Sunday, September 23, 2018
Health

As clinic access tightens, group touts pregnancy-ending drug

NEW YORK — The tightening of restrictions on abortion clinics in many states has emboldened some abortion rights advocates to launch an outreach effort, reminding women they have relatively safe and effective means of ending a pregnancy on their own through use of a miscarriage-inducing drug.

Anti-abortion groups are wary of the phenomenon, disavowing any drive to prosecute women who self-abort but favoring crackdowns on illegal distribution of the drug. Even in the abortion rights community, the outreach effort has raised some concerns.

Dr. Hal Lawrence, president of the American College of Obstetricians and Gynecologists, says it's always preferable for a woman undergoing abortion to be under direct supervision of a medical professional.

Advocates of the new approach say they would agree, under ideal conditions, but they worry that many women — out of fear, poverty or lack of a nearby clinic — are not getting access to professional services and need accurate information if they're considering self-induced abortion. Notably, they want to highlight the option of using the drug misoprostol as a generally safe method for inducing a miscarriage within the first 12 weeks of pregnancy.

"There will always be people who need to do this for themselves, and they deserve to have the resources and information so they can do so safely and effectively, free from the threat of arrest," said Jill Adams, executive director of the Center on Reproductive Rights and Justice at the University of California-Berkeley law school.

She is chief strategist for the Self-Induced Abortion Legal Team, formed this year by women from several legal organizations after consultations with reproductive-rights experts and activists.

The team's goals — outlined in a recent online document — include halting prosecutions of women for self-induced abortions and expanding access to reliable information on how abortion medication can be obtained and used safely outside the formal health care system. Adams said a short-term goal is finding ways to increase access without breaking any laws.

"We're not here to incite unlawful activity, nor to reprimand anyone if they do step outside the law," she said. "We're here to equip our friends and allies with the information they've been asking for."

In the United States, misoprostol is legally available only through authorized medical professionals; it is commonly used in combination with another drug, mifepristone, as part of a nonsurgical abortion procedure with a strong safety record. In many Latin American and Caribbean countries, misoprostol is widely available, even over the counter in pharmacies in some countries, and has been used extensively for self-induced abortions in countries such as Brazil that have restrictive abortion laws.

Used alone, misoprostol is considered to be effective 75 to 90 percent of the time, according to the World Health Organization. That's lower than the rate of more than 95 percent for the two-drug combination, but reliable enough that the WHO has circulated guidelines for how to use it alone.

There's no precise data on the extent of self-induced abortions in the United States; they are rarely reported to any authority or statistician. An informal barometer was provided by economist Seth Stephens-Davidowitz, who calculated in a recent New York Times article that there were 700,000 Google searches for information about self-induced abortion in the United States in 2015. Eight of the 10 states with the highest search rates were among those with multiple restrictions on abortion, he said.

John Seago, legislative director of Texas Right To Life, says he would support efforts by law enforcement to crack down on any illegal trafficking of abortion-inducing drugs, but he opposes prosecutions of the women who terminate their own pregnancies.

"By putting that type of law in place, we'd be dissuading her from seeking medical help afterward," Seago said.

That outlook is shared by most national anti-abortion leaders.

"It's a subject that we in the pro-life movement are struggling to get our heads around," said Eric Scheidler of the Pro-Life Action League. "I'd put the focus on going after the providers of the drug. We don't want to go after the woman."  

Although there are laws in numerous states that could be used to prosecute women who self-induce abortions, prosecutions are rare. Adams' legal team has identified 17 such cases in recent years that led to arrests or convictions.

Dr. Anne Davis, a professor of obstetrics and gynecology at Columbia University Medical Center, sees the potential for misoprostol but worries that women acting on their own might be sold counterfeit versions or might fail to obtain proper instructions on how to use the drug.

However, Davis expressed empathy with pregnant women in some locations who face confrontations with anti-abortion activists.

"The experience of going to a clinic in a hostile state has become so incredibly unpleasant for women," she said. "If there's a way we can do this that doesn't involve having to face that, of course we're going to try."

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