As abortion rights have come under increasing attack in the United States, commentators have held up self-administered abortion pills as a backup plan for a post-Roe world. They point to the millions of pregnant women worldwide who are using pills to self-manage abortion, citing them as an example of what reproductive health care might look like should in-clinic abortions be made illegal.
There’s no question that abortion pills are revolutionary. In the hands of women, the pills have transformed self-induced abortion from a once-dangerous endeavor into a safe procedure. Abortion help lines have walked women through the process of self-management, sometimes remotely or even over the internet. Where abortion is illegal, black market access to the drugs has resulted in significant decreases in complications and deaths.
Yet, even with these major advances, the idea that “coat-hanger abortions” are a thing of the past is misguided. The International Women’s Health Coalition welcomes do-it-yourself abortion pills as the extremely safe, effective and empowering technology they are. But we worry about the many women who will be left behind unless legal restrictions are removed, funding for abortion services is provided and barriers to access are eliminated.
What kinds of barriers stand in the way of on-demand, self-managed abortion? First, despite their promise, abortion pills — mifepristone and misoprostol in combination, or misoprostol alone — remain difficult to obtain worldwide, even in countries with liberal abortion laws like India and South Africa. They are often prohibitively expensive: In South Africa, a 200-milligram tablet of mifepristone, which begins the process of self-inducing an abortion, costs about $16 — a significant sum for many in the country. In India, a country where the average monthly income among the urban poor is approximately $50, a $5 tablet of mifepristone can be out of reach. In the United States, abortion pills are similarly costly — from $300 up to $1,000.
In places where the laws are restrictive — as they are in countries like Brazil or El Salvador — those barriers mount. In the United States, a patchwork of state-level restrictions perpetuate the falsehood that medication abortion must be taken in a clinical setting to be safe. Nineteen states currently require a clinician to be physically present during a medication abortion, thus prohibiting the use of telemedicine. If Roe v. Wade is overturned and state-level laws further restrict access, medication abortion will most likely become significantly less accessible.
As with surgical abortions, when abortion laws are restrictive, women turn underground. They buy drugs of uncertain provenance, or resort to combining the drugs with herbal teas or other unsafe methods — all common occurrences in Brazil. While obtaining good-quality abortion pills online is possible in America at this time, increased legal restrictions will force many women to turn to less reliable retailers.
Then, even when women can afford to obtain high-quality pills, there is no guarantee that they’ll have access to accurate information about how to use them effectively, causing additional stress and decreasing the likelihood that the abortion will work. In India, the information that accompanies abortion pills is often inaccurate. Abortion pills bought online in the United States typically come without instructions about how to use them, and what to expect as an abortion proceeds. (The International Women’s Health Coalition’s fact sheet on self-managing an abortion is the most popular download on our website — a strong indication of the desire for accurate information from all corners of the globe.)
Most distressingly, in an environment that is hostile to reproductive rights, women can land in jail for provoking their own miscarriage, as has happened to at least 25 women in El Salvador. In the United States, some states — including New York — have laws directly criminalizing self-induced abortion. In Indiana in 2015, when Vice President Mike Pence was governor, Purvi Patel was sentenced to 20 years in prison after her miscarriage was suspected of having been induced with medication. Her conviction was overturned on appeal, but the prosecution was an ominous sign of where aggressive enforcement could lead.
Abortion pills and community self-help networks have saved women’s and girls’ lives and safeguarded their health around the world. They are a critical tool and will be used, no matter the legal regimen governing abortion. But abortion pills will not solve all the problems of a post-Roe world, especially for those who cannot afford or have access to them. For them, the coat hanger may yet make a terrifying comeback.
Françoise Girard is the president of the International Women’s Health Coalition and a longtime advocate and expert on women’s health, human rights, sexuality and H.I.V. and AIDS.
Source: Read Full Article
Home » Analysis & Comment » Opinion | Abortion Pills Are No Post-Roe Panacea
Opinion | Abortion Pills Are No Post-Roe Panacea
As abortion rights have come under increasing attack in the United States, commentators have held up self-administered abortion pills as a backup plan for a post-Roe world. They point to the millions of pregnant women worldwide who are using pills to self-manage abortion, citing them as an example of what reproductive health care might look like should in-clinic abortions be made illegal.
There’s no question that abortion pills are revolutionary. In the hands of women, the pills have transformed self-induced abortion from a once-dangerous endeavor into a safe procedure. Abortion help lines have walked women through the process of self-management, sometimes remotely or even over the internet. Where abortion is illegal, black market access to the drugs has resulted in significant decreases in complications and deaths.
Yet, even with these major advances, the idea that “coat-hanger abortions” are a thing of the past is misguided. The International Women’s Health Coalition welcomes do-it-yourself abortion pills as the extremely safe, effective and empowering technology they are. But we worry about the many women who will be left behind unless legal restrictions are removed, funding for abortion services is provided and barriers to access are eliminated.
What kinds of barriers stand in the way of on-demand, self-managed abortion? First, despite their promise, abortion pills — mifepristone and misoprostol in combination, or misoprostol alone — remain difficult to obtain worldwide, even in countries with liberal abortion laws like India and South Africa. They are often prohibitively expensive: In South Africa, a 200-milligram tablet of mifepristone, which begins the process of self-inducing an abortion, costs about $16 — a significant sum for many in the country. In India, a country where the average monthly income among the urban poor is approximately $50, a $5 tablet of mifepristone can be out of reach. In the United States, abortion pills are similarly costly — from $300 up to $1,000.
In places where the laws are restrictive — as they are in countries like Brazil or El Salvador — those barriers mount. In the United States, a patchwork of state-level restrictions perpetuate the falsehood that medication abortion must be taken in a clinical setting to be safe. Nineteen states currently require a clinician to be physically present during a medication abortion, thus prohibiting the use of telemedicine. If Roe v. Wade is overturned and state-level laws further restrict access, medication abortion will most likely become significantly less accessible.
As with surgical abortions, when abortion laws are restrictive, women turn underground. They buy drugs of uncertain provenance, or resort to combining the drugs with herbal teas or other unsafe methods — all common occurrences in Brazil. While obtaining good-quality abortion pills online is possible in America at this time, increased legal restrictions will force many women to turn to less reliable retailers.
Then, even when women can afford to obtain high-quality pills, there is no guarantee that they’ll have access to accurate information about how to use them effectively, causing additional stress and decreasing the likelihood that the abortion will work. In India, the information that accompanies abortion pills is often inaccurate. Abortion pills bought online in the United States typically come without instructions about how to use them, and what to expect as an abortion proceeds. (The International Women’s Health Coalition’s fact sheet on self-managing an abortion is the most popular download on our website — a strong indication of the desire for accurate information from all corners of the globe.)
Most distressingly, in an environment that is hostile to reproductive rights, women can land in jail for provoking their own miscarriage, as has happened to at least 25 women in El Salvador. In the United States, some states — including New York — have laws directly criminalizing self-induced abortion. In Indiana in 2015, when Vice President Mike Pence was governor, Purvi Patel was sentenced to 20 years in prison after her miscarriage was suspected of having been induced with medication. Her conviction was overturned on appeal, but the prosecution was an ominous sign of where aggressive enforcement could lead.
Abortion pills and community self-help networks have saved women’s and girls’ lives and safeguarded their health around the world. They are a critical tool and will be used, no matter the legal regimen governing abortion. But abortion pills will not solve all the problems of a post-Roe world, especially for those who cannot afford or have access to them. For them, the coat hanger may yet make a terrifying comeback.
Françoise Girard is the president of the International Women’s Health Coalition and a longtime advocate and expert on women’s health, human rights, sexuality and H.I.V. and AIDS.
Source: Read Full Article