It's likely you've heard stories about what abortion was like before Roe v. Wade declared it a protected right in 1973. In states where the medical procedure wasn't legal, women would seek out undercover networks to find someone who would secretly perform back-alley procedures, often in unsafe and unsanitary conditions. Many women had complications, got infections, and died. This is a reality many reproductive rights advocates fear will return should the Supreme Court, with Donald Trump's new nomination on it, work to overturn Roe. In truth, however, according to experts, there are more options for self-managed abortion today, if it does happen that the medical procedure does, again, lose its legal protection.
"We’re not in 1960, where we didn’t have access to medication abortion," Yamani Hernandez, the executive director of the National Network of Abortion Funds (NNAF), tells me in an interview for Elite Daily. "There’s this narrative that in this new climate [where Roe could be overturned], people will resort to desperate measures, and we really push back on that narrative because we know that also the technology has changed, the medicine has changed, and we know that people are able to have an abortion with medication."
Unlike in pre-Roe days, in 2018, medication abortion and the internet exist, along with organized groups of advocates ready to fight back against restrictive laws.
In terms of the realistic possibility of Roe being overturned, it would take time to actually demolish the 45-year-old legal precedent, and it's possible a typically "conservative" justice, like Chief Justice John Roberts, might not be keen on giving it their vote (however, it is possible that the court would approve more specific state-level abortion restrictions).
Still, many states and regions have already been working with de facto abortion bans. Lawmakers have been introducing restrictions for years that work to undo access, leaving many women in so-called "abortion deserts," without access to medical care.
This means that abortion rights advocates have already been working to increase access for women who live far away from providers. One of the easiest ways in which to do so is to increase access to medication abortion.
There are currently two medically-approved ways to get an abortion: with an in-office procedure or with pills, commonly referred to as "medication abortion." In 2014, 32.2 percent of abortions done before eight weeks of pregnancy in the U.S. were done via medication, per the CDC. Medication abortion was approved by the Food and Drug Administration (FDA) for use to end first-trimester pregnancies in 2000 (it would've been earlier, had it not been for anti-abortion activists), according to Smithsonian Magazine. The process for a medication abortion consists of taking two types of pills: mifepristone, which stops the production of progesterone (a hormone necessary for pregnancy), and misoprostol, which induces a miscarriage-like abortion. (Abortions can also be induced just by using misoprostol, although the success rate is slightly lower, per the International Women's Health Coalition.) Although anti-abortion lawmakers have introduced bills to the contrary, people typically do not need a doctor present to be able to take two pills — indeed, people take pills for all kinds of medical needs every day without needing a doctor to watch them do it.
"We know that medication abortion is safe and effective," Erin Matson, co-founder of Reproaction, tells me in an interview for Elite Daily. "Not only have these pills been approved for use safely with more than a 15-year track record from the Food and Drug Administration, but we also have reams of data from other countries where abortion is extremely restricted that shows that women are fully capable of using this safe and effective medication on their own."
Reproaction launched a campaign to inform women and activists about self-managed abortion with the medication this year, including building a grassroots base of activists with information about it and informing women on the World Health Organization (WHO) guidelines on self-administered misoprostol.
"What I want to convey here is that self-managed abortion with pills is safe, is effective, and no matter what the law does, Reproaction is committed to making sure that people have accurate information about how to end a pregnancy," Matson says. "Everyone has a right to this information, and we are very proud to share it."
Although taking the abortion pills is, medically speaking, safe, there is a murky legality to doing so without a doctor's prescription. As Reproaction notes on their page about self-managed abortion, at least 20 women have been arrested for ending pregnancies outside of medical settings, under laws specifically criminalizing self-induced abortions, laws against fetal violence, and other criminal laws. In fact, Reproaction notes on the page that if a woman experiences complications (which are rare) that require medical treatment, she "should not tell medical personnel that she has taken misoprostol or she may be at legal risk."
As the site explains, misoprostol cannot be found in a woman's bloodstream, and the effects are like a miscarriage, so there is no way for a health provider to find out a woman has taken it unless she informs them.
"This is important because a woman who ends her pregnancy using abortion pills is at more legal risk than medical risk. A doctor could report her to authorities, and in some unfortunate cases that has happened," Matson tells Elite Daily about that disclaimer on the site. "We have a moral imperative to overturn unjust laws that criminalize self-managed abortion — the criminal code has no place in reproductive health care."
Reproaction is only providing information, not the pills themselves, but other organizations have worked to make the pills accessible. This includes groups such as Women on Web (WoW), a nonprofit that literally provides medication abortion to women in countries with restricted access, like in Ireland before abortion was legalized. (A 2017 report on WoW found that 95 percent of women who used their services in Ireland successfully ended pregnancies while less than 3 percent had complications that required treatment. No deaths were reported.)
When it comes to legal fights in the U.S., advocates have pushed for medication abortion to be accessible via telemedicine, whereby a woman can get a prescription without physically going to a doctor. Laws for that vary by state. Meanwhile, a bill has been going through the California State Legislature that would require public universities to provide the medication abortion pills at student medical centers on campuses, which could be a model for other more Democratic states.
Abortion rights activists, like Hernandez, would like to see "a world where you can go to the pharmacy and — just like Plan B is offered — be able to get your abortion pills at the pharmacy over the counter. We’re not in that world right now, but that’s the world that we’re fighting for."
Hernandez adds that having medication abortion be accessible breaks down many of the barriers NNAF sees in the 150,000 calls for help they get each year (of that, they have the funds for about 30,000 people), like "having to travel long distances, cross immigration check points, [and] set up child care," which means that medication abortion's accessibility is "a crucial part of racial and economic justice."
As the pre-Roe days prove, banning abortion does not mean stopping abortions from happening — it just means pushing people to find alternative ways to get abortions. Thanks to advances in medicine, the internet, and abortion rights activists, women faced with that potential future may not have to resort to back-alley doctors and wire hangers. It's a relative comfort.