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The future of do-it-yourself abortions is the internet, not a street doctor



For many people, the phrase "illegal abortion" brings to mind images of secondary clinics, medical suppliers with questionable credentials and, of course, the dreaded hanger – an object so evocative that it has often been used as a symbol of protest. But those images are obsolete, belonging to a "it was pre-Roe". In these days, the real action of abortion is now online, as a group of reproductive rights activists use the internet to spread the word about how to use the pills to abort. They hope to offer pregnant women who live in places where abortion is almost inaccessible, or even illegal, access to safe and effective ways to take charge of their fertility.

Thanks to the introduction of mifepristone and misoprostol abortion pills – which, in combination, effectively induce abortion from 95% to 98% of the time – it became possible to terminate an unwanted pregnancy without an invasive medical procedure. More precisely, it is possible that women take these pills to induce an abortion alone, without the assistance of a doctor. These pills can be purchased online, so for many people it is possible to avoid the clinic altogether.

People looking for self-managed abortion information have a number of places to turn to, including Plan C, ReproAction and safe2choose. In many cases, these services are just lists of facts about self-managed abortion. But some, like SASS (an acronym for self-managed, safe, and supported abortion), offer access to counselors who can guide visitors through the self-managed abortion process, answering any questions they may have about their specific situation.

Launched in April 2017, SASS is an online consulting service provided by the international group of abortion activists Women Help Women. Outside the United States, Women Help Women is one of the few full-service self-managed abortion support operations that not only provides support and information, but abortive pills to people who use the service (Women on Web offers a similar service service, safe2choose recently made the decision to move away from direct shipping). But because many US regulations legally prohibit this type of configuration, SASS works slightly differently.

When someone arrives at SASS, he receives a complete guide on how to have a self-managed abortion. There is an extensive list of questions and answers, covering all the facts about self-managed abortion: places where you can get abortion pills, how to safely induce abortion using both mifespristone and misoprostol or just misoprostol alone, what to expect during the abortion process, what kind of complications require a visit to the hospital and, perhaps most important of all, what you should tell a doctor if you land in the emergency room, especially if you are in a state where self-managed abortion is illegal. The site also lists resources for people who would prefer a clinical abortion but simply do not know how to make it happen, including information on abortion funds that are set up to facilitate the procedure for low-income people.

For people with more specific questions, there's an additional option: a web-based helpline that allows users to connect with SASS consultants outside the United States. Users send their questions through a secure portal and are provided with a randomized link where their response will be published within a few hours. After seven days, the page becomes empty, leaving no evidence of the original application.

If that system looks like a little cloak and a dagger, it's for good reason. "We wanted to make sure that that contact with SASS would be safe," says Susan Yanow, a member of the US Women's Women Help team. In many states – including alleged havens for reproductive rights, such as New York – self-managed abortion is a crime.

Because a self-managed abortion is clinically indistinguishable from an abortion, prosecutors rely on other clues to ascertain whether someone has attempted an abortion. A lost message or an e-mail referring to self-managed abortion can land someone in prison, as evidenced by the experiences of people like Purvi Patel, an Indian woman who was sentenced to twenty # 39; years in jail after prosecutors claimed that his abortion had been caused by abortion pills (the conviction of Patel was later overturned by an appeal court).

While the people who tried to abort in pre-Roe against Wade were at risk of infection, infertility and even death, today a self-managed abortion with mifepristone and misoprostol brings with it a range of different challenges. .

The most significant obstacle is getting access to the pills in the first place. SASS lists a number of options. Misoprostol (which is often prescribed to prevent ulcers and alone is 85% effective when used to stop a pregnancy) can sometimes be acquired by a doctor, veterinarian, or counter in a country like Mexico. Several online pharmacies sell abortion pills, but they can be expensive, slow to arrive and of dubious quality. That's why Plan C offers a report card that evaluates different services.

But there is no guarantee that the information is still up-to-date. The online pharmacy system is "like whack-a-mole – good information today is not necessarily good information next week or next month or next year, because [the pharmacies] come and go, "says Abigail Aiken, an assistant professor at the University of Texas-Austin who studies the motivations and experiences of people pursuing self-managed abortion.

Complications can happen and happen: Katherine Olivera, a member of the International Women's Health Coalition program who previously worked at Falls Church Healthcare Center – one of the few abortion providers in northern Virginia – is concerned with problems such as "a diagnosis of ectopic pregnancy missed or failed abortion. "

But the greatest risk for people trying to self-manage abortions can be legal: even if self-managed abortion is not explicitly illegal, the practice can be prosecuted under fetal harm laws (which are present in ten states , including Massachusetts, Michigan and Washington) or through the incorrect application of archaic anti-abortion statutes (which exist in fifteen states, including Alabama, Minnesota and Nevada). The threat of being arrested after being directed to the emergency room to seek treatment for complications is what supporters consider the most vicious threat – a project that SASS hopes to fight by educating people on how to avoid incriminating themselves.

It is difficult to say how frequently a self-managed abortion in America can abort if Roe v. Wade is overturned. Although the defenders suspect that state-level attacks on access to abortion have increased self-management abortion, there is not much data on its frequency, partly due to # 39; emphasis placed on the protection of the anonymity of the people who use their services. "We to think it's increasing, but we do not know, "says Yanow Yamani Hernandez, executive director of the National Network of Abortion Funds, notes that while the organization receives requests for self-managed abortion, the frequency of requests" it's something we keep track of ".

But projects like SASS are working to ensure that whatever happens in the struggle for reproductive rights, we will not go back to the clothes hanger. By providing information, legal advice and emotional support, self-managed abortion activists are paving the way to a new future of reproductive rights, where information is the most powerful tool for ensuring body autonomy.


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