No, We Won’t Go Back To The Days Of Coat-Hanger Abortions
If you’ve attended a women’s march or pro-choice rally, you’ve probably seen the specter of a twisted iron coat hanger. It might be a crude, scribbled drawing on a poster, or perhaps even a real one, grasped tightly in someone's hands.
Or maybe you've heard someone drop the term "coat hanger abortion" when talking about the dark history of reproductive rights.
Whatever the context, the term has become a catch-all phrase symbolizing the dangerous world of secret, at-home abortions before the practice was legalized by the landmark 1973 Supreme Court decision in Roe v. Wade. "A coat hanger abortion is an unsafe abortion," says Marva Sadler, senior director of clinical services at Whole Woman's Health, a non-profit abortion provider operating clinics in several states.
But when the Supreme Court officially overturned Roe v. Wade on June 24, leaving it up to individual states to decide whether abortion is legal, access to abortion care was restricted for millions of women around the country.
Luckily, there are still plenty of options for self-managed care out there for women (yes, even if you're in a state where abortion has been banned) thanks to safe and effective medication abortion pills—and experts agree that the days of dangerous at-home abortion methods can remain long behind us.
How does overturning Roe affect safe abortions?
Before abortion was legalized, the process was secretive, which also made it more dangerous. "There were also increasing numbers of women showing up in hospital emergency rooms with perforated uteruses and other signs of having tried to abort [a] fetus," says Carol Sanger, a Columbia Law School professor who specializes in abortion and family law.
While this dangerous historical "coat hanger" method is by no means currently prevalent, it does occasionally still occur. At its root, these dangerous and desperate methods can be linked to societal views and regulations surrounding the practice of abortion.
In 2015, a Tennessee woman was arrested after attempting to abort a fetus at 24-weeks using a coat hanger. Tennessee's law only permitted abortions up to the point of "fetal viability," (which means the fetus can survive outside the womb), The New York Times reported.
The founder of a women's reproductive rights group in the state, SisterReach, "faulted Tennessee lawmakers for creating a hostile climate for abortion," the article said.
"If they have this stigma in their community, or fear of criminalization, these are reasons that turn patients towards sometimes unsafe measures," says Dr. Selina Sandoval, MD, an ob-gyn specializing in abortion care and complex contraception and a fellow with Physicians for Reproductive Health.
When abortion was legalized in 1973, the positive effect was made clear in maternal abortion deaths statistics. "Thirty-nine illegal abortion deaths were reported in 1972 in New York. Nineteen in '73 and three in 1975," Sanger says, referencing the years leading up to and following the Roe decision in 1973. "There was a massive decline in maternal mortality and obstetric injury."
Even with limited access to care, the days of coat hanger abortions should be long behind us.
"I don't think we will go back to those days," says Sanger.
That's because self-managed abortions look very different today than they did in the days before the practice was legalized, thanks to safe and effective medication abortion pills—mifepristone and misoprostol—that can be used up to 10 weeks into a pregnancy and can be taken at home.
These pills didn't exist back before Roe v. Wade. The FDA approved mifepristone in 2000, and two decades later, the two-drug combination now makes up more than half of all abortions in the US, per the Guttmacher Institute. "Before these medications were available, patients didn't have as many safe options to self-manage their abortions," Sandoval says. And using the coat hanger image perpetuates a "harmful and false narrative about what self managing care can look like" these days, she adds.
In states where abortion remains legal, these pills can be ordered online and mailed to your home, picked up from a doctor, a nurse, at Planned Parenthood, or at a clinic.
And, there are still ways to access safe abortion care even if the right to it has been overturned in your state.
What should I do if abortion is banned in my state?
If abortion pills are not legal in your state, you're more than 10 weeks along, or nearby abortion clinics have shut down, you still have options.
Sandoval says that people seeking information about abortion can visit the Miscarriage and Abortion Hotline or PlanCPills.org, where you can get resources and information about abortion pills. (Experts also suggest that if you are searching for abortion information online from a state that has trigger laws, it's safest to use a private browser or VPN.)
If medication abortion is illegal in your state, Sandoval says it's important to talk to trusted people in the community that "you feel safe talking to" but also "being very careful when we're doing that." She warns against going to "crisis pregnancy centers" because they don't always provide accurate information about abortions.
Providers are also doing their best to keep their doors open.
Sadler says that people should continue to reach out to their local abortion clinics and can use Whole Woman's Health as a resource, no matter where they live. The non-profit operates nine clinics in five states, and offers virtual services in five states, too, its website states. "We're absolutely still committed to helping women find and access safe and legal abortion care," she says.
Other options could include traveling to a state where abortions are legal or ordering pills from outside the country, said Stephanie Toti, senior counsel and project director at The Lawyering Project. However, "folks who have the resources to travel will be forced to travel out of state at great expense and inconvenience," she told Women's Health in May.
In response, companies like Amazon, Tesla, and Citigroup have said they will help cover employees' costs to travel for an out-of-state abortion, CNN reported. And other abortion funds like the Northwest Abortion Access Fund (and about 80 other similar orgs) can help with the financial burden, too, per NPR.
The higher cost for abortion care especially affects those who have historically been affected by the criminalization of abortion: Low income communities "are disproportionately affected by criminalization of pregnancy outcomes," as are communities of color and people who identify as LGBTQ, Sandoval explains.
How does a medication abortion work again?
The mifepristone pill is taken first, blocking the progesterone hormone receptor, and prepping your body for a miscarriage, Sandoval explains. This pill is followed by misoprostol, which is typically placed between the cheeks, the gums, or vaginally, around 24 to 48 hours after taking the first pill. Misoprostol causes cramping and bleeding "to empty your uterus," according to Planned Parenthood.
Sandoval says the bleeding can start as soon as 30 minutes after the second medication is administered. Within two to four hours, you can expect to pass large blood clots.
This can all happen in the comfort and safety of your own home, without the oversight of a medical professional. However, Sandoval recommends having a support person present during the process.
Meet the experts: Dr. Selina Sandoval, MD, is an ob-gyn specializing in abortion care and complex contraception, and a fellow with Physicians for Reproductive Health. Marva Sadler is the senior director of clinical services at Whole Woman's Health, a non-profit abortion provider operating clinics and offering virtual services in several states. Carol Sanger is the Barbara Aronstein Black Professor of Law at Columbia Law School, specializing in abortion and family law, and author of About Abortion: Terminating Pregnancy in the 21st Century. Stephanie Toti is the senior counsel and project director at The Lawyering Project, a legal advocacy organization that works on improving access to reproductive healthcare.
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