Clinics Close, but Abortion Continues

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Among women in the study, nearly half reported using the licensed abortion drug misoprostol or another medication in their most recent attempt to self-terminate a pregnancy, while 38 percent used herbs they heard could induce abortion, and nearly 20 percent used a physical method, such as being hit in the abdomen. Nearly 28 percent said they had succeeded in ending the pregnancy. Among those who had failed, 33.6 percent subsequently had abortions at a clinic (often 100 miles or more from home), and 13.4 percent continued the pregnancy. Eleven percent said they had suffered a complication following their self-attempt at abortion.

The most common reasons they gave for having tried to end a pregnancy on their own, without involving the health care system, were that it seemed easier or faster, that the procedure at a facility was too expensive and that the nearest clinic was too far away. Although this survey did not include adolescents, pregnant teens are often reluctant or unable to seek parental consent that many states require for a medically supervised abortion, which prompts some teens to attempt a self-induced abortion.

According to Dr. Ralph and co-authors, “abortion clinics and practitioners report caring for an increasing number of individuals who have attempted self-managed abortions.” The researchers predicted that efforts by women to induce abortions on their own will become increasingly common as access to facility-based abortion care continues to decline.

For instance, the last clinic in Missouri that provides abortions, operated by Planned Parenthood, could be forced to stop the practice in a dispute with state regulators. It won a reprieve to continue operating through next May. Missouri and Mississippi are among a number of states in which lawmakers have banned abortions in early pregnancy, and most recently Texas banned all abortions after six weeks of pregnancy, a point at which the vast majority of women don’t yet know they are pregnant. Last month, the Supreme Court accepted a case that could result in overturning Roe v. Wade.

“As more abortion clinics close and restrictions increase, the convenience of self-managed abortions will likely make them more prevalent,” Dr. Ralph said in an interview. “Just because states make abortion more difficult to access doesn’t mean the need for abortion will go away. We should make sure that women have the safest and most effective methods available.”

She noted that pandemic-induced limitations on in-person medical visits may have made it easier for women in many states to access self-managed abortion in their homes. More doctors are now willing to provide abortion counseling over the phone and may even “distribute abortion medication by mail or hand it to women in the parking lot,” she said.

Used correctly within 70 days of the start of a woman’s last menstrual period (10 weeks gestation), medical abortion is effective in ending pregnancy more than 95 percent of the time, the Guttmacher Institute has reported. There are two prescription drugs, best used in combination, that can induce abortion early in pregnancy. One, an oral drug called mifepristone, is taken first to block the hormone progesterone needed for pregnancy to continue; the other, misoprostol, is dissolved in the mouth or inserted vaginally one or two days later to induce contractions and expel the contents of the uterus, ending the pregnancy.