life after roe

How Self-Managed Abortions Changed After the Overturn of Roe

New RU-486 Pill Now Available
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Since the U.S. Supreme Court overturned Roe v. Wade, it’s been unclear how many abortions are taking place outside the formal health-care system and whether they’ve helped make up for the loss of clinician-provided care. New research finally offers some answers: According to a report published Monday in the Journal of the American Medical Association, there were more than 26,000 additional self-managed abortions in the first six months after Dobbs. By comparison, previous research by the Society of Family Planning’s #WeCount project had estimated that there were around 32,200 fewer clinician-provided abortions during the same time frame.

The report comes as the legal battle over the FDA’s approval of mifepristone, one of the two pills used in medication abortions, makes its way to the U.S. Supreme Court. On Tuesday, the justices will hear oral arguments on the case, which will help them determine whether to reinstate restrictions on mifepristone that health experts say are outdated and medically unnecessary, like requiring that the pill be administered in-person by a physician and limiting its use up to seven weeks of pregnancy.

“The need for abortion hasn’t necessarily changed,” says Dr. Abigail Aiken, an associate professor at the University of Texas at Austin and one of the study’s authors. “But the place in which people are accessing has changed because abortion within the formal health-care setting is now so unavailable for large swaths of the country.” She added that other studies have found increased demand for abortion pills outside the clinic setting in the past, including when patients faced short-term abortion bans during the early months of the COVID-19 pandemic and after Texas enacted SB8 in September 2021, banning most abortions at six weeks of pregnancy.

The study examined data from telehealth organizations that offer abortion care with the help of providers based outside the U.S., volunteer-run community networks, and online vendors selling abortion pills. It estimates there were around 27,838 additional provisions of medication for self-managed abortions between July and December 2022, compared to pre-Dobbs levels. Out of those provisions, it estimates the pills led to 26,055 self-managed abortions. Aiken says there is a disparity because not everyone who orders medication will necessarily use it. “People might order from multiple sources, or they might get to the clinic when they couldn’t before because the money comes through or they’re able to travel,” she says. “They might experience a pregnancy loss or they might change their mind and continue their pregnancy.”

The report found that volunteer-run community networks accounted for around half of all monthly provisions, which Aiken says could be attributed to the fact that these groups often offer medication at little to no cost, as well as peer-to-peer support that helps patients navigate their abortions. “Even though self-managed abortion in general is less costly than in-clinic care, there’s a big range when it comes to cost,” Aiken says. Telehealth services such as Aid Access offer medication for $150 or less, while online vendors’ prices are comparable to in-clinic care, she adds. “Finding that $90 might be the difference between paying your rent and getting your abortion.”

Self-managed abortion is legal in all states except Nevada, which explicitly bans it after 24 weeks of pregnancy. While that hasn’t stopped overzealous prosecutors from stretching the boundaries of the law, Aiken says the report is a reminder that, while criminalization remains a risk for those self-managing their abortions, the vast majority will not face legal consequences. “The people that do get surveilled and prosecuted — that’s such a devastating thing that we can’t forget that it’s a risk,” she says. “But it’s not common, at least for now.”

Research has also consistently shown that abortion pills are extremely safe, with fewer than 0.4 percent of patients experiencing serious complications that require hospitalization. “I’ve been having conversations about self-managed abortion in the U.S. for quite a while, and still sometimes you have to counter the idea that just because it’s happening outside of a formal health-care setting, it must be unsafe,” Aiken says. “But we do have evidence and data to say this is something that people can do safely on their own.”

The Cut offers an online tool you can use to search by Zip Code for professional providers, including clinics, hospitals, and independent OB/GYNs, as well as for abortion funds, transportation options, and information for remote resources like receiving the abortion pill by mail. For legal guidance, contact Repro Legal Helpline at 844-868-2812 or the Abortion Defense Network.

How Self-Managed Abortions Changed After the Overturn of Roe