In 2012, Jennifer Whalen discovered that her 16-year-old daughter was pregnant. She promised to support her in whatever decision she made, and after a few days, the high schooler decided she couldn't have a baby. From there, Whalen and her daughter began investigating how to obtain an abortion in their rural town of Washingtonville, Pennsylvania.
They discovered that the nearest clinic was 75 miles away, and the procedure alone would cost between $300 and $600—two huge barriers, especially given the fact that the family had only one car. After searching online for another solution, Whalen stumbled upon a website selling misoprostol and mifepristone—the FDA-approved regimen for a medication abortion—for $45. She purchased the pills.
Whalen's daughter miscarried with no ill effects, but they went to the hospital anyway. Not long after their visit, police came to their home with a search warrant. "They asked me whether I bought the pills online," Whalen told the New York Times in 2014. "I was surprised when they told me I had to have a doctor's scrip. I didn't know that."
Two years later, Whalen pleaded guilty to a felony charge of offering medical consultation about abortion without a medical license, and began serving a 9-to-18-month jail sentence.
For many people, "self-induced abortion" is synonymous with frightening, often violent imagery involving coat hangers. But cases with that narrative are usually the exception, according to reproductive rights advocates: It's actually more common for individuals to self-terminate using herbs or pharmaceuticals.
An unpublished report by the now-shuttered Reproductive Health Technologies Project called self-use of misoprostol, one of the components of medication abortion, "the new 'best kept secret' in efforts to expand US women's access to reproductive health care options." While the current standard of care for medication abortions is the combination of mifepristone and misoprostol, the report's authors write, some medical experts recommend the use of misoprostol alone if mifepristone is not available—according to the International Women's Health Coalition, misoprostol is about 75-85 percent successful in inducing abortion in the first trimester when taken alone.
But, as evidenced by Whalen's case and others like hers, self-induced abortion comes with incredible legal risks. Even though only a handful of states explicitly prohibit it—in South Carolina and New York, for example, it's a misdemeanor to self-induce an abortion without a physician's advice—authorities are finding other ways to punish people who terminate on their own.
"Prosecutors are being very creative and egregious and taking criminal, civil, regulatory statutes and stretching them way beyond the letter of the law, way beyond their legislative intent, and applying them to situations of self-induced abortion," explains Jill Adams, the chief strategist with the Self-induced Abortion (SIA) Legal Team, a consortium of state and national organizations working toward the right for people to end their pregnancies "outside of the formal health system"—meaning, in most cases, not quite legally—with dignity.
To date, the SIA Legal Team has identified 17 arrests associated with self-induced abortion, with charges ranging from fetal homicide to aggravated assault, battery, and child neglect. However, it's likely that many more people are self-inducing than most realize: In a study presented last year at the North American Forum on Family Planning, researchers estimated that anywhere from 100,000 to 240,000 Texas women between the ages of 18 and 49 had tried to end a pregnancy on their own.
Historically, many women who ended their pregnancies did so at home. In the eighteenth and early nineteenth centuries, early abortion was legal under common law, according to Leslie Reagan's When Abortion Was a Crime, a landmark survey of the history of abortion law published in 1997. Until the "quickening," which refers to the moment at which a woman can feel the fetus moving in her—about four months into a pregnancy—the procedure was not seen as criminal, and indeed was widely accepted. Many women at the time didn't see termination before this point as "abortion," as we understand it now; instead, they conceptualized it as "restoring one's menses," or simply making a missing menstrual period return.
"Restoring the menses was a domestic practice," Reagan writes. "Savin, derived from juniper bushes, was the most popular abortifacient and easily acquired since junipers grew wild throughout the country. Other herbs used as abortifacients included pennyroyal, tansy, ergot, and seneca snakeroot. Slave women used cottonroot. Many of these useful plants could be found in the woods or cultivated in gardens, and women could refer to home medical guides for recipes for 'bringing on the menses.'"
Today, however, abortion outside of an institutional, medical setting is unthinkable to most people. But Adams says there are myriad reasons why a person might choose to have a self-induced abortion: In addition to financial and geographical limitations, an individual might simply be too intimidated to walk into a clinic, especially if a barrage of anti-abortion activists stands in their way. Also, she says, people who historically have not had a positive experience dealing with formal medical care—those who identify as LGBTQ or gender-nonconforming, for example—may feel uncomfortable having such an intimate experience in that setting.
It's really irrational to expect that there's a one-size-fits-all model to abortion care that's going to work for everyone.
"Abortion is a very common experience," Adams says. Because of the sheer number of people who will have an abortion in their lifetime, and considering how diverse that group will be, "it's really irrational to expect that there's a one-size-fits-all model to abortion care that's going to work for everyone."
Those who oppose the use of misoprostol at home argue that the one-size-fits-all model exists to protect women's health. According to the World Health Organization, taking misoprostol alone is not as effective as its use in combination with mifepristone. "The effectiveness of misoprostol alone is lower, the time to complete abortion is prolonged, and the abortion process is more painful and associated with higher rates of gastrointestinal side-effects than when misoprostol is combined with mifepristone," a report noted. But because of its wide availability and affordable cost, "its broader use has been reported to contribute to a decrease in complications from unsafe abortion."
Part of the mission for the SIA Legal Team, Adams explains, is "to work toward a future in which everyone has legal and actual access to self-directed and provider-directed options, when they're choosing the setting, the method, the companion, and the timing of the abortion that's right for them"; this would include ensuring that women know the safest methods for taking the pill and how to seek help if something goes wrong. They're doing this through various law and policy tools, including disseminating information about self-induced abortion to stakeholders in the reproductive justice movement; drafting model legislation to remove problematic statutes where they exist; and providing strategic support to attorneys representing people on trial for self-abortion.
Currently, no members of the group represent anyone facing legal repercussion for self-inducing, but they hope to do so in the future. "We're building the resources to be able to do that, because we suspect the need is going to increase significantly," Adams says. "We think no one should have to fear arrest or jail for taking care of themselves, for ending their own pregnancies."
Western medicine did not invent abortion.
Other community groups have long been assisting people during their abortion experiences, both inside and outside of a clinic. Full Spectrum Doulas in Seattle, for example, was founded in 2010 and strives to support individuals during all aspects of pregnancy experiences and outcomes. Alison Ojanen-Goldsmith, a founding board member and researcher on self-induced abortion, says they define their work as "informational, emotional, and practical support." That support, she tells Broadly, can range from sharing information about various options, including procedures and clinic locations, to providing transportation and child care, to helping process the abortion experience months or even years later through conversation.
In an interview on the blog Radical Doula, Ojanen-Goldsmith said part of her goal as a full-spectrum doula is "to work towards demedicalizing healthy women's reproductive experiences, including birth, menstruation, abortion, and menopause. Women should be able to access (both physically and financially) medical interventions for these experiences if they want and need them, but the medical model should not represent the entirety of options for healthy women and their bodies."
People have been taking care of themselves for thousands of years, she says. "The right of people to end their own pregnancies in their own ways—it's a fundamental human right. [People] shouldn't be stigmatized for their decisions to do this."
To be clear, Ojanen-Goldsmith says, this is a real reproductive justice issue. "Many of the folks that I interviewed [for research purposes] who wanted to access abortion outside of a clinic came from marginalized and vulnerable communities. I think that's really important to keep in mind. People want to, and should be able to access care within their communities. Western medicine did not invent abortion."
Adams offers another reason for why it's important to halt the criminalization of self-induced abortion immediately. "If the legal system is allowed to scrutinize the behavior, actions, and admissions of pregnant people because of the suspicion that they're acting in order to harm a pregnancy or induce a miscarriage," she says, "then we're not only going to ensnare in the criminal justice system people who have acted intentionally to end a pregnancy, but we're going ensnare all sorts of people who have simply suffered pregnancy losses."
"Because," she continues, "it's very difficult to discern whether someone's had a prompted miscarriage or an unprompted miscarriage."