New Site Aims to Make Self-Induced Abortion Safer
No one knows exactly how many women in the United States induce their own abortions every year, but we do know that, despite abortion being legal, a number of women take matters into their own hands. In the United States, women self-managing their own abortions - whether because they can’t access or afford a legal abortion in a clinic, because of feelings of fear or shame, or because they simply prefer the privacy of ending a pregnancy themselves - have long relied on word of mouth, Google, or their own instincts to figure out what to do and whether something has gone wrong.
That’s what Women Help Women wants to change. The organization just launched a new website that offers personalized information for women seeking to end early pregnancies with misoprostol, an abortion-inducing medication. The site doesn’t sell medications, but it lays out the World Health Organization (WHO) guidelines for using misoprostol (or misoprostol in combination with another drug, mifepristone), and allows women to send protected messages to experts on medication abortion.
The service is called Self-managed Abortion: Safe and Supported (SASS), and is live today on Abortionpillinfo.org. Here, Susan Yanow, the founding director of the Abortion Access Project and a consultant to Women Help Women, explains about how the website works, what Women Help Women does to mitigate risks to users’ health and security, and whether this is the future of abortion rights.
Why this particular project and why now?
We know that women have been self-managing their abortions for many years. We know that with the ascendency of a very misogynist administration that is already working to cut support for family planning and for abortion services that more and more women are going to lose access to clinics. So it is a critical time to make sure that women who are choosing to self-manage their abortion outside of the medical system have accurate information and the support that they need to be safe.
What’s the goal of the site?
The goal is to give accurate medical information according to the WHO protocols, to make sure women understand the best way to use the medicines, if they have it, for effectiveness but also for safety. So part of the information that will be shared is the WHO info about who should not use the medicine, and although complications are very rare, what are the signs of a complication. And, very importantly, if a woman does have a complication, she will be encouraged to seek medical care, but she will also be given the information that miscarriage happens with 15 to 20 percent of pregnancies, and that miscarriages look the same as medication abortions and are treated the same way. So she will absolutely be confident that medical practitioners will be able to treat any symptoms she has but she doesn’t have to say why she’s bleeding.
The goal is also to reduce legal risk. This will be a secure portal like any health-care provider. The woman will enter her information, she will get a response within a couple of hours, and what she will get is a link to tell her to go to another secure portal to get the answers. The only email she will have in her phone will be a secure link, and the information at the link will disappear in seven days.
The goal of this is not to direct women toward self-managed abortion. If a woman, for example, were to write, “I can’t find the money, what should I do?” she will be given information about abortion funds and clinics in her state. The only time women will be given information about the WHO protocols is if they indicate they have already made the decision to self-manage their abortion.
The abortion rights movement in the United States has long pushed for abortion to be safe, legal, and accessible. Is there a worry that taking abortion out of clinics and doctors’ offices and into women’s private homes could undermine the broader goals of the pro-choice movement?
There are a lot of respected researchers looking at the possibility of misoprostol and mifepristone being over-the-counter. There is consensus in the medical and activist communities that abortion is overregulated in the U.S. Esteemed researchers are writing and publishing about the impact of over-restricting access to abortion pills. So this is part of that movement.
We do know from research that has been done in Texas that there are women showing up [at hospitals and clinics] who said they tried and failed [to use misoprostol to induce an abortion]. Given that if one uses misoprostol alone exactly according to the WHO protocols, it’s 80 to 85 percent effective, we can assume either those women didn’t use it correctly or they’re in that 15 to 20 percent. That means 80 percent [of women who are self-inducing using misoprostol alone] aren’t showing up at the clinics. The goal of this project is not to drive women away from the clinics, it’s to support women who have already made a decision not to go to a clinic.
Are you concerned at all, working in such a polarized political environment on an issue that is so controversial, that something could go wrong?
The something that could go wrong could be medical, it could be legal, it could be related to security. Let me start with the medical. One always worries about that tiny, tiny percentage of women who are going to have a complication. One worries if you’re a clinic, one worries about the women who are already doing this, and of course Women Help Women worries about the women who get information from Women Help Women. But it reduces that risk if the woman is more informed. Women Help Women conceives of this as a human rights project. But one could also look at it as a harm-reduction program. Take needle-exchange programs - even with a needle exchange, there could be a bad outcome, but it certainly reduces the risk of infection. Abortion pills are safer that Viagra and they’re safer than penicillin. Of course we know that with any medication and any medical procedure, there’s a small risk of a bad outcome. But since abortion pills have such a demonstrated record of safety, we hope this helps women get medical care if they need it.
What could go wrong legally, well, there could be more arrests, whether a woman accesses this project or does it on her own. Our hope is if a woman truly understands that an abortion with pills is like a miscarriage, she’s less likely to say something that puts her at legal risk.
For security, when it comes to hacking the website, this site is not hosted in the U.S. There is a security team that is very confident in the security protocols that have been taken. We know from what has happened to Planned Parenthood and the cyber security attacks, we know what abortion opponents are capable of, but we can’t let that knowledge of their capacity for sabotage stop this project from going forward.
How confident can women be that their identities will be protected?
Women will not be asked for identifying information except for a first name or nickname. They will be asked, “Have you confirmed the pregnancy and if so, how?” They will be asked, “How many weeks pregnant are you?” and linked to a pregnancy calculator that helps calculate the last menstrual period. They will be asked, “What state do you live in?” And that’s it. If a woman writes in a second time, we will have the information that has been shared with her, but even in the extremely unlikely event someone gets their hands on it, it would say something like, “Jill, confirmed pregnancy via pregnancy test, New York.” And people may not even give their accurate name. It’s just so we have a way to keep their thread and identify them for the purpose of giving them full information on a second response.
If a woman calls you and asks for help procuring abortion-inducing pills, what happens?
There will be information on the webpage that says how women have gotten the medicines in the past. And that information is gathered from news stories of women who have been arrested and from some of the research that’s been published. But women will not be directed to a specific site to buy misoprostol because, to be honest, there isn’t one that is trustworthy.
Do you see this as a stopgap measure in response to the past decade’s barrage of abortion restrictions? Or is this part of the future of abortion rights?
It is not a stopgap measure. All over the world, women are using these medicines. The recent WHO study on maternal mortality on unsafe abortion noted that there have been increases in maternal mortality from unsafe abortion due to population expansion all over the world except in one place, and that was Latin America. In Latin America, misoprostol is over the counter.
If we truly believe in women’s self-determination, they should also have a choice in how. I think of it like the birth movement. Women should have the choice in having a birth in a hospital or at home with a midwife. They should certainly have the choice of whether to have a vaginal or a cesarean delivery. So why shouldn’t they have a range of choices for how to end an unwanted pregnancy as long as they have the information and it’s safe? This is a response to a more hostile climate, but we hope it will be part of building a vision for what abortion care could be. It isn’t the wave of the future. It’s already here.
Who are the people answering women’s inquiries about self-managing their own abortions?
Women Help Women has 23 staff based on four continents outside of the U.S who currently answer emails in six languages. Some of them have psychology and social work degrees; the majority do not, but they have been doing this for between two and nine years. Most of the people who are the counselors previously worked for Women on Web [an organization that helps women obtain and use misoprostol]. There are two physicians who are available pretty much around the clock if there’s a situation the counselor is unsure of with medication. But the Women Help Women staff is extremely well trained on giving information, not advice, and having a very deep knowledge of abortion, both misoprostol alone and the misoprostol/mifepristone regimen. Many of them have started abortion hotlines and have trained others.
Anything else women should know about this new site?
The overarching value here is that this project was initiated because of a deeply held belief that when anyone decides to end a pregnancy, they should be able to do it safely, effectively, without stigma, and with dignity. So I just want to make sure that anyone reading this understands that this is not about desperate women and second-class care. It’s about supporting women wherever they choose and however they choose to end an unwanted pregnancy.
This interview has been edited for length.
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