Abortion Without Provider Involvement: Exercising Autonomy Beyond Partisan Politics
Taken from the March/April 2017 issue of The Women's Health Activist Newsletter.
As an organization, we place the utmost value on women having the autonomy, information, and resources necessary to make decisions that are best for them and their family—in fact, we were founded on this value. We trust women and support them to make decisions that make sense for them in their lives, and we reject narratives that don’t place women’s autonomy in the highest regard.
Sadly, in the United States, anti-choice politicians are enacting politically motivated barriers that prevent women who seek both medication abortion and surgical abortion from accessing the safe and effective care they need.
Since 2011, there has been a large upswing in the number of anti-choice bills introduced and passed at the local, state, and national levels. According to the Guttmacher Institute, in 2016 alone, legislators in 18 states put into place 50 new restrictions on abortion care; a total of 338 new restrictions have been enacted since 2010.1 That trend is expected to continue. Just days into the new Congressional session, Republicans have already introduced several anti-choice bills restricting access to abortion care.
Barriers to provider-led abortion access are one factor that is contributing to an increasing number of women seeking ways to end their pregnancies without involving a provider.2 Women also may seek to have an abortion without a provider’s involvement as a matter of personal preference. When women who want provider-led care are blocked from receiving it, and forced into alternatives they would not otherwise choose, the healthcare system is broken. The NWHN will fight not only to fix problems with access but also to ensure that women can access services in the setting that is best for them; we respect all women’s choices in this matter.
We believe that women and people who can become pregnant should have access to safe, affordable abortion care with the assistance of a medical provider if and when they so choose. Without exception. Women should not have to see a doctor, or “get permission” from the medical community, before ending their pregnancy with an FDA-approved medication.*
We recognize that, in some situations, it is appropriate for doctors and providers to serve as a “gatekeeper” to health care (e.g., when it takes specialized training to diagnose a condition, or safely use a prescription medication). In these cases, the provider protects the patient from harm by serving in this capacity. Our values lead us to a different conclusion, however, when a person decides to terminate a pregnancy. Even if they have access to a provider, a person may choose to self-induce an abortion to end the pregnancy. We acknowledge and support that choice.
The NWHN believes that people in the United States should be able to walk into a local pharmacy and purchase the drug needed for a medication abortion (misoprostol, brand name Cytotec) over-the-counter, in order to end their pregnancy. This is already common practice in Mexico and many other Latin American countries, enabling women to make the decision to end a pregnancy for themselves without involving a physician at all. Unfortunately, misoprostol is not currently available over-the-counter in the United States.
Misoprostol is an inexpensive medication that, in addition to being an abortifacient, is commonly prescribed to treat stomach ulcers and post-partum hemorrhage. Decades of experience with medication abortion have shown that misoprostol is a safe and effective medication for use in terminating an unwanted pregnancy. In the U.S. and many other countries, misoprostol is used in combination with mifepristone (brand name Mifeprex) for medication abortion, or abortion with pills. Mifepristone blocks the hormone progesterone and misoprostol causes the uterus to expel the fetus; when used together, the drugs are over 97% effective at terminating pregnancy.
We firmly believe that women who choose to self-induce should not face criminal charges. Given the increase in restrictions to abortion access, and the increasingly partisan and anti-choice Congress, however, we expect the criminalization of people who self-induce may escalate in the future.
The NWHN seeks to eliminate the full range of barriers to abortion access—from insurance coverage, to cost, to geography, to stigma—that block women who would prefer provider-led abortion care from receiving it. But we also acknowledge and support the right of women to end pregnancies on their own, safely, with FDA-approved medicine, and without fear of persecution.
It is important to remember that medication abortion without the involvement of a provider is not a failure of the system; rather, it is one option that women ought to be able to choose. As a society, we must trust that people will make the best decisions for themselves and their families, even if it is not the method preferred by their provider. Reproductive health care needs are as unique as the people who have them, and we must trust people to make the decisions that are right for them.
* This paper addresses the use of FDA-approved medications for self-induced abortion. It is not intended to address the use of unregulated products or techniques, such as herbs or uterine massage, with unknown safety and effectiveness. We do not consider menstrual extraction, as practiced by self-help groups, to be self-induced abortion.
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References
1. Nash E, Benson Gold R, Ansari-Thomas Z, et al., Policy Trends in the States: 2016, Washington, DC: Guttmacher Institute, January 23, 2017. Available online at: https://www.guttmacher.org/article/2017/01/policy-trends-states-2016
2. Stephens-Davidowitz S, “The Return of the D.I.Y. Abortion, New York Times Sunday Review, March 5, 2016. Available online at: http://www.nytimes.com/2016/03/06/opinion/sunday/the-return-of-the-diy-abortion.html