me it was a good option if you’re having trouble getting to a clinic. Even though I’m only 30 minutes away from the clinic here, I didn’t have anyone to come pick me up after the procedure, and I definitely didn’t have $650 to pay for it.
I reached out to Aid Access and they got back to me, and shipped my pills. On January 7th my pills arrived in Customs, but then the package was stuck there for an entire month. I asked Aid Access to send another package and that one reached Customs on February 1st. So I felt hopeful, but then that package didn’t leave Customs until the 8th. The next day I got a notification that the first package was at my local post office, but when I went to pick it up they told me it was actually in transit to my house. I took the rest of the day off and camped out, waiting for the mail to come.
When I initially ordered the pills I was four weeks and five days along. But when I finally got the pills I was nine weeks and three days—I was super worried because they say you can take the pills up to 13 weeks, but it can be a little more complicated after the 10th week. This is my second medication abortion; I had one last year, but I went through a clinic that time. With this one, I didn’t know what to expect because the last time I was about five weeks along, and I was doing this one four weeks later.
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I took the first pill about an hour after I got the package. I couldn’t miss another day of work so I took the second set of pills the next day around 6 pm, on the way to my son’s school. I put them in my mouth and let them dissolve, and by the time I got to his school to pick him up I swallowed the rest. When I got home I had terrible cramps and threw up as soon as I walked through the door. For about four or five hours I was cramping really bad and I was in the fetal position on my bed. Then I sat on the toilet for about an hour. At some point I felt like I had passed a really big clot and I didn’t want to look, but after that the cramps started going away. I went to sleep and when I woke up the next morning I wasn’t nauseous anymore and I didn’t have any symptoms and I went to work.
When I was pregnant with my three-year-old I got diagnosed with massive depression, so while I was waiting for the pills to come I kept falling into a depressive mood—turning my phone off and not answering people’s calls because I didn’t want to talk. I was having a whole bunch of thoughts like, I want another kid but I’m not where I want to be. Why am I not where I want to be? I’m also a school therapist so my job is talking to kids who have mental illnesses; there were a lot of days of work I missed because I didn’t have the energy to do that work with the kids when my mind was on this stuff.
I’ve still been having some blue moments, just about life in general, but otherwise I feel perfectly fine. I feel way better than I had been feeling.
“I thought about paying my rent or car payment late, but those options just weren’t good enough for me.”
I knew I was pregnant because I missed my period and I didn’t feel well. I took a pregnancy test and it was positive; I just knew right away I wasn’t going to keep it.
I made an appointment at an abortion clinic to do the first ultrasound and it showed that I was five weeks along. But in [my state] you have to do abortion counseling, so that appointment was like $100. Then you have to make a second appointment to do the procedure or get the pill, and that was going to be around $500. I have insurance and my insurance actually covers abortion but there’s a deductible, so I was going to have to pay out of pocket because I hadn’t met my deductible.
On paper I look like someone who could afford an abortion, which is weird to say. There are women who are single moms with three kids and make $30K a year. I make money, but I have to pay for rent, car payments, student loans, and health insurance—I don’t have the expendable income to just drop $600.
I tried as many ways as I could to come up with the money. I thought about paying my rent or car payment late, but those options just weren’t good enough for me. So even though there are two abortion clinics in [my city], I decided to use Aid Access. I had read a bunch of articles in VICE, The New York Times, and Vox, so it seemed trustworthy.
They were pretty responsive—they got back to me less than 24 hours later. I sent them a picture of my ultrasound because they wanted that, and they also asked for my photo ID and my address, to send the pills. That was kind of scary because I knew this wasn’t 100 percent legal. But I sent everything in an email, paid the $90 for the pills, and then sent the prescription to the pharmacy in India.
Aid Access warned me it could take up to three weeks for the pills to get to me, but I was really hopeful in the beginning. The pills left India and arrived in the U.S. within two to three days. But then they were stuck in Customs for 16 days and those were like the longest 16 days of my life. I was really nervous, and was kind of obsessed: They gave me a tracking number and I think I clicked on it like three times a day to see if there was any update. I was also researching Aid Access and Customs every day—I probably did 100 Google searches.
That’s when I found [an online group] because I’d clicked on a link where someone was asking about how long it would take their Aid Access pills to be released from Customs. Some women only had their pills in Customs for three or eight days. A lot of people in the group had used Aid Access and it was nice to talk to people who really understood the situation I was in.
I didn’t tell anyone what I was going through—except for you (VICE), and people in the group. It was a weird secret to keep because I was tired and super cranky and nauseous, and I couldn’t tell anyone why I wasn’t acting like myself.
I was probably 11 weeks when the pills came. Aid Access told me I could take the pills safely up until 12 weeks, but that after 10 weeks there are more risks for dangerous side effects. I was scared for my health, and I didn’t want to end up in the hospital. But I did a lot of research and read a lot of online posts and by the time I took them I felt like I was making a good decision and wasn’t putting myself at risk: I looked up the warning signs for infection and I knew that if I had to go to the hospital I could tell them I was miscarrying.
I felt very prepared for the worst outcome. I couldn’t have a baby so there wasn’t any other choice—no matter how long Customs made me wait I wasn’t having this baby and I didn’t have $600 to pay the clinic.
I took the pills at home alone. I took the day off to take the second set of pills; I would’ve liked to do it on the weekend rather than take a day off, but [I didn't want to wait any longer]. I get a lot of comfort from a warm shower, so I spent the whole termination in the shower—I was in there for like three hours.
Afterward, I felt fine and happy. It took a huge weight off of my shoulders. I felt present for the first time in three weeks.
“It took about three weeks for the pills to get to me. The waiting was the hardest part because I was still sick every day.”
I usually start my period at the beginning of the month. But I do have some months where if I’m super stressed out I’m a week or two late, so it’s something I’ve gotten used to. In December I was really busy with work so I was a little late, and I thought it was no big deal. But then I started feeling nauseous every day and my boobs were constantly sore, so I took a pregnancy test.
I peed on the stick and within minutes it showed a line and then half a line [not two lines]. I thought, That’s weird, but I’m 100 percent positive I'm pregnant.
I love kids—I have nieces and nephews—but I didn’t want my own. And even if I did choose to have kids, I knew it wasn’t the right time. So I knew immediately I was going to have an abortion; I didn’t really have to think about it. But I didn’t have insurance at the time. This was just before Christmas, and I knew I didn’t have four, five, $600 to spare. So I thought, How am I going to pay for this?
I started googling “how much does an abortion cost?” At the time, I didn’t even know there was such a thing as a medication abortion. Once I learned about it, I started looking up how to order abortion pills online. That’s when I came across Aid Access and found [the online forum] where I did most of my research about the site.
I read other women’s stories about using the service, and I thought, OK, this is my option, especially since I saw that it was only $90 and if you can’t afford to pay it they’ll give the pills to you for free or at a different rate.
I reached out to them and let them know that I could only pay $40 right now, and they told me that wasn’t a problem. I sent them a photo ID and filled out all of my information, sent the payment, and sent the prescription to the pharmacy. Instead of my home address I gave them my work address because I’m the one who signs for the mail at work and I didn’t want to risk the package getting left on my doorstep.
It took about three weeks for the pills to get to me. The waiting was the hardest part because I was still sick every day and super tired. I didn’t tell any of my friends, except for one after the fact, and I didn’t want to tell my boyfriend either; I still don’t plan on telling him. I know he’s pro-choice and I knew that if I told him I didn’t want to keep the baby he would understand. But at the end of the day it’s my body and my decision.
When I took the pregnancy test I was about seven weeks along, and I knew doctors recommend you take the pills before the 10-week mark. But to be honest I wasn’t too worried about it—even if I was past 10 weeks I would have done it anyway and if it didn’t work I would’ve figured something else out. I was like, the pills are my option right now so this is how I’m going to do it.
I received the pills on a Thursday, and I knew I needed to do it as soon as possible, but I didn’t want to take any days off work. So I took the first pill at 1 pm that day, and then on Friday I left work at exactly 5 pm and took the set of four pills about 15 minutes into my drive home.
About five minutes away from home I started cramping. As soon as I got there I took ibuprofen. Then I ran a super hot bath and sat in it for over an hour. At that point I was getting more cramps, but they felt kind of like period cramps. Once I started bleeding I got out of the bath and sat on the toilet. Then the cramps stopped for a bit and I put a pad on and drove over to my boyfriend’s house—I had told him I was getting my period. But as I was on the way to his house I started cramping again, horribly. I’ve never given birth but I imagine that’s what contractions feel like. I have a pretty high pain tolerance so I was just counting the seconds through them until they would go away.
When I got to his house I told him I was having really bad cramps and then every time I felt blood coming out of me I would just use the restroom. I probably used the restroom about seven times in two hours. At about 9 pm I used the restroom again and actually saw the embryo come out of me in the toilet. It scared me and I flushed it really quickly, but this wave of relief came over me and it seemed like I immediately felt normal again. The cramping had subsided, I didn’t feel sick. The next morning I woke up and felt so much better.
Everyone feels differently about [getting an abortion], and some people can be more emotional or sad about it, but I was the opposite. I was just happy and relieved it was over. Sometimes I feel like I should feel worse about it, but I don’t. I know it was the right decision for me. I wouldn’t do anything differently.
*Name has been changed.
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This article originally appeared on VICE US.