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This year has seen a number of states pass laws that restrict abortion. At the same time, according to new data from the Guttmacher Institute, there is some evidence that a growing number of women are taking matters into their own hands; they are using pills to induce their own abortions without seeing a doctor. Some activists are trying to spread information about that option, which they say is now safer and easier. NPR's Sarah McCammon has the story.
SARAH MCCAMMON, BYLINE: When Arlen found out she was pregnant earlier this year, she was still finishing college and knew she didn't want a child. There's a clinic near her home in El Paso, Texas, but Arlen says she still faced obstacles to getting an abortion.
ARLEN: I started, like, researching about, like, prices. And I was like, well, I don't have $500. So I was like, OK, there's got to be other ways.
MCCAMMON: Arlen is in her 20s. She's asked us not to use her last name in order to protect her privacy. Arlen's online research led her to information about self-induced abortion with pills; that means using pills to bring on cramping and bleeding to intentionally end a pregnancy.
ARLEN: For me, it was very, like, taking my power back. Like, I'm going to do this.
MCCAMMON: There are multiple ways of inducing an abortion with medication. The most effective method, approved by the Food and Drug Administration up to 10 weeks into a pregnancy, requires two drugs, but that combination is heavily regulated and can be hard to obtain. The World Health Organization says a single drug also can be effective, provided patients get follow-up care. Arlen learned online that she could get that drug, sold to treat ulcers, at a pharmacy across the border in Juarez, Mexico.
ARLEN: And even, like, my friend that was with me, she was kind of, like, shocked about how easy it was to - like, no questions, no nothing. She was like, oh, my god, like, it's for real.
MCCAMMON: Arlen didn't want to take the pills alone, so she went to a friend's home in El Paso and followed the instructions she'd found online. Over the next few hours, she says she experienced a lot of cramping and bleeding and some vomiting.
ARLEN: The first time I saw blood I was so relieved because I wasn't happy about it, but I was just like, it worked and - it wasn't, like, sadly upsetting; it was just kind of, like, a thing that had to happen.
MCCAMMON: A network of reproductive rights advocates is working to spread information about self-induced abortion with pills to people like Arlen, both over the Internet and in person. This comes at a time when getting an abortion at a clinic is becoming more difficult in many parts of the country. Michele Landeau is with the Gateway Women's Access Fund in Missouri.
MICHELE LANDEAU: We are trying to plan ahead for the possibility that abortion might not be available in the state of Missouri.
MCCAMMON: In a downtown storefront in St. Louis last month, Landeau spoke to a small group of activists who planned to share what they're learning - things like the legal risks that come with self-induced abortion and information about which medications are considered the safest and most effective.
Missouri is among a growing number of states where lawmakers have passed bans on abortion early in pregnancy. The law is one of several currently tied up in legal challenges, and the issue is likely to end up before the Supreme Court. Landeau told the group that women seeking abortions now, even under restrictive conditions, are in a different world than women before the Roe v. Wade decision legalized abortion nationwide in 1973.
LANDEAU: The days of, you know, coat hangers and dying on the floor of a hotel room - you know, the Internet has happened since then, and a lot of advances in medical science have happened since then.
MCCAMMON: For those who can't cross the border to Mexico, the Internet is reshaping their options. That was true for a student and stay-at-home mom in Roanoke, Va. She's asked us to call her by her first initial, S, to protect her privacy. S says, about three years ago, when she wanted to end an unplanned pregnancy, she ordered pills online without seeing a doctor, using a pharmacy based outside the United States.
S: With a credit card. It showed up within two weeks. So by five weeks, I was able to take the pills and start the abortion.
MCCAMMON: S says she went with a two-drug combination she was able to get online. It's not the one preferred by the FDA and the American College of Obstetricians and Gynecologists because it's less effective than other methods, but S says it worked for her. Still, she had some fears about taking the pills herself.
S: I am a very nervous person. I couldn't get it out of my head. What if this happens? What if this happens and I leave my children on their own? But our plan was to either call 911 or to just go to the hospital, depending on how bad it was.
MCCAMMON: The American College of Obstetricians and Gynecologists says medication abortion, using the FDA-approved protocol early in pregnancy with a health care provider supervision, is safe and effective. Dr. Daniel Grossman is a reproductive health researcher at the University of California, San Francisco. He says abortions can be safely self-induced with pills under the right conditions.
DANIEL GROSSMAN: The bottom line is I don't have serious medical concerns about the safety of people self-managing an abortion on their own if they have information about evidence-based regimens about how to use these medications, that they know, you know, for example, that it's important to know how far along they are in their pregnancy, they know how to take the medications and if they have access to backup care in case of a rare complication.
MCCAMMON: Dr. Ingrid Skop is with the American Association of Pro-Life Obstetricians and Gynecologists and an OB-GYN in San Antonio. Skop is morally opposed to abortion, and she worries that some women may not be able to take abortion pills safely without a doctor's supervision.
INGRID SKOP: If a woman is further along in the pregnancy than she realizes - and that happens frequently; we change due dates a lot because maybe she has irregular periods or she just wasn't paying attention - the failure rate is much, much higher.
MCCAMMON: Abortion pills are less likely to be effective as a pregnancy gets further along. In a recent study, half of reproductive health care providers surveyed said they thought self-induced abortion was safe, according to the reproductive health journal Contraception. For abortion rights advocates, another worry is that women could be prosecuted for running afoul of laws and regulations surrounding abortion and abortion pills.
Pamela Merritt of Reproaction is leading a campaign to spread information about self-induced abortion around the country. She told the activists gathered in St. Louis recently that she worries about the women who take pills on their own and the people who advise them.
PAMELA MERRITT: If you walk away from this forum with anything, understand that the logical consequence of an abortion ban in 2019 is not a wire hanger; it is jail.
MCCAMMON: That fear of imprisonment for self-inducing an abortion is real, if a bit premature, says Mary Ziegler, a law professor at Florida State University. Some states prohibit self-inducing, but Ziegler says prosecutors often have been reluctant to press charges.
MARY ZIEGLER: Because, I think, from a standpoint of politics and optics, it's a disastrously bad idea for pro-lifers to prosecute women.
MCCAMMON: But speaking via Skype, Ziegler said she can imagine more prosecutions happening in the future. If new state laws restricting abortion are upheld, clinics are likely to close. Ziegler says that would leave women with few options for ending unwanted pregnancies, and states may feel pressure to prosecute them.
ZIEGLER: Simply because women, in many of these cases, would be the only people you could prosecute if you wanted to enforce the law.
MCCAMMON: Ziegler says the next phase of the decades-long battle over abortion rights could be less about clinics and more about the patients who seek or who self-induce abortions.
Sarah McCammon, NPR News, El Paso.
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