Today we have an important guest post from Argiope.
The post stands on its own, but this is the fight we’re in, and this tweet is a good example of what we’re up against.
When we say they’re coming for birth control this is what we mean https://t.co/leUiBq7RYe
— Molly Jong-Fast (@MollyJongFast) April 3, 2024
What if most abortions were DIY?
by Argiope
Access to mifepristone is about compassion. Combined with misoprostol, it’s the safest and most effective medication for women experiencing miscarriage or who no longer want to be pregnant. In terms of the science, mifepristone is currently over-regulated in the US. It has a 20-year track record of global safety. Currently, though, mifepristone can only be accessed through a special, cumbersome process requiring physicians to maintain clinic-based access to the drug and dispense it from specially ordered supplies. The current case before SCOTUS merely preserves the status quo.
Imagine an alternative world where you could obtain a safe abortion, in the privacy of your own home, from your local primary care physician or midwife. Or, one in which you could get pills administered by your pharmacist.(Hello, Ontario!) In both scenarios, only the people you choose to tell know you had an abortion. No screaming protesters at the doors of the clinic. No doctors worrying about which bullet-proof vest to wear, or which route to take to work, to avoid murderous fanatics.
It’s high time we recognize the power of the US Postal Service. Justices Alito and Thomas certainly have: it’s why they want to bring back the Comstock Act to prohibit mail distribution of these meds. Shaming and punishing people for having abortions—or, let’s face it, sex for pleasure—is impossible, if it’s impossible to know who’s having them or which physical locations to target with stochastic violence.
Now let’s tease out this thread a bit further, in accordance with science, safety, andWorld Health Organization (WHO) guidelines: imagine pregnant people managing their own abortions, without a physician, midwife, nurse, or even local pharmacist being involved. The world where individuals can decide to end their undesired early pregnancy with safe medications, obtained through the mail, is here now. But too few people know about it.
That’s where this near top-10,000 blog comes in: we know people. We know people who live in deep red states that have banned abortion—or, to be more precise, have banned their state’s clinicians from providing abortions. In these states, abortion is still available, but people who want it must either travel for care or do it themselves.
Self-managed abortion using a combination of oral mifepristone and vaginal misoprostol tablets is safe up to 12 weeks of pregnancy. Based on studies from low-medical resource areas around the world, the WHO recommends that pregnant people can:
- Safely determine whether they are appropriate candidates for medication abortion.
- Take the pills correctly.
- Determine whether the abortion was successful
- Decide whether they need medical help—all without clinician involvement.
No ultrasounds. No examinations. Just safe pills and sound information are required.
Most abortions in the US happen by nine weeks.
In regions where people learn about—and have access to— medication abortion by mail, gestational duration is decreasing. In regions where people must travel to a distant clinic for procedural or medication abortions, gestational duration is on the rise. There are reputable web-based services to help people obtain medication abortions by mail, and more are being developed every day: to begin, see see planCpills.org, Aid Access, and I need an A.
Aid Access provides telehealth options where clinicians get involved. PlanCPills.org offers both telehealth options and direct mailing of mifepristone and misoprostol dose packs from vetted overseas pharmacies. Shipment from overseas, though, is slow and cheap. Telehealth is more expensive and fast. In fact, telehealth is typically faster than making an appointment at a nearby clinic.
Access to follow-up care remains important for self-managed and telehealth medication abortion. It’s important to know that no clinician in an emergency or OB department can tell how a miscarriage in progress got started, unless they see pills in the vagina or the patient tells them they were used.
So if someone DIYs their abortion and feels they need help due to uncommon complications, doctors and nurses don’t need to know the issue is associated with medication use because it doesn’t change the course of treatment. In Texas and other ban states, don’t-ask-don’t-tell is sadly back for clinicians.
The rare ones who voluntarily narc on patients to the police or child protective services put patients at risk and betray their ethical obligations. But patients who don’t report pill use are unlikely to be identified during follow-up care, and clinicians can protect their patients when it’s legally possible to do so, through careful documentation.
Safe abortion saves lives and life trajectories, and self-managed abortion with appropriate medications is safe for most people.
So how can you help improve access?
- Spread the word.
- Share resources.
- If you live in a ban state, planCpills.org stickers and plaster them on lamp posts and in public restrooms.
- If it’s not legally risky for you to do so, order a dose of pills, just in case, for the young people in your life. Tell them which medicine cabinet they are kept in.
- If you live in an access state, talk with your GYN provider or family practice clinician. Ask them if they would be willing to do the paperwork to provide medication abortion in the office, if they don’t already. Expanding access points to care could allow abortion clinics to focus on patients who can’t get care anywhere else.
- Tell your governor to support Shield Laws that allow clinicians to provide telehealth abortion care for residents of ban states.
- Ask your blue state government to support publicly funded abortion.
- Wherever you live, work to elect Democrats.
- Support access to contraception and oppose state funding for crisis pregnancy centers. Push back on medical misinformation using facts from reliable sources like Guttmacher.org.
- Donate to abortion travel funds and to keep accurate information flowing to the people who need it.
Let’s keep this horse from returning to the barn, no matter what happens in November.
