Abortion in a Post-Roe World? “People Are Resilient and Resourceful”

Thanks to new medications and innovative organizations committed to reproductive health and bodily self-determination, a reversal of Roe v. Wade would not send us back to the pre-Roe world of coat hangers and hospital wards full of deathly ill women.

A pro-abortion rally in Philadelphia in 2019. (Joe Piette / Flickr)

The day after the Supreme Court announced they would hear the Mississippi abortion ban case, internet searches related to self-managed abortion surged across the United States—especially in states hostile to abortion rights. Online searches for terms related to abortion pills such as “misoprostol” and “medical abortion” exploded by more than 5,000 percent in the 24 hours after the court’s announcement.

“We see a definite spike in visitors to our website when there is news about abortion bans,” said Elisa Wells, co-founder and co-director of Plan C Pills, which provides up-to-date information on how to access abortion pills online. “People are looking for ways to access abortion pills. The need for abortion is never going to go away. When you cut off mainstream supply of it through clinical means, people will look for other ways to access the service.”

Some fear if Roe is overturned, the U.S. could return to a pre-Roe world when women regularly died from illegal abortions, or suffered infections or infertility. Online reaction to the SCOTUS announcement, however, is evidence a post-Roe world would be quite different because we now have extremely safe and highly effective abortion pills that are easy to obtain and use.

Abortion pills—mifopristone and misoprostol—end a pregnancy by inducing a miscarriage. Mifepristone interrupts the flow of the hormone progesterone that sustains pregnancies, and misoprostol causes contractions to expel the contents of the uterus. Used in combination, they are 95 percent effective in the first 10 weeks of pregnancy. Misoprostol alone is 80–85 percent effective.

Many people in the U.S. are turning to the internet to find alternatives to clinic-based abortion health care. Some are ordering abortion pills online and self-managing their abortions, which means ending a pregnancy without medical assistance. Others are turning to clinic-supported services, such as Aid Access—a Netherlands-based organization with doctors who screen patients online asynchronously and provide abortion pill prescriptions to eligible people.

Recently-published research reveals that Aid Access received 57,506 requests from people in the U.S. seeking abortion pills between 2018 and 2020, before the pandemic began. Online demand for abortion pills surged when the pandemic hit in early 2020, especially in states that closed abortion clinics such as Texas, where requests for abortion pills made to Aid Access increased by 94 percent.

Ongoing and increasing legal barriers to abortion have fueled the rise in self-managed abortion, despite Roe still being the law of the land. Because of anti-abortion pressure, the FDA tightly restricts access to mifepristone. Pharmacies can’t distribute the drug; only certified physicians can. While the FDA recently allowed qualified providers to mail the abortion pill to patients, 19 states prohibit medication abortion via telemedicine and mailing pills. Meanwhile, burdensome regulations have shut many clinics, especially in the South and Midwest.

“Right now Roe v. Wade is still standing, but we have over 57,000 people trying to access abortion via Aid Access alone,” said lead author of the Aid Access study, Dr. Abigail Aiken of University of Texas at Austin. “So we can see that even though we still have the right to abortion in this country, so many people struggle to actually exercise that right and access abortion.”

As a result, more and more people are purchasing abortion pills online and self-managing their abortions at home.

Organizing to Support One Another

Despite ongoing barriers, there has never been a better time for people seeking online information and resources for self-managed abortion. As legal restrictions on abortion are increasing, reproductive health advocates are stepping up and creating organizations and websites to guide and support people seeking to self-manage abortion. These organizations provide information on reliable websites for purchasing abortion pills and learning how to use them, and where to find medical, emotional, and legal support for self-managing abortion.

The organization Plan C has a state-by-state guide on how to find medication abortion health care, including a list of reliable websites selling abortion pills and information about cost and shipping time for each website. For as little as $105, people can order abortion medication sent directly to their homes.

(Plan C)

Once someone obtains abortion pills, many resources are available to support using the pills. Plan C lists vetted organizations offering support services in a range of areas. For example, reliable information about how to use the abortion pill is available online in 27 languages at howtouseabortionpill.org.

Other resources include:

Medical Support

M + A Hotline offers anonymous, confidential, private and secure communication via text or phone with pro-choice doctors that have years of experience with miscarriage and abortion.

Emotional Support

Reprocare operates an anonymous healthline seven days a week providing peer-based, trauma informed emotional support.

Exhale offers a free, confidential textline to individuals who have had abortions, and to their partners, friends, allies and family members. Staffed by peer counselors, Exhale is a space to process feelings around abortion.

Connect and Breath offers a talkline staffed by people trained to “listen and provide unbiased support and encouragement of self-care.”

Legal Support

Repro Legal Helpline provides detailed information on their website about the legality of self-managed abortion and offers legal support by phone or by a secure online form.

“Some of the groups are newer organizations that have formed in response to the growth in self-managed abortion in this country. And some of the groups are existing organizations that have been around for a long time that are recognizing that self-managed abortion is happening and they are expanding their information and services to include that as well,” said Wells.

These organizations and others are creating a network of support across the country for people seeking safe self-managed abortion.

“A Country of Haves and Have-Nots”

A reversal of Roe v. Wade would not send us back to the pre-Roe world of coat hangers and hospital wards full of deathly ill women because of new medications and innovative organizations committed to reproductive health and bodily self-determination. But if the Supreme Court allows states to undermine the legality of abortion, discrepancies in access to abortion health care will increase further across the country.

A Stop Abortion Bans rally in St. Paul, Minnesota, May 21, 2019. (Fibonacci Blue / Flickr)

“In a post-Roe world, we would become a country of haves and have-nots—where some people have access to legal abortion and others do not,” said Wells. “In restricted states, abortion would become almost impossible to obtain—except through self-managed options, which would likely put people at legal risk, especially those who are already marginalized due to their skin color, economic status or gender identity. In states without these restrictions, abortion is likely to continue to be readily available through modern, safe telemedicine and clinic-based services.”

Whether or not Roe is reversed, women will organize and support each other to provide the heath care we need.

“People are resilient and resourceful,” said Aiken. “They are going to find other ways. People have always found ways to get the abortion care they need. Hopefully now they will find it in a way that is safer and more accessible and more acceptable to them.”

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Carrie N. Baker, J.D., Ph.D., is the Sylvia Dlugasch Bauman professor of American Studies and the chair of the Program for the Study of Women and Gender at Smith College. She is a contributing editor at Ms. magazine. You can contact Dr. Baker at cbaker@msmagazine.com or follow her on Twitter @CarrieNBaker.