3. The At-Home Abortion Revolution
A growing number of people are using pills to end their pregnancies without involving medical providers. Advocates say this practice — called self-managed abortion — is safe, effective, and should be more accessible. But it’s sometimes criminalized.
Guests:
Kelsea McLain, We Testify abortion storyteller
Dr. Daniel Grossman, Director of Advancing New Standards in Reproductive Health
Dr. Jane*, a founder of the Miscarriage and Abortion Hotline
Jill Adams, Executive Director of If/When/How
Music by Lily Sloane, logo by Kate Ryan. Photos courtesy We Testify.
*pseudonym
[Full transcript below photo]
Garnet Henderson [00:00:00] Welcome to ACCESS, a podcast about abortion. I'm your host, Garnet Henderson.
[intro music plays]
Kelsea McLain [00:00:38] You know, you graduate college, there were no prospects, there were no jobs. You were interviewing for endless jobs and getting passed over for people that had, you know, master's degrees or doctorate degrees. And it was a really tough work climate. So I was kind of working in restaurants and I'd just recently been fired from a job working in a restaurant. And it wasn't a very fair firing. Thankfully, unemployment was available, but that was the first time in my life that I'd really had to depend on a fixed income. I had always been able to work for tips and work extra hard if I needed to make extra money for a bill. So I was in a really difficult spot. I had rent that was a lot larger than what my unemployment could cover. I had a health insurance policy that I was stubbornly keeping up with because I kind of felt bad trying to go after other forms of public assistance. There was that shame and stigma around receiving help. So I had the unemployment. I thought that was enough.
Garnet Henderson [00:01:30] That's Kelsea McLain. Like a lot of people who came of age during the Great Recession, Kelsea really struggled financially after graduating from college. And when she discovered she was pregnant, she couldn't afford an abortion.
Kelsea McLain [00:01:42] I came back from a trip visiting my then boyfriend, now husband. We were long distance at the time. And I was drowsy all the time, I just didn't feel good. I was like, really emotional. And I started figuring out like, oh, my period's late, too. So I took the test. I didn't tell anyone I was taking a test and it turned positive instantly, and I knew pretty much instantly that I did not want to continue that pregnancy. I had always been someone who was very pro-choice. I'd certainly had conversations with myself about how I wanted to start and grow my family. And it wasn't going to be until I was in a committed, stable relationship where I could make all my ends meet, and it could just be easy, because parenting is really hard. So I want to make it as easy as possible. And I was certainly not in any of those circumstances at the time. And I was at a stage in my life where I was really actually considering if I wanted to have children at all. I felt at first like it was just like this secret I needed to keep, that I was going to have an abortion, no one was going to know I was ever pregnant. It wasn't gonna be a big deal. I think a lot of the shame and stigma I felt was kind of tapped into the fact that in college I was a sexual health educator. And I know so much about how to prevent pregnancy. I know more than the average person about how to prevent pregnancy. And I was like, you know, I'd always had this, like, really screwed up idea that while abortion is necessary and important and should be accessible, it was like, you know, used by women that we're being too smart or, you know, weren't educated. And there I was. So I felt guilt. I felt shame. And so I called the clinic and the clinic was like, oh, we're sorry. That's five hundred dollars. So give us money, please. And I was like, well, I literally just paid, you know, $250 on my health insurance premium. I called my health insurance, they wouldn't do anything. So I just Googled, like, what can I take to cause an abortion? And I found some Web sites that listed a bunch of different herbal remedies. I tried and herbal abortion for about a week, and really spent the last of my money at Whole Foods on expensive herbs. And ultimately nothing happened.
Garnet Henderson [00:03:59] Herbal abortions have been around for centuries. But while some of these methods may work, ingesting enough of a particular herb or vitamin to actually cause an abortion could be toxic. Fortunately, Kelsea was OK, but she was still pregnant. Ultimately, she was able to connect with an abortion fund which helped cover some of the costs of the medication abortion she chose to have.
Kelsea McLain [00:04:24] I really wanted to do the pill abortion. I didn't like the idea of a surgical procedure. Even though I knew it wasn't like a surgery, it still felt invasive. It felt uncomfortable. I didn't want to be in stirrups. So I, I looped my mom and my boyfriend in, and they were both so supportive and my mom was just like sad that I didn't tell her right away. Like, that was the biggest, like, the bad feeling was just like, why didn't you come to me sooner? I want to help you through this. And same with my partner. You know, he just felt bad that I didn't trust him. And like, I think it took a while for us all to understand that it wasn't about them. It was about me.
Garnet Henderson [00:04:59] About six years later, Kelsea's birth control failed and she got pregnant again. This time, the circumstances were very different. After having an abortion. Kelsea dedicated her professional career and volunteer work to destigmatizing abortion. She's now an abortion storyteller with an organization called We Testify, and she's worked as an abortion funder, a clinic escort, and at the time of her second pregnancy, she was actually working in a clinic. So she had another medication abortion. And it was pretty straightforward. But a few years later, her birth control failed again. And this time she just wanted to take care of things on her own.
Kelsea McLain [00:05:40] I know every abortion doctor in the state. I do reproductive rights work full time. I know all the clinic owners. I know a lot of the staff at these clinics. I just really wanted to have an abortion and not have everyone in my business. And it felt impossible to do. Even though I'd fought really hard against multiple abortion stigma after having that second abortion experience, needing a third abortion was really affecting me. Like, I just felt bad. I knew that this issue is like a hurdle I was gonna have to get over with myself. And, you know, I knew that if I ever wanted to talk about feeling bad about that, like, you know, anti-abortion folks capitalize and be like, see, she feels guilt, she feels shame. And like, I'm really aware that I feel guilt and shame because I know how other people are going to view my decisions and my experiences, not because I actually feel bad. Like, you know, I could have 10 abortions and feel the same. But I do care how other people view me. I had a lot of stress, anxiety and just crying and sadness through this whole thing. And I think part of it, too, was I was really coming to terms with the fact that I really wanted to be a childfree person and that felt like such a hard, even though I knew it's what I wanted, it's just like it's a thing. It's a big thing to admit you're not going to have children in this world. And so I was like, you know, maybe you just keep this secret for now because you have that right. You've been so open and public about your two abortions. Maybe you just deserve to have a little bit of privacy. And so I decided to self manage without involving a physician at all.
Garnet Henderson [00:07:15] Having multiple abortions is common. Nearly half of all pregnancies in the United States are unintended, and in 2014, the Guttmacher Institute found that 45 percent of people seeking abortions said they'd had at least one abortion before. But there's so much stigma around abortion in our culture, especially when it comes to having multiple abortions. Even Kelsea, someone who has dedicated much of her life to destigmatizing abortion, was affected by this. But that wasn't the only thing driving her decision. Kelsea was familiar with medication abortion. She wanted to be able to do it for herself.
Kelsea McLain [00:07:55] I'd been wanting to have miso on hand for a while because I'm nervous about abortion rights. And I knew I would want to take care of a friend or a loved one if they needed someone to take care of them. And I'd want to be able to take care of myself if I needed to care for myself. So it was my way of getting my hands on miso. And also, basically, just seeing, like, what self managing is all about, because I've been through this medication abortion process. I know what it's like. So I want to know more about that.
Garnet Henderson [00:08:20] So Kelsea tried an abortion using misoprostol. Just a note here that everything we talk about today is going to make more sense if you've listened to our previous two episodes, which included a lot of information about medication abortion. So if you've listened to those episodes, you'll remember that the FDA-approved protocol for medication abortion involves two pills, mifepristone, or mife, and misoprostol, or miso. Together, these pills are 95 to 98 percent effective in ending a pregnancy, with serious complications occurring less than one third of one percent of the time. Miso, that second pill, is about 85 percent effective in ending a pregnancy on its own. So it's less effective by itself, but it's easier to get than mife. And why is that? Well, as we discussed last time, mife is heavily regulated by the FDA. Miso, on the other hand, has been around for longer and was originally approved for uses other than abortion. So it's not subject to those same regulations. It was actually developed to prevent stomach ulcers, but it had this side effect of causing uterine contractions. It didn't take long after the drug entered widespread use in the late 80s for people to start seeking it out for this off label purpose, especially in countries where abortion was illegal. Since then, many studies have validated that miso is safe and effective for abortion. And it has lots of other uses in obstetrics, like labor induction, miscarriage management and treatment for postpartum bleeding. So at this point, there's a decades long history of people using miso to end pregnancies on their own. This is usually referred to as self-managed abortion, when someone decides to end a pregnancy without involving a medical provider. Kelsea's was one of those minority of cases where the miso didn't work. Ultimately, she went to a clinic and had another medication abortion with the combined mife-miso protocol. But she doesn't regret trying on her own.
Kelsea McLain [00:10:35] I look back on it now and I'm really glad I did it, and I'm really thankful that I could at least have the option to maybe try to self manage. The only thing you know, now I really want to advocate or is the right for more of us to self-manage and self-manage with the right combination of drugs. And not have to rely on lying and deceiving to get the drugs that we need and possibly facing incarceration or criminalization for just wanting to manage our own health.
Garnet Henderson [00:11:02] Abortion is legal in the United States. But in many parts of this country, especially right now, it is so difficult to get an abortion that many people don't have the access they need to exercise that right. As abortion restrictions have tightened in the U.S., interest in self-managed abortion has grown. The pandemic has only accelerated this demand. When we talk about abortion being inaccessible, one thing that often comes up is this image of the coathanger. It evokes the very real history of unsafe abortions in our country before Roe vs. Wade, the Supreme Court decision that legalized abortion. And some people do still turn to methods of ending a pregnancy that could be unsafe or ineffective. But one very important thing has changed since the pre-Roe days, and that's the advent of medication abortion. Nowadays, most people who choose to self-manage are using these pills that we know to be safe and effective. Most of them are probably successful. In fact, when people self-manage their abortions, the biggest risk they're taking often isn't a physical one. It's a legal one. At least 21 people have been prosecuted in the United States on charges of ending their own pregnancies. Experts say the true number could be much higher, because these cases don't always end up in the news. One reason you're hearing from Kelsea, someone whose self-managed abortions were not successful, is because she's less likely to face legal consequences for sharing her story. We're going to come back to these legal risks later. But first, let's learn more about self managed abortion.
Daniel Grossman [00:12:46] The whole process of even a facility-administered medication abortion is really self managed by patients at home. The patient gets evaluated the facility, but then takes medication at home and has to recognize on their own when to take the medication, what's a sign of a complication, seek appropriate care when needed, and confirm completion at the end. So the terminology around self-managed is a little confusing because even a facility-based medication abortion is really largely self managed.
Garnet Henderson [00:13:18] That's Dr. Daniel Grossman. He's an OBGYN and the director of Advancing New Standards in Reproductive Health, a leading sexual and reproductive health research group at the University of California, San Francisco. So this process of self-managed abortion using pills really isn't that different from the process when you get the pills from a doctor. And thanks to the Internet, it's easier than ever before to learn how to have a safe abortion using pills. For one thing, the World Health Organization has studied medication abortion extensively, and all that information is online, including specific recommended protocols. There are also a number of organizations, including Women Help Women, Women on Web, Plan C, and Reproaction, just to name a few, that provide information about how to use abortion pills online. So just how common is self-managed abortion?
Daniel Grossman [00:14:15] In Texas, we did several studies looking at self-managed abortion. Most of the research that has been done up until now has really been focused on patients who are presenting for care at abortion clinics, and looking at how commonly they report, attempting to take something or do something on their own to self-manage or self-induce an abortion. There is a national survey of abortion patients that the Guttmacher Institute does every few years. And in the 2014 survey, about 2.2% said that they had ever used something to try to self-induce an abortion. 2.2% Of abortion patients nationwide. About 1.3% say they used misoprostol. And 0.9% percent say that they used something else like vitamin C or herbs. In a previous version of that survey from 2008, it was around 2% said that they had taken something in the current pregnancy. And also in that version of the survey, they looked at predictors that were associated or factors that were associated with ever having attempted to self-manage abortion. And they found that foreign-born women were more likely to say that they had ever attempted to do this on their own. Although I should say that that survey includes people who might have used something while they were living in another country. So in our work in Texas, we have done a couple rounds of a statewide survey of abortion patients, and we've found that about 7% of abortion patients report taking or doing something in their current pregnancy to try to end it before they came into the clinic. So that's quite a bit higher than what we see nationally. Why that might be the case. There might be several reasons why this is more common in Texas compared to other parts of the country. It may be that, you know, there were restrictions on access, it's harder to access clinic-based care. You know, Texas is also adjacent to Mexico and throughout Latin America. Latin America was really the place where we first heard about women using misoprostol on their own to essentially get around that very restrictive legal environment there. And so it may be that that practice was sort of kind of diffusing across the border from Mexico. And certainly there's a lot of Latin American immigrants in Texas and maybe that's the reason why. Misoprostol is often available in pharmacies in Mexico without a prescription. And we've also heard from people that they have friends or relatives in Mexico send the medications to them. Sometimes these medications are available in flea markets or kind of informal stores in Texas.
Garnet Henderson [00:16:51] In fact, in the Rio Grande Valley, right along the border with Mexico, Dr. Grossman said it was more common that people reported using miso, taking it early in pregnancy, and having uncomplicated, complete abortions. It's actually difficult to know how many people are self-managing with pills for this reason. Most people who use these medications that we know to be effective are probably successful. They don't need follow up medical care. So we don't know about them.
Daniel Grossman [00:17:20] So it does look like it's more common in Texas compared to other parts of the country. We have not clearly shown quantitatively that self-managed abortion has become more prevalent in Texas since these restrictive policies went into effect that closed about half of the clinics in the state. We did hear in-depth interviews that we did with people who had recently attempted to self-manage their abortion around the time the clinic closures, who talked about the reasons why they did this. And certainly we heard from people who said, you know, the nearest clinic closed, and when they found out they were going to have to travel an extra 100 miles to get to the next nearest clinic, it just seemed like it would be so much easier to try to take these medications that they heard worked. We also did a study in Texas, which was the first study to look at the prevalence of self-managed abortion among the general population of Texas, women aged 18 to 49. And we found overall about 1.7% reported that they had ever attempted to self-manage an abortion at some point in their lifetime. Which is a small proportion overall, but when you multiply that times the large population of Texas works out to about 100,000 women.
Garnet Henderson [00:18:32] In addition to providing people with information about how to use mife and miso, the Internet has also made it easier to actually get pills. In the U.S., the most reputable online source of medication for the combined mife-miso regimen is called Aid Access. It was founded by a Dutch doctor named Rebecca Gomperts, who first entered the public eye in the late 90s when she founded Women on Waves. She literally set sail to provide abortions in international waters to people living in countries where abortion was illegal. Dr. Gomperts later founded Women on Web, which is essentially a telemedicine abortion service. Women on Web didn't ship pills to the U.S., because abortion is legal here. It seemed like we shouldn't need it. But Women on Web started to receive a lot of requests from the United States. Researchers from the University of Texas found that over one 10 month period, women on Web received over 6,000 requests for pills from U.S. residents. 76% of those came from states that are considered hostile to abortion access. So in 2018, Gomperts founded Aid Access to serve oeople in the U.S. Aid Access essentially uses that no-test telemedicine protocol we talked about in our last episode. The person seeking the abortion has a telemedicine consultation with a doctor who confirms that medication abortion will be an appropriate option. If so, they write the prescription and the pills are then shipped from a pharmacy in India. In its first year alone, Aid Access received about 21,000 requests for pills. Again, a majority of these requests came from states with restrictive abortion laws. So barriers to clinic based abortion care do seem to drive interest in self-managed abortion. But Dr. Grossman says it's important to remember that there are plenty of other reasons, too.
Daniel Grossman [00:20:29] It's not just because of barriers to care. Certainly, that's an important reason that we hear from a lot of patients in the in-depth interviews that we've done, particularly the financial barriers, an abortion in a clinic will cost too much or it'll cost too much to travel to a more distant clinic or arrange child care, get time off work, things like that. But people also talk about a preference for self-medication. Some people say that they see this as more like a process of menstrual regulation that's just bringing back a missed period and kind of less of an abortion when they do it on their own. Some people talk to us about how they use alternative medicine and vitamins and supplements for all their health care and just see this as a natural extension when it comes to abortion.
Garnet Henderson [00:21:18] Dr. Grossman points to some studies done in other countries which show that when people have relatively easy access to these drugs in pharmacies, they're able to take them as directed, and they have a high rate of success and a low rate of complications. And so far, there's no evidence that people here in the U.S. are experiencing dangerous outcomes from self-managed abortion using pills.
Daniel Grossman [00:21:41] In our work in Texas, for example, where we know people are doing this, we're not hearing about many cases of patients who are presenting with complications, for example, in emergency departments. So I think, you know, patients have information about how to use the regimens correctly. If they have access to high quality drugs, they know how far along they are in their pregnancy. As a physician, I don't have many safety concerns about self-managed abortion. I have many more concerns about the legal risks that patients may be taking when they use things on their own to self-manage an abortion in this country.
Garnet Henderson [00:22:14] But ideally, people would have medical support through this process if they want it. And some abortion providers are working to make that a reality.
Dr. Jane [00:22:23] We had heard that Aid Access was getting very busy and was overloaded with people after they were getting their pills with questions. And we thought that that need should be met by doctors in our own country, where we believe that access should be broadened. So a few of us got together and decided to to make a hotline. And we now have 20 clinicians who take call and we're open from 10 a.m. to 10 p.m. in all time zones with somebody who gets back to people within 30 minutes.
Garnet Henderson [00:23:03] This is an expert I'm going to call Dr. Jane. That isn't her real name. She chose to speak with me anonymously.
Dr. Jane [00:23:10] I'm a family physician who provides primary care as well as full spectrum reproductive health care in my office. And I am active in advocacy efforts to make primary care be a place where people can access abortions, because I think it's a low-tech option that shouldn't be overly medicalized and should be part of the regular health care that people get.
Garnet Henderson [00:23:36] Dr. Jane is one of the people behind the Miscarriage and Abortion hotline.
Dr. Jane [00:23:41] It is called the Miscarriage and Abortion Hotline, because I think people see this on a continuum. We will get calls from people who say I'm, I took pills to have a miscarriage. So it turned out to be especially good that we opened up the definition because it's more commonly thought of that way. And we get calls from people who are just having a miscarriage and they don't know where to turn. And so we answer their medical questions. And a miscarriage is a natural process. And most of what we do on our hotline is reassure people that what they're experiencing is OK.
Garnet Henderson [00:24:23] Between mid-March and mid-April, that time period when several states attempted to ban abortion temporarily, Aid Access saw a 27% increase in requests for pills. And Dr. Jane said the Miscarriage and Abortion hotline saw a big increase in calls starting around that time.
Dr. Jane [00:24:41] Yeah. Huge increase, like, I would say maybe five times as many calls early in the pandemic.
Garnet Henderson [00:24:50] Despite that increase in demand, Aid Access actually had to shut down for a while. Remember how I said that the medications usually ship from India? Well, passenger flights were grounded for months there, which caused major delays even in cargo shipping. While cargo flights have resumed, Aid Access is still warning people that pills could take up to three weeks to arrive. And Aid Access isn't the only one. Pretty much all the online sources of abortion pills rely on Indian pharmacies. So these delays mean that more people will, like Kelsea, be using miso only. This is still safe. But it does mean that nearly one in five people will be unsuccessful.
Dr. Jane [00:25:35] The main worry is did it work? Especially since people are using misoprostol alone. Their worry is, I I've taken this many pills, I had this amount of bleeding. How do I know it worked?
Garnet Henderson [00:25:47] So, what happens when a medication abortion doesn't work? Well, it really depends on the situation. In some cases, another dose of miso may be appropriate. But in others, an aspiration procedure might be necessary. People whose self-managed abortions are unsuccessful need follow up medical care, but seeking that care could be what exposes them to legal risk. To learn more about that, I spoke with Jill Adams, the executive director of If/When/How, a reproductive justice legal organization working across several areas of law and policy, one of which is self-managed abortion.
Jill Adams [00:26:28] Despite there being a constitutional right to abortion, people throughout the country have been arrested and tried for ending their own pregnancies. Moms and friends, for example, have also been arrested for helping their loved ones self-manage abortion. And while there are only five states with laws that explicitly ban self-managed abortion, the absence of such a law has not stopped prosecutions in other states. So elsewhere, prosecutors have misapplied state laws that were never intended to be used against someone for ending their own pregnancy or for supporting someone ending their own pregnancy. And some of the examples of the misapplied laws include drug possession, fetal harm, child abuse, concealment of a birth. And as these prosecutions demonstrate, it's really just the whole kitchen sink. When an overzealous prosecutor is hell-bent on punishing someone they believe has self-managed an abortion, they will often do so not because of what the law in their state says, but in spite of it. You know, courts reviewing these prosecutions have generally sided with the people who've ended their own pregnancies. But by then, defendants' entire lives might have been turned upside down. After their, their mug shots and photos of their homes and their private health information has been strewn throughout the media. You know, some people find themselves unable to find work. Ostracized and unsafe in their own communities. And it isn't just the people who self manage. We're worried about. We are also concerned about those who support them, assist them and advocate on their behalves. So the communities and the clients we serve at If/When/How occupy four concentric circles. Centermost are the people who end their own pregnancies. But we know that most people don't do this in total isolation. They do it with the support of their partners, their friends, their aunties, their loved ones in their ambit. And then, you know, in the next concentric circle out beyond them is a ring of helpers. They may be cultural healers, community based abortion providers or values-driven distributors who make sure that people have what they need to self-manage. And then in that outermost circle, another growing population of clients are activists willing to take chances and willing to use their own privilege to buffer others who cannot be as visible and taking a stand to destigmatize and decriminalize self managed abortion.
Garnet Henderson [00:29:13] Medication abortion essentially causes a miscarriage. Medically, it's virtually impossible to distinguish between someone who had a spontaneous miscarriage and someone who took pills to trigger one. But that hasn't stopped some medical workers from reporting people to the police. Probably the best known case of this, one you may have heard of, is that of a woman named Purvi Patel.
Jill Adams [00:29:39] So Purvi Patel is a woman who is living in Indiana and ended a pregnancy at home with with pills she'd ordered from an online pharmacy. And she was experiencing heavy bleeding and drove herself to the hospital. And the nearest hospital had a Catholic affiliation. And the OBGYN treating her was part of a national anti-abortion group of OBGYNS. And he was very suspicious based on what he deemed her lack of remorse. There was some sort of standard he held for a person who had experienced a miscarriage. They had to be sufficiently remorseful or else give rise to his suspicions. And Ms. Patel had said she'd had a miscarriage, but he was he was suspicious and alerted law enforcement. At one point he even left the hospital while she was under his care so that he could go to the site where she said she'd disposed of the products of conception. And he beckoned the police officers to her bedside, where they conducted an interrogation at like 2:00 or 3:00 in the morning with no lawyer present from Ms. Patel while she was recovering from surgery. And she went to trial and it was barbaric. And the state of Indiana, while Mike Pence was governor, convicted her of two charges, of negligent of a dependent and of feticide, and sentenced her to forty six years in prison to be served concurrently in 20 years. And through a lot of advocacy, thankfully, the Indiana Court of Appeals vacated the feticide conviction and knocked down the neglect conviction and she was released. The court said, wait a second, these laws were not meant to apply in these circumstances. This feticide law is meant to protect a pregnant person by harm from a from a would-be abuser or a third party. And under this law, just as under the fetal harm laws and the other 36 states that have them, the pregnant person is the victim of that would-be crime, not the perpetrator. But by the time she was freed, miss Patel had been locked up for three years. Three years behind bars for taking the same pills that she would have received from a licensed medical provider if she had the resources and had been a clinical abortion patient.
Garnet Henderson [00:32:08] And if you're thinking, wait a second, this sounds wrong. Aren't doctors supposed to keep my information confidential? You're right about that.
Jill Adams [00:32:18] It is shocking and upsetting that in so many of the known cases of people being criminalized for self-managed abortion, it's been the medical providers to whom people have reached out for help that have turned them over to the law enforcement. Now, in Ms. Patel's case, that doctor was politically motivated. But in so many of the other cases, whether it's a social worker, a doctor, or anybody else who's a mandatory reporter, they mistakenly believe they have a duty to report, when in fact, not a single state has a law that mandates reporting to law enforcement of a suspected self-managed abortion, even a confirmed self-managed abortion, including when the patient is a minor. And so people are really confused about their duties. And we are trying to reach members of these communities, first responders, social workers, emergency room staff and licensed medical professionals to make clear to them that not only are they not obligated to contact the police, but when they do, they are almost certainly violating their patients privacy rights. And there could be repercussions for that. It's another very unfortunate side effect of this phenomenon of criminalizing people for self-managing their abortions, because it's a public health problem. It's going to have a chilling effect on people seeking medical care when they need it, if they're scared to walk into a hospital for fear that they are going to end up walking out in handcuffs.
Garnet Henderson [00:34:02] And the same marginalized groups who face greater barriers to abortion access in the first place are also more likely to be criminalized for self-managing abortion.
Jill Adams [00:34:12] Who are the people who are the most likely to be suspected, investigated, accused, charged, tried and convicted for self managed abortion? The threat of criminalization looms most heavily over immigrants, Black, indigenous and people of color, young people, trans, gender nonconforming and non binary folks, and people in rural areas, to name a few. And that's for several reasons. First of all, many members of those groups face some of the highest barriers to clinic-based abortion care, which might give rise to the need to self-manage an abortion. Number two, because of the inequities, the structural inequities in our health care system that give rise to disparities in health outcomes, many members of these groups are more prone to have a negative pregnancy outcome, like a miscarriage and pregnancy loss. Even when it's not intended, can give rise to suspicion. Members of these groups are forced into many more interactions with various government agents, so cops, ICE officials, county welfare officers, social workers, school officials and on and on. All of which could again expose them to risk. And then finally, it's been well-documented that Black, indigenous, people of color and Medicaid enrollees are more likely to be criminalized in relationship to their pregnancy.
Garnet Henderson [00:35:49] If/When/How operates a helpline called the Repro Legal Helpline, where people can get information about their legal rights regarding self managed abortion and, if needed, get connected with a lawyer. According to Jill, calls nearly doubled in the first few weeks of the pandemic.
Jill Adams [00:36:07] The need for people to access abortion, including self-managed abortion, is is increasing during the pandemic. Pregnancies are increasing because people are losing their jobs, their money, their employer-based health insurance. And all of that is interfering with contraceptive access. Also, we know that intimate partner violence, including reproductive coercion, is on the rise, and that's trapping people in abusive relationships who will need access to discrete abortion care. And at the same time, clinic-based abortion has become more limited, whether through state prohibitions on provision or through reduced clinic workforces. And there are new barriers and risks present because people are having a more difficult time procuring abortion pills through the reliable NGOs and the online pharmacies they're accustomed to using due to these major disruptions in shipping by air or sea. It's lamentable. It's deplorable, really, that in the midst of this health crisis, Black, indigenous, people of color who have unintended pregnancies are facing basically a triple threat of lacking access to trustworthy health care, needing to maintain social distance, to stay safe from exposure, and being at greater risk of criminalization for self-directing their health care.
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Kelsea McLain [00:38:02] I think that's really the thing that folks need to understand is that, like, it's not just about giving folks more options, it's literally about giving folks sometimes the only option they'll have to be able to access an abortion. I really do think that it's time to kind of liberate access to these medications.
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Garnet Henderson [00:38:40] Just a reminder that for a future episode, I'm seeking stories about abortion during the pandemic. Whether you had an abortion or you work in abortion access in some capacity, I want to hear from you. You can email or send a voice memo to accesspodcast@protonmail.com. That's also in the show notes. You can remain anonymous, and if you're worried about security, you can make a protonmail account, which is free, and your message will be fully encrypted end to end.
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Garnet Henderson [00:39:26] ACCESS is produced by me, Garnet Henderson. Our music is by Lily Sloane and our logo is by Kate Ryan. Many thanks to today's guests and special thanks to Renee Bracey Sherman and We Testify. You can subscribe to ACCESS whereever you get your podcasts and follow us on Instagram and Twitter @accesspod. A full transcript of this episode is available on our website, apodcastaboutabortion.com. Thank you so much for listening to these first three episodes. I have so many more stories I want to bring you and you can help make that possible. Visit glow.fm/apodcastaboutabortion to make a donation in support of the show. That's linked in the show notes as well. You can also leave a rating or review, that stuff really does help. And best of all, you can share the show with your friends. ACCESS will be back with more episodes in a few weeks. See you then.
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