More than four decades after the Supreme Court guaranteed a woman's right to terminate a pregnancy, up to 240,000 women in the state of Texas have reportedly attempted to self-induce an abortion.
The numbers are on the rise and, according to researchers, are the result of increasingly restricted access to abortion clinics and the availability of over-the-counter, abortion-inducing medication.
The latest research from the Texas Policy Evaluation Project (TxPEP) estimates that between 1.7 and 4.1 percent of Texas women ages 18 to 49 have attempted to self-induce an abortion. The findings, released last week, come from a statewide survey and interviews with nearly 800 women carried out in 2014 and 2015.
"They didn't do this because this was their ideal form of health care, but because they felt that they had no other option," said lead TxPEP researcher Daniel Grossman, a professor of obstetrics and gynecology at the University of California at San Francisco.
Reproductive health advocates see the numbers as a concerning reflection of the decisions faced by women who live in conservative states where sweeping legislative measures have aimed to prevent women from terminating their pregnancies.
"This new study confirms that women who are denied safe, legal abortion care where they live are more likely to take matters into their own hands—with often devastating consequences," said Nancy Northup, president of the Center for Reproductive Rights.
Because women tend to underreport their personal history, and because the decision to have an abortion remains stigmatized, the study employed a third-party reporting methodology that asks respondents to answer on behalf of their best friend, as well as themselves.
In the study, respondents cited four main reasons for self-induction: financial constraints that would prevent them from traveling for the procedure, the closure of local clinics, a recommendation to self-induce from a close friend or family member, and a desire to avoid the stigma or shame of going to an abortion clinic.
These concerns were reflected in the answers given by women in the interviews. One woman living in the Rio Grande Valley, the stretch of Texas that runs along the border with Mexico, told researchers, "I didn't have any money to go to San Antonio or Corpus. Like I was just dirt broke. I was poor."
The most commonly reported method that women used to end their pregnancy was a drug called misoprostol, often referred to as miso, which is often available without prescription in Mexico. The drug—indicated by label to treat ulcers—is commonly used to terminate pregnancies by women in countries where abortions have been legally restricted.
While the World Health Organization has deemed misoprostol an effective means to end a pregnancy, its use does not come without risks if women do not have accurate information regarding its use.
A 24-year-old woman, speaking to researchers, described her experience as "probably one of the worst pains I've gone through," adding that despite knowing how much bleeding to expect, that there was "always that slight uncertainty of like, I don't really know what I'm doing."
Prior studies indicate that women in Texas are more likely to self-induce an abortion than women living elsewhere in the country. In 2008, a national study of abortion patients found that less than 2 percent reported taking something to try to cause an abortion before going to the clinic.
In Texas, by contrast, a 2012 study found that 7 percent of abortion patients had tried to end the pregnancy themselves before seeking the help of a physician.
But that was before Texas passed one of the most restrictive abortion laws in the country, in 2013. More than two years later, and with several parts of the bill yet to be implemented, more than half of the state's abortion clinics have closed their doors.
In a state with 5.6 million women ages 18 to 49, only 14 abortion clinics are still in operation. And in the Rio Grande Valley, the poorest part of the state, with counties that are among the poorest in the country, only a single abortion clinic has been able to keep its doors open.
The numbers in the most recent study mirrored this reality. Researchers found that Latina women in the Rio Grande Valley were more likely to have attempted to terminate their own pregnancy.
"These are the populations that are being hardest hit by the clinic closures," said Grossman. "We think that as clinic-based care becomes more constrained, we suspect that these numbers will go up."
This is of central concern to reproductive rights advocates, who see the restrictive laws in Texas as a direct violation of a woman's legally guaranteed right to terminate a pregnancy. They have turned to the legal system for remedy, and earlier this month, the Supreme Court announced that they would hear the case, Whole Woman's Health v. Cole.
The court has temporarily blocked some aspects of the law from taking effect, and it plans to hold its first hearing – to review a challenge against the most restrictive parts of the Texas abortion law – next summer. If fully implemented, the National Abortion Federation has estimated the total number of abortion clinics operating in the state will be reduced to 10.
"We are counting on the U.S. Supreme Court to overturn these deceptive laws and reject the underhanded tactics of legislators who care more about political gamesmanship than the health, well-being, and constitutional rights of women in their state," said Northup, who believes that the full implementation of Texas House Bill 2 would have a "devastating impact" on women's health in Texas.
The recent TxPEP study is likely to further fuel the ongoing legal debate, providing documentation of the continued and potentially increasing prevalence of self-induced abortions across the state of Texas.
"There are some who have been saying this doesn't happen since abortion became legal in the U.S., and that's a myth," said Grossman. "This is not ideal health care; this is a procedure that is legal, and their care is being complicated."
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