Attempts to induce abortions reported
A new survey of women in Texas has found that many experience barriers to getting abortions through local clinics and have tried to terminate a pregnancy on their own.
In the survey of 779 Texas women ages 18 to 49, conducted by the Texas Policy Evaluation Project, about 1.7 percent reported having tried to self-induce an abortion, mainly through the use of abortion drugs obtained without a doctor’s prescription or ineffective natural remedies.
The researchers found no evidence of any invasive methods that involved inserting objects into the uterus. And they acknowledged that their data did not show whether self-induced abortions increased after the Texas Legislature imposed new restrictions on the procedure.
“We are very concerned that as clinic-based abortion becomes harder to access in this state, more women will take matters into their own hands,” said Dr. Daniel Grossman, a professor at the University of California, San Francisco and co-investigator for the project.
The findings, he said, reflect the intersection of two trends in reproductive health: tighter restrictions on abortion access in Texas clinics and the increased availability of abortion drugs, such as misoprostol, over the counter in Mexican pharmacies.
Restrictive laws
Texas has been a hotbed in the battle over abortion. The U.S. Supreme Court has agreed to hear a challenge to House Bill 2, passed in 2013, which imposed some of the strictest requirements in the country on abortion providers. The law bans abortions after 20 weeks of pregnancy, sharply limits the use of abortion medications, requires abortion clinics to meet the expensive standards of hospital-style surgical centers, and mandates that abortion doctors obtain admitting privileges at nearby hospitals.
The Texas Policy Evaluation Project is a partnership between the University of Texas at Austin, the University of Alabama Birmingham and Massachusetts-based Ibis Reproductive Health, which advocates increasing access to safe abortion. The project was organized to study Texas laws affecting abortion access. The group previously found that after HB2 was passed, the number of abortions in Texas dropped 13 percent, and 23 of the state’s 41 clinics have closed.
“The reality is these laws do not prevent the need for abortion. They do not address the factors leading to unplanned pregnancy. They simply block access for women to professional medical care in their communities,” said Amy Hagstrom Miller, founder and CEO of Whole Women’s Health, the lead plaintiff in the HB2 challenge under consideration by the Supreme Court. “Women still need abortions in our communities, and many of those women take matters into their own hands.”
Anti-abortion activists called the study deeply flawed and questioned its relevance to the HB2 debate.
“The case is trying to be made that HB2 is going to have this major spiral effect, and you really can’t draw that analysis,” said Melissa Conway, a spokeswoman for Texas Right to Life. “It’s not tied to HB2 in any way.”
Lack of context
The survey did not collect data on when the selfinduction attempts occurred or how many of the women were successful in terminating their pregnancy on their own or by visiting a clinic.
“Some of these attempts happened before 2013, and we don’t have any clear data indicating the rate of self-induction has gone up since HB2,” Grossman said. “We weren’t specifically asking about attempts since HB2.”
The percentage suggests that over the past four decades, more than 100,000 women in Texas have tried to terminate pregnancies themselves.
Grossman said previous evidence suggests rates of self-induction are higher in Texas than in other states. A 2012 study by the project found that 7 percent of patients at Texas abortion clinics had previously tried to terminate pregnancies on their own. A survey by the Guttmacher Institute, by comparison, found the national rate of self-induction to be about 2 percent of abortion patients.
The latest survey, Grossman said, is the first to look at how many women in the general population have tried to self-induce.
The researchers conducted follow-up interviews with 18 women who had tried to self-induce. Of those, 10 used misoprostol, with seven reporting a successful termination. Of the other three, two went on to have abortions through clinics, while one continued her pregnancy.
Alternate methods
The other eight women tried herbs, teas or other nonpharmaceutical products.
“Not surprisingly, none of those worked, and they ended up seeking abortion at a clinic,” Grossman said. “None of the women we spoke with had serious medical complications related to their self-induction attempt.”
Misoprostol is one of two drugs generally used together to induce abortions in the U.S. Women are generally given mifepristone, better known as RU486, first, and then misoprostal, sold under the brand name, Cytotec, 24 to 48 hours later.
Grossman said that combination is 90 percent to 95 percent effective in terminating a pregnancy. Misoprostol alone is about 85 percent effective if taken in the first 10 weeks of pregnancy and is often used alone as a lower-cost alternative. It can be purchased without prescription in Mexico and other countries but can have serious complications if used improperly.
Money and stigma
Many of the women interviewed said they did not have the money to pay for a clinic abortion or to travel to the nearest clinic. Others said they wanted to avoid the stigma associated with going to a clinic.
Cecile Richards, president of Planned Parenthood Federation of America, called the findings disturbing.
“Most people thought we were well past the days of women taking matters into their own hands, but laws that make it impossible to get safe and legal abortion are taking us backwards,” she said. “These desperate measures will only become more commonplace if this law takes full effect.”