By Choice or Necessity, the Future of Abortions May Be at Home

Photo: James Keyser/Getty Images

“We won’t go back” has become a slogan for pro-choice activists, who have responded to an onslaught of abortion restrictions by invoking the bad old days of dangerous at-home abortions that preceded Roe v. Wade. But there’s some evidence suggesting we already have gone back — and that a new generation of safe, self-induced abortions might be the future of reproductive justice in the U.S.

Since the Texas abortion law opposed by Wendy Davis went into effect last November (closing all but six of the state’s clinics), the recorded abortion rate is down 13 percent, according to 538. It’s impossible to know if that actually means fewer abortions are taking place, however: Some pregnant women are taking matters into their own hands, and no one collects the data on home abortions.

For example, there have been reports of women in Texas’s impoverished Rio Grande Valley buying misoprostol — an ulcer medication that induces miscarriage by causing the uterus to contract — in local flea markets. After the markets were shut down by police raids, women traveled across the border to Mexico, where miso, as it is called, is sold over the counter. That’s what women in Brazil and other staunchly anti-abortion Latin American countries used starting in the ‘80s, until the government caught on to miso’s off-label use and heavily regulated it.

Now Brazilian women are turning to Rebecca Gomperts. The Dutch doctor is famous for “Women on Waves,” an at-sea abortion clinic that docked in international waters outside countries where abortion is still illegal. Plagued by legal battles, Women on Waves recently pivoted to become Women on Web, a telemedical abortion clinic. According to a report in this weekend’s New York Times Magazine, Gomperts’s team in Amsterdam provides medical consultations to desperate women in countries where abortion is illegal, as far away as Costa Rica, Pakistan, New Zealand, India, Uganda, South Korea, and Saudi Arabia. If the women are early enough in their pregnancies, Women on Web will have a prescription for misoprostol and mifepristone (a more tightly regulated drug that breaks down the uterine lining and is often used in combination with miso) filled by a drug exporter in India and shipped directly to them. The organization provides women the information they need to spot any possible complications that would require them to seek local medical care.

In said Times Magazine article, Emily Bazelon reports that Women on Web gets 40 to 60 emails a month from women in the United States — “double the number from two years ago” — but the organization is prioritizing cases in countries where safe abortions are totally unavailable. Still, some abortion-rights activists advocate normalizing home medical abortions in the U.S. as well, Bazelon writes, either out of illegal necessity (like a Womb of One’s Own’s Jane Doe) or simply because the technology exists (as writers for RH Reality Check have argued). Unlike coat hangers and knitting needles — the classic tools of at-home-abortion horror stories — miso and mifepristone present few risks. In a Planned Parenthood study of 230,000 medical abortions, only 0.65 percent had serious complications like bleeding or infection, Bazelon writes. It’s so safe that Planned Parenthood doctors in Iowa administer medical abortions by webcam (opening a remote-control pill drawer containing one dose), a program state Republicans have challenged to the Iowa Supreme Court.

It’s hard to imagine in our current political climate, but some have argued that miso, which is 85 percent effective on its own, could one day be the Plan C to emergency contraceptive’s Plan B. After all, the morning-after pill was also a controversial, prescription-only drug, until — 15 years after it was approved by the F.D.A. — a federal judge ruled that blocking its sale was the “obviously political” “suppression of women.”

The Future of Abortions Could Be at Home