If we want fewer people self-managing abortions later in pregnancy or delivering babies under distress, the answer is not more punishment. It’s accurate information and access to care.
A teenage girl and her boyfriend are facing criminal charges in North Carolina after allegedly attempting to self-manage her abortion using pills. She was reportedly 31 weeks pregnant when she took the medication. At that stage of pregnancy, the medication induced labor and she gave birth, presumably without medical assistance. The state charged her with “assault with a deadly weapon,” treating the abortion pills as the “deadly weapon.”
I won’t repeat the girl’s name here. It’s already been plastered across headlines and social media, and that exposure is part of her punishment.
When I first read the details of this case, I felt an immediate rush of empathy—and dread. Our work at Patient Forward focuses on eliminating barriers to abortion care later in pregnancy so no one feels forced into situations like these because they lack clinical options.
I know what it feels like to need an abortion later in pregnancy and fear that time is running out. However when I needed an abortion at 31 weeks, I had the resources and support that made it possible for me to get one safely. Even after learning third trimester abortion care was banned in my state, my obstetrician still referred me to a safe clinic in Colorado. My mother withdrew $10,000 from her retirement savings so I could pay for it. My husband handled flights, hotels and other logistics.
In the end I didn’t just receive safe, supported care. I also received privacy. My story became public only because I decided to tell it.
The teenager in North Carolina received neither. The difference between us wasn’t the complexity of our pregnancies. It was access.
Despite the growing availability of safe later abortion care in clinics and hospitals, more people are self-managing abortions with pills—even into the third trimester. For many people, accessing care in a clinic, often across state lines, has become increasingly difficult. And this is especially true for people struggling at the margins of our failing systems.
Abortion bans and restrictions in 41 states disproportionately burden people seeking abortion care after the first trimester, when costs and logistical barriers increase. For many people, pills feel more possible to obtain than an expensive procedure across the country.
When people cannot access healthcare, they do not stop needing it. They reach for the care that is available. However, people using abortion pills at home later in pregnancy can become more vulnerable to criminalization when they are more likely to draw attention from healthcare providers, law enforcement or others. They are more likely to seek medical care during or after the abortion. Fetal remains are more recognizable. Each of these circumstances can invite scrutiny.
According to If/When/How, an estimated 87 percent of criminalization cases involving self-managed abortion occur in the second and third trimesters. So while abortion care later in pregnancy generally is much less common than early abortion, it represents the overwhelming majority of cases where someone is punished for taking abortion pills.
The truth is that the greatest risks for someone self-managing an abortion later in pregnancy are often not medical. They are legal. Like this North Carolina teenager, people are publicly exposed, investigated, and charged with serious crimes unrelated to abortion.
Even in states where providing clinical abortion care is banned, self-managing your abortion is legal. So then how can these prosecutions be happening? In short: fetal personhood.
Fetal or prenatal personhood is a dangerous legal theory that grants embryos and fetuses rights under the law. This is different from how individual people may think of a developing pregnancy as a person. This is about how criminal law applies and determines how the government gets involved. Fetal personhood shapes how police, prosecutors, healthcare providers, and courts respond to pregnancy outcomes.
When those responses are surveillance, prosecution and incarceration instead of healthcare, they do not make anyone safer. They deepen trauma, destabilize families and discourage others from seeking medical care out of fear.
If we want fewer people self-managing abortions later in pregnancy or delivering babies under distress, the answer is not more punishment. It’s accurate information, practical support for people trying to access care and policies that empower people to make decisions about their own bodies—including the decision to get an abortion.
And then even if we do all of that, tragedies will still happen. Young, scared people without support or resources will still find themselves making desperate decisions we may not understand. We should meet these crises with empathy and care, not judgment and punishment.
This is not an intellectual debate about abortion policy. It is a question about what kind of society we want to be, and whether we are ready to grow up and take collective accountability for the violent systems we’ve built that would abandon a desperate teenager to induce her own pregnancy. These cases are not isolated islands or individual “choices” disconnected from their surroundings. They are products of the environments we create and the conditions we allow to persist. In that sense, these tragedies are on all of us.
The young woman in North Carolina deserved so much better. She deserved access to comprehensive healthcare. She deserved anonymity. And she deserved compassion, not handcuffs.
