In the 21st century, you can order an abortion online. “It can be done without ever leaving your home,” says Elisa Wells, co-director of the organization Plan C, which provides information and instructions on how to self-manage an abortion. “You go online. You either have a virtual consultation or an e-visit – this is done simply by filling out a form and chatting with the provider. And then they ship the pills to your home… No need to miss work. No need to meet protesters. And there’s no need, if you live in the state of Texas, to expose anyone to the threat of a lawsuit under the state’s new medieval abortion ban.
The new Texas law uses the the specter of civil lawsuits to scare abortion providers — and anyone else who might help a pregnant person have an abortion — by denying care to women whose pregnancies are past six weeks gestation. But, according to legal experts, someone who manages their own abortion using pills ordered over the internet would not be breaking the law – even if they terminate beyond the six-week limit.
“The best reading of the law is that it would not apply to self-directed abortions,” Marc Hearron, senior attorney for the Center for Reproductive Rights, told reporters on a call earlier this month. Indeed, the law, known as SB 8, targets anyone in the state of Texas who helps someone else terminate a pregnancy, but explicitly bars the pregnant person themselves from being sued. in justice.
When SB 8 went into effect the first week of September, traffic to the Plan C website soared 2,357%, with 30% of those new visits coming from Texas. AidAccess, one of the organizations that Plan C recommends to women seeking the abortion pill, has experienced the same effect. They generally saw less than 2,000 visits per day before the ban. “It jumped to around 10,000 on September 1, then on the 2nd it was around 30,000,” says Christie Pitney, a certified nurse midwife who works with AidAccess.
The “abortion pill” is actually two types of pills that are taken together: mifepristone and misoprostol. A single tablet of mifepristone is taken first, followed by four tablets of misoprostol 24 to 48 hours later. Most people who choose to use pills over surgery – roughly 40 percent of women in the United States — self-administer these pills at home. Studies indicate that the self-administered abortion pill is 95% effective in terminating an unwanted pregnancy for up to 11 weeks. And since more than 90 percent abortions take place before 13 weeks, theoretically the vast majority of unwanted pregnancies could be terminated safely and privately at home. “We have a safe, modern and efficient form of health care. And there’s no reason anyone in Texas or Alabama shouldn’t have access to it,” Wells says.
AidAccess is just one of the providers helping people in Texas and across the United States self-manage their home abortions. The organization is an American spin-off of the international organization Women on the Webitself a spinoff of Women on Waves, which was started by Dutch doctor Rebecca Gomperts in 1999 to provide non-surgical abortions in countries with restrictive abortion policies, often aboard a docked ship off their coasts.
While SB 8 halted ground clinic operations in Texas (clinic abortions reportedly down 90 percent), Pitney says SB 8 had no impact on AidAccess’s operations at all. “It honestly hasn’t been talked about that much – we’re all very concerned about the effects of SB 8 on accessibility in Texas,” Pitney says. “I just don’t think that applies to AidAccess.” The organization works the same way for women in Texas today as it has since its inception in 2018.
AidAccess has 10 medical providers serving all 50 states – seven based in the United States and three based overseas. Anyone wishing to terminate their pregnancy privately at home need only complete a detailed medical history form. If it’s not a simple case – if the patient’s pregnancy is too advanced or if she has a history of medical complications – she will have a telemedicine appointment with a provider who will guide her through her options.
But if it is a simple case, the supplier sends a prescription to a pharmacy, which sends the pills directly to the patient’s address. For patients in certain states, the provider and pharmacy will be local. But the Texas patients, Pitney says, work with a European-based supplier and receive pills made and shipped from India. (Overseas shipping times have lengthened during the pandemic, prompting AidAccess to offer the option to pre-order the pills so women can keep them on hand in case of an emergency.) The cost, for the whole process, including the pills, ranges from $105 to $150, depending on the location of the patient.
Neither AidAccess nor Plan C has been able to provide exact figures on how many people have taken advantage of the self-administered abortion option since the Texas ban went into effect. a little over two weeks ago. But if recent history is any indication, demand has likely increased: For four weeks in 2020, Texas officials used the coronavirus pandemic as an excuse to suspend abortion care entirely. Meanwhile, Dr. Abigail Aiken, an associate professor at the University of Texas at Austin who uses AidAccess data in her research on self-managed abortions, found that requests from the state of Texas increased by 94% .
“We’ve seen applications from Texas nearly double in this short window,” Aiken says. “When clinical care was out of reach, the need for abortion did not disappear. People needed to find other solutions, and they did. (Aiken says she doesn’t yet have enough data to properly analyze demand trends in the period after SB 8 comes into effect, but she plans to do so.)
AidAccess isn’t the only way Texans can self-manage their abortions. “[People] use mail forwarding services, such as ipostal1.com — there are others, that’s just one — to access these new telehealth services in states where it’s allowed,” Wells says. Women can create a mailbox in a state, like California, for example, where telemedicine abortions are more commonly available. Medical providers are only supposed to dispense the drug to a patient in a state where they are licensed to practice telemedicine, but Wells says, “We know that sometimes [providers] ask, during this consultation: Do you live in the state of California? And we know that people, during the consultation, say Yes.”
Wells is careful to note that while in most states it is not a crime self-managing an abortion is not true in all areas. Arizona, Delaware, Nevada, Oklahoma, and South Carolina, for example, have laws explicitly prohibiting induced abortions. “We try to provide as much information as possible about what we know about the potential [legal] the risk is and then allow people to make their own decision,” she says. “We refer people to If/when/how is the Repro Legal Helpline. It’s a free, confidential service that can help you understand what the risks are based on where you are and what they know about different state laws.
In Texas, those who choose not to self-manage have the option of turning to one of eight Texas abortion funds to help defray the cost of travel out of state for an abortion in a facility. clinical. This work, however, runs into obstacles created by SB 8. Anna Rupani of Fund Texas Choice recounts rolling stone that before the ban, his organization used to respond to 10 to 15 requests each week. Now they’re lining up 70 to 100, and as those people travel further, the costs to support them have gone from $350 at the most to over $2,000 in some cases. “We’re nervous and we’re exhausted and we’re terrified, to be honest,” Rupani says of his work since SB 8 came into effect. “Before, I could help anyone who came to the door. Now I can’t.
This feeling of helplessness is aggravated by the fear of being exposed to justice. “There’s a fear of lawsuits happening,” she says, “and they’re supposed to kick us out of business and terrify us into not doing our job.”
Other Texans are heading to Mexico, Wells says, where abortion was recently decriminalized and pharmacies are known to carry misoprostol. “We know people are crossing the border into Mexico and buying misoprostol on their own,” Wells says. For decades, misoprostol alone has been used in Brazil, and across Latin America, to trigger the onset of a miscarriage. (Today the World Health Organization approved the use of misoprostol alone – which studies show is approximately 85% effective in terminating a pregnancy – when mifepristone is not available.)
An emergency motion filed by the Justice Department late Tuesday night, however, gives some advocates hope that SB 8 will soon be discontinued. Citing testimonies from providers and patients forced to travel “hundreds — and sometimes thousands — of miles to obtain an abortion under harrowing circumstances amid a COVID surge,” the DOJ sought a temporary restraining order. suspending the application of SB 8 in Texas.
But even if that happens, Aiken, a researcher at the University of Texas, says the need for self-managed abortion won’t go away in the state — just as it didn’t first appear suddenly when the law came into force. Coming into force.
“SB 8 is the most extreme abortion ban in the nation, but it’s really a continuation of what the Texas legislature has done for the past 10 years,” Aiken said. “The right to choose abortion in Texas exists on paper but, for so many people, only on paper — we already have a bunch of state laws that make getting to a clinic an obstacle course… I think it’s important to [view] any increase that we view as a continuation of a trend, and not just as, Oh, all of a sudden people need self-directed abortion. They needed it in Texas for quite some time.