The U.S. Supreme Court is expected to hand down a decision in May for a Texas law (HB2) that restricts the number of abortion clinics operating within the state.
Among other things, HB2 requires that abortion clinics meet ambulatory standards for surgical centers in order for these facilities to stay open.
Today, just eight abortion clinics are open in the Lone Star state.
Texas isn’t alone when it comes to restrictive abortion laws. Since 2010, nearly 290 laws that impose restrictions on abortion access have been approved.
Abortion rights advocates say these laws are causing more women to self-abort unwanted pregnancies. However, hard data on the topic is challenging to find. Few studies about self-induced abortions exist.
Trying to Spot a Trend
A recent New York Times op-ed column took to the Internet to look for trends.
Using Google search data, the author detailed a correlation between a rise in Internet searches on self-abortion and an increase in laws across the U.S. that limit women’s access to abortion clinics.
“It’s not surprising,” Liza Fuentes, MPH, senior project manager at Ibis Reproductive Health, told Healthline. “Women still need abortion care.”
According to abortion rights advocates and healthcare providers, women who live in regions with restricted access to abortions — which includes waiting periods, parental consent, and mandatory ultrasounds — take terminating pregnancies into their own hands.
The methods range from driving across state lines to find a clinic that will provide an abortion or purchasing the FDA-approved abortion pill from the black market. Others use herbal tonics to end a pregnancy, while a small percentage relies on potentially dangerous physical tactics.
Google search data appear to mirror these methods.
According to the Times column, there were 700,000 Google searches related to self-abortion in 2015. Nearly one-fourth of the searches related to obtaining abortion pills through unofficial channels, such as “buy abortion pills online.”
Nearly 120,000 searches were seeking information on how to have a miscarriage, and some 4,000 were looking for directions on coat hanger abortions.
The report also illustrated trends related to regional access. Mississippi, a state with only one abortion clinic, saw the highest rate of searches for self-abortion.
Surgery vs. Medicine
The Supreme Court ruling in the 1973 case Roe vs. Wade made abortion legal in the U.S.
Today there are two legal methods for women in the U.S. to receive an abortion — surgical or medical.
In recent years the use of medical abortions has increased.
Mifepristone, also known as RU486, was approved by the FDA in 2000, and is recommended for use within “49 days of the start of a woman’s last menstrual cycle.” The drug is only available in doctors’ offices, clinics, or hospitals.
Misoprostol came on the market in 1973 and is FDA approved to treat ulcers through a prescription. However, its alternative usage includes labor induction and abortion.
Taken together mifepristone and misoprostol provide a 95 percent success rate in terminating a pregnancy. They may also be used separately with a lower success rate.
In 2001 just 6 percent of all eligible abortions were the result of using mifepristone, according to a report by Gynuity Health Projects. By 2015, the drug accounted for nearly 30 percent of all eligible abortions.
“The pill has been a revolution,” Dr. Beverly Winikoff, MPH, president of Gynuity Health Projects and professor of clinical population and family health at the Mailman School of Public Health at Columbia University, told Healthline.
However, misoprostol is by far is the most preferred method of women who decide to self-abort, according to a 2015 report by the Texas Evaluation Project.
The researchers surveyed women in a clinic about their history with self-abortion and whether they knew a friend who had tried misoprostol.
“[O]nly 13 percent of respondents in this survey said they’d heard of [misprostol]. However, it was the most commonly reported method among women who reported knowing someone who had attempted self-induction,” the report stated.
The report also revealed that, “22 percent of the women said that they, their best friends (including suspecting their best friends), or someone else they know, had ever attempted abortion self-induction.”
Researchers estimated that anywhere from 100,000 to 250,000 women living in Texas are choosing to self-abort.
Finding a Way
Researchers also concluded that misoprostol’s popularity is due to the close proximity of Texas to Mexico. In that country, the medicine is available in some pharmacies. They concluded that women were crossing the border to get the drug.
Winikoff said women who don’t have easy access to Mexico rely on online pharmacies or even the black market to get what they need.
“If [a woman] buys from the black market, she may get a sugar pill, and not good instruction, and access to a place if there are complications,” she said. “You go to a clinic, you get good instruction.”
The FDA states on its website that women should not attempt to buy abortion drugs on the Internet “because you will bypass important safeguards designed to protect your health.”
Despite the availability of medicine, some women who decide on self-abortion still turn to so-called ancient remedies, according to Fuentes. Herbal teas or tonics made of parsley or caffeine are some examples, she said. However, they don’t work.
A small percentage of women employ methods such as using a coat hanger or getting punched in the stomach, according to Winikoff. But this applies mostly to women who are marginalized, she noted.
Health risks with self-abortion include severe bleeding and infection. In rare cases it can lead to sterility and death.
The FDA has received reports that some women have died from sepsis after medical abortion. However, the website doesn’t list any numbers nor does it differentiate between doctor-supervised or self-abortion.
“In a clinic with a doctor, 99 percent of the time, it works without any problems,” Winikoff said. “If it doesn’t, you go back to the clinic.”
Women who self-abort don’t have ready medical expertise and support should something go wrong. “Many people will show up in an emergency room,” she added.
Fuentes added these women likely end up getting a surgical abortion, which is what they were trying to avoid.
In some cases a woman may end up carrying a baby to term. But the data surrounding that outcome are hard to come by, she noted.
“The research is just now emerging,” Fuentes said. “Most women end up getting to a clinic. However, we don’t know how many carry to term.”
The Guttmacher Institute considers 27 states hostile toward abortion rights, while 10 are considered friendly.
The disparity among states plays a big role in how women access abortions, according to Winikoff.
Both she and Fuentes said that for decades women have been going to other states to access abortions, which the Times column didn’t account for.
For example, “Pennsylvania has some bad [abortion] laws, but a lot of the population is close to New Jersey which has easy [abortion] access laws,” Winikoff said.
She and other experts said that some women simply cross a state line to access medical treatment or medication needed for an abortion.
“In Texas, that is not true,” Winikoff said. “Those people are isolated for services and have bad [abortion] laws. These people really need the Internet to tell them what to do.”
Fuentes added the Times column makes it clear that there is a real need for women to have legal, unobstructed “access to high quality care, with patient centered outcomes,” she said. “And this includes people being able to choose.”