50 new york | november 11–24, 2019
is going to turn into a bus stop,” shuttling patients from hostile
states to better ones, says scrap-metal heir Jerry Sternberg, who
wore a cowboy hat and a leather vest when I met him recently
at a donor lunch in Asheville, North Carolina (I was in North
Carolina to speak about my book at a Planned Parenthood
event, for which I was paid). He and another large donor had
helped Planned Parenthood build a new clinic a few years ago,
“but we’ll charter a ship if we have to.”
That’s assuming the bus or the ship has somewhere to go.
There’snoreasonthejusticeswhoopposeabortionhavetostop
at just reversing Roe and allowing some states to ban it. Histo-
rian Mary Ziegler, author of the forthcoming Abortion and the
LawinAmerica:Roev.WadetothePresent,putsit starkly:
“Overturning Roe isn’t the endgame. Banning abortion every-
where is the endgame.”
Which brings us back to those home abortions.Daniel
Grossman, a physician and public-health researcher whose
work the Court relied on in Whole Woman’s Health v.Heller-
stedt, has noticed something different at the medical meetings
and conferences he’s been to lately, even among OB/GYNs in
red states who aren’t abortion providers. They’re talking about
what they can do if abortion is made illegal. “All this has
seemed very theoretical to clinicians up until very recently. For
the first time, people are bringing this up themselves. They’re
asking what they can do in a way I’ve never seen before,” he
tells me. The answer is likely getting out of the way, helping
give information on and facilitate access to medication to end
a pregnancy safely at home.
Until recently, reports of self-managed abortion were largely
anecdotal. Whole Woman’s Health CEO Amy Hagstrom Miller,
an independent abortion provider, said she first heard about
women taking abortion pills at home at her clinic in McAllen,
Texas. It’s just across the border from Mexico, where abortion
is largely illegal and where misoprostol is sold by pharmacists
as an ulcer medication. “There are communities that have
always done their own health care,” she says. “They don’t trust
medicine for a whole bunch of reasons.” Still, says Grossman,
“I wasn’t sure that the searches online ... translated into people
really contacting these services and trying to get the product.”
But when the FDA cracked down on the abortion-pillopera-
tion Aid Access earlier this year, founder Rebecca Gomperts
offered numbers on American demand: 37,000 patients had
contacted the organization in a little over a year; 7,000 packets
of abortion pills were shipped.
“There’s an openness among mainstream medical commu-
nities now to demedicalize abortion,” Grossman says. “A few
years ago, that would have been a crazy idea, and literally
people laughed at me. And now I have a grant that is support-
ing research to build the evidence base to explore whether this
is possible.” Some of the questions: Can patients determine
how far along they are? Can they read a simple label on how
to take the pills properly?
We still have no idea how many people are ordering pills
from other websites—like the one Purvi Patel used in Indiana
in 2013. We know about women like Patel only when things
go wrong. She took pills she had ordered online to end her
pregnancy but started hemorrhaging. (At doctors’ offices, the
pills are recommended only up until ten weeks’ gestation; it
turned out Patel was more than 20 weeks along.) Atthe ER
she went to, an anti-abortion doctor called the police and left
the hospital to go dumpster diving for Patel’s fetus. Patel was
charged with feticide and child neglect. At trial, prosecutors
used her email records to accuse her of having done “what was
easiest and most comfortable for her, even if it was not legal,”
of taking “care of herself while her baby laid dying.” Patel was
sentenced to 30 years in prison; she served two before being
freed on appeal.
Patel’s case represents what everyone agrees is the worst-case
scenario for home abortion even when the procedure itself is
technically legal. “There is common ground,” concedes Wen.
“Ithinkwe’d agreethat womenshouldnotbecriminalizedfor
seeking these methods.” Grossman points out that in Latin
America, physicians have developed a postabortion-care proto-
colthatdoesn’t askwhetherthemiscarriage wasinduced.
But activists also imagine a best-case scenario even in
abortion-friendly states, where, they hope, mifepristone and
misoprostol could be far more accessible, perhaps dispensed
by pharmacists. Grossman explains that some states have
already made it easier to access birth control without a pre-
scription, and he argues that states, not the FDA, would have
the authority to allow abortion pills to be administered at a
pharmacy. In an ideal world, patients could still choose the
quicker clinic-based vacuum aspiration if they wanted to.
“Then maybe abortion after the first trimester would happen
in a smaller number of facilities that are regionally concen-
trated,” Grossman says. What a move toward legal self-man-
aged abortion means for independent clinics like Whole Wom-
an’s Health or for the national network of Planned Parenthoods
remains to be seen. Hagstrom Miller is ambivalent: “I love the
idea of self- managing the abortion, but I don’t want someone
to do it where they feel like they’re hiding or feel ashamed or
scared.” And, she says, because early abortions make up the
majority of procedures, “I wouldn’t be able to stay open only
for post-ten-week abortions. Therein lies the challenge.”
For now, Planned Parenthood is largely steering clear of the
debate. When I ask acting president Alexis McGill Johnson
about self-managed abortion, she stresses that the organization
abides by the law. A spokesperson follows up with a carefully
worded email: “Planned Parenthood is strongly opposed to the
criminalization of self-managed abortion. No one should fear
arrest or prosecution because of a pregnancy outcome. Under
the current rules, medication abortion has to be provided by a
medical professional, and Planned Parenthood follows all laws
and regulations.”
Promoting abortion without doctors could make abortion-
rights activists look like they’re somehow in favor of the back
alley—but it could also scramble traditional right-wing attacks.
An anti-abortion activist in Missouri recently conceded to the
New York Times, “Between the increased use of medication
abortion and of self-managed abortion, should focusing on the
clinic itself really be our primary goal?” Without a building or
a doctor to target, abortion opponents are left to crack down
on the network or on the woman herself.
If, as naral president Ilyse Hogue puts it, “the right’s over-
reach is our superpower,” self-managed abortion might pro-
vide the ultimate overreach—the prosecutorial kind. Repro-
action has started putting anti-abortion politicians on the
spot, asking them about what the punishment should be for
women who abort, and some have been unusually honest.
“They’re really afraid of it,” says Erin Matson, the group’s co-
founder. “You can’t firebomb every single person’s house in
America, wondering what’s in their medicine cabinet.” ■