The World Needs Safe, Self-Managed Abortion: Here's Why.
Safe, legal, affordable, and uninhibited access to abortion is a global issue and necessity.
Advances in medical research continues to report that self-managed abortions with pills are now a safe option for people who choose to have an abortion outside of medical settings. While legal restrictions inhibit safe abortions, many people can still access safe abortions at home with access to the correct pills, medical care, and scientifically-based information. There are still barriers to accessing a self-managed abortion with pills, and some reasons why it's not always the right choice for everyone who chooses to have an abortion, but increased access to medical abortion is a huge step towards decreasing the number of unsafe abortions and expanding people’s choices when they do not want to be pregnant.
Legal Fights for Abortion
Activists around the world are working to create and build on legal frameworks to ensure that people are supported when they decide to have an abortion. In 2019, thousands of people marched the streets of Buenos Aires fighting for their government to legalize abortion, wearing green handkerchiefs, which have become emblematic of the Latin American fight for safe and legal abortion. In 2016, activists in Poland held a strike to protest a complete ban on abortion, which successfully led to the withdrawal of the ban. Mozambican activists documented the harmful effects of unsafe abortion practices and that led to a legal reform on abortion laws in 2014. All around the world, activists are working to make safe and legal abortion access a reality.
Even in countries like the United States, where abortion has been legal for decades and is still legal in every state, conservative politicians are quickly trying to change that by placing extreme limits on when and how people can get abortions. According to Al Jazeera: “In 2019, nine US states passed laws effectively banning abortion in the earliest stages of pregnancy, before many women even know they are pregnant.” While none of these bans are currently in effect because of legislative proceedings or court fights, that can change, and meanwhile, abortion remains out of reach for many.
Any ban on abortion, even when not in effect and no matter how seemingly benign, is a step towards a frightening future without the legal right and access to safe, legal abortion. The Turnaway study, a study that surveyed people who were turned away from getting desired abortions, shows how abortion restrictions often lead to people carrying pregnancies that they wanted to end. Some people are able to leave a state or country to access an abortion, but others, especially young people and people who don’t have money to cover the expenses of an abortion, might effectively be forced into carrying a pregnancy that they don’t want, a profound violation of their bodily autonomy, and one that often adversely effects both physical and mental health. In a global context, legal restrictions, expensive abortion options, and stigma influencing whether medical providers are willing to perform abortions can lead people to choose unsafe abortion methods.
Research finds that the number of safe abortions has decreased, and the number of unsafe abortions has increased in recent years. Between 2010 and 2014, an estimated 25 million abortions were unsafe each year. The vast majority of unsafe abortions take place in developing countries, where maternal death rates are high and access to safe and legal abortion is limited or nonexistent.
People may seek out unsafe abortion methods for many reasons. Since abortion has an ancient history, people have used many different methods for terminating pregnancies, including herbs, inserting tools into the vagina, consuming toxic products, or causing trauma to the pregnant person's body. There is no research to document the safety or effectiveness of these methods. According to the Guttmacher Institute, many people who choose these methods do so because of “greater proximity, lower cost and confidentiality of traditional providers.”
Even in places where abortion is legal, many states and countries have few abortion providers, so if someone wants an abortion and doesn’t live close to a clinic, they may need to travel hundreds of miles or, if they can’t, look for options closer to their home. In 2014, only 10% of counties in the US contained abortion clinics. Yet, the study Abortion incidence and service availability in the United States found that only 39% of women of reproductive age lived in those counties.
In Mozambique, while legal changes to abortion policy in 2014 have given people their more rights to have legal abortions, activists and public health officials have continued to build health infrastructure to make abortion and contraceptive care available on the ground throughout the country. They are also creating education programs to ensure people who choose to access abortions know about safe options. In Mexico, people choosing an abortion can travel to Mexico City to access an elective abortion before 12 weeks of pregnancy: until recently it was the only state in Mexico that permitted abortion upon request without conditions. The state of Oaxaca recently decriminalized abortion, but because of the state’s high rate of rural and marginalized populations, there needs to be an effort from the Health Ministry to make abortion services accessible.
Differences in Access to Reproductive Care
Limits to abortion don’t happen in isolation and don’t have a neutral impact. Just like most other injustices, they impact marginalized people disproportionately.
In the United States, the Hyde Amendment is one of the biggest barriers to poor people and people of color seeking abortion. The Hyde Amendment states that federal funds cannot be used for abortions, unless there is a risk to life or the pregnancy was caused by rape or incest. This means people on Medicaid cannot use their insurance to pay for the cost of an abortion, unless their state proactively decided to allow state Medicaid funds to be used for elective abortions (only 16 states do). Research from the Guttmacher Institute finds that women of color are insured through Medicaid at higher rates than white women, due to social and economic inequality. Women of color also seek abortions more often than white people do, likely due to lack of health care access and insurance, which limits access to birth control, and also due to systemic racism and discrimination. Poor people make up three-quarters of people seeking abortions. The Hyde Amendment purposefully hits these populations hardest.
Restriction on abortion happens through other means as well. Morena Herrera, founder and president of the El Salvador-based Agrupación Ciudadana por la Despenalización del Aborto, states, “The most vulnerable are the most affected by restrictive legislation. Obviously, this includes women who live in poverty, but also younger women, and those who have less information and less power to make decisions about their own reproductive processes.” Without access to information, financial resources and flexibility of schedule, it is much more difficult to have a safe abortion.
While much of the language around abortion access is framed as a women’s issue, and it is an issue that predominantly affects women, we must also be aware of the needs of all people who are able to get pregnant and who need access to abortion. Ibis Reproductive Health studied transgender and gender-expansive people’s experience with reproductive care. They found that “high rates of discrimination, denials of care, and limited provider knowledge often lead to [transgender and gender-expansive] individuals experiencing delays in care and receiving inaccurate health information.” These factors, particularly discrimination and stigma, are found to intensify the existing barriers to accessing abortion. Amber Sollenberger, a sex educator and abortion rights activist, talks about the need to recognize the diversity of genders of people who choose abortions: “providing the most welcoming and affirming environment that you can I think is super important, especially with something that is already so stigmatized.”
People living with disabilities experience a completely different set of issues with regard to their reproductive choices. Nicole Lee, a writer and mother of two living with a spinal cord injury, describes her experience having an abortion after having her first child. The clinic did not provide her with counseling during the abortion process, nor care afterwards. Later on, Lee says that when she decided to have another child, most people outside of her close friends and family questioned her decision. She writes about her experience and explains that she still considers herself lucky to have been able to make her own decisions about her body and family planning. She states, “Pregnancies have been forcibly terminated, babies and children taken away, and women and girls sterilized against their will. In some countries (including my native Australia), forced sterilization of disabled women still happens.” This is a violation of people’s right to decide if and when they want to have a child, the right of children to be with their parent, and the right to make decisions about their own body.
According to the World Health Organization, of the estimated 25 million unsafe abortions that occur every year, 97% of them happen in developing countries. They state, “Complications from “least-safe” abortions can include incomplete abortion (failure to remove all of the pregnancy tissue from the uterus), haemorrhage, vaginal, cervical and uterine injury, and infections.” Most of the deaths due to unsafe abortions happen in Africa, where 29% of the world’s unsafe abortions take place.
Self-Managed Abortion is a Valid Option
As the World Health Organization explains, “Abortions are safe if they are done with a method recommended by WHO that is appropriate to the pregnancy duration and if the person providing or supporting the abortion is trained. Such abortions can be done using tablets (medical abortion) or a simple outpatient procedure. Unsafe abortion occurs when a pregnancy is terminated either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both.”
Because medical abortions — unlike surgical abortion — are safe to use at home and with limited supervision, they are considered safe as long as the person having the medical abortion:
- has access to accurate information, and
- has access to trained assistance if they should need it.
The Guttmacher Institute talks about innovation around self-managed abortion in restricted contexts in Latin America. They say, “Misoprostol use is still highest in Latin America, where the drug has been widely known and available from informal sources for the past two decades; recently, improved access to the Internet in urban areas worldwide has sped up one-to-one interpersonal communication about misoprostol. One strategy that has been commonly used in Latin America to improve the quality of misoprostol use has been telephone hotlines to answer women’s questions, although the extent of their coverage is unknown and may be limited.” With more resources available through telemedicine, networks of informed groups can provide accurate medical information and help individuals access safe care before, during, and after the abortion. This means that people are more able to choose the safest and best abortion option for themselves.
Choosing an Abortion, Despite Barriers
No matter where you are and the legal constraints on abortion in your area, remember that choosing when and if you want to carry a pregnancy to term should be your decision and your right. We all should have the right to make decisions over our own bodies, and there are organizations and activists around the world and in your community fighting to make sure that everyone does.
If you find yourself in need of support, listen to yourself and your own voice, and reach out to a knowledgeable and supportive organization — including Scarleteen, whose direct services can be found here — and a trusted friend or family member who will help support your choice.
For more information, check out these online resources:
- Heather Corinna’s article about abortion, which includes helpful information about support, emotions, reaction, and making decisions that are sometimes difficult.
- Steph Herold's article about which apps are helpful and have accurate information about abortion, and which ones spread misinformation.
- Women on Web/Aid Access are organizations that can provide high quality mifepristone and misoprostol to people who need to have an abortion but don’t have access locally. They use the mail, drones, and even boats through Women on Waves.
- Safe2choose is an informative website providing information about safe abortions and options for medical abortions. They provide an email to contact a counsellor.
- International Women's Health Coalition has a guide for taking Misoprostol at home.
- National Network of Abortion Funds provides information about finding an abortion clinic and funding for an abortion. This site is US specific.
- Plan C is a team of researchers working to investigate and advocate for access to abortion pills through telemedicine. The have a report card that is frequently updated reviewing the products from telemedicine services.
- Ipas: An international organization focused on increasing safe abortion practices and contraceptive use to countries in Africa, Asia, and Latin America.
- World Health Organization: The WHO is dedicated to public health generally, and has comprehensive information about abortion and access to abortions globally.
- Shout Your Abortion and Amber Sollenberger’s zine on reproductive justice are resources for learning more about the reproductive justice framework and our ability to make decisions for ourselves.
- All-Options is an organization dedicated to helping people who are pregnant find the best fit for them and feel supported no matter what their decision.