We have already told WHY WITHDRAWAL OF ABORTION of the MMI system and especially their ban is dangerous and that medical abortion is safer, easier and cheaper than surgery (both for women and for the health care system). When people talk about regions where women have limited control over their bodies, they usually think of the Catholic countries of South America or the Islamic East – but not the United States, in which a woman’s right to abortion is guaranteed by the constitution. Nevertheless, it is in the States that restrictions often make abortion impossible, and the activities of prolife activists sometimes reach the level of extremism. We figure out who helps women by sending medicines by mail, and what needs to be done to reduce unwanted pregnancies.
Abortion by mail
The organization Women on Web is engaged in sending drugs for medical abortion – they are ordered women in countries where abortion is prohibited. According to a number of studies, medical abortion at home is safe if the woman follows all the recommendations. After a request, a doctor speaks with a woman remotely, who finds out the gestational age (it should be no more than ten weeks), the presence of contraindications and explains how to use the drugs on their own and in which case it is still necessary to consult a doctor. Depending on the country, the price of the service varies (for example, € 70 for Kenya and € 90 for Singapore), but women in difficult economic situations are encouraged to donate any amount raised to the project.
The phrase “home abortion” sounds as creepy as “home birth” – but it is the result of stereotypical thinking. In fact, medical abortion at home cannot be equated with a criminal one – on the contrary, it is quite safe, according to WHO, and even the practice recommended by this organization. To avoid negative consequences, three conditions must be met: an independent assessment of the fact that the gestational age allows a medical abortion, the ability to correctly apply drugs without the direct supervision of a doctor, and then checking the result using pregnancy tests and checklists (the woman must make sure that the process is completely completed). According to the same WHO guidelines, the most difficult of these points is the first, but still, in most cases, a woman is able to determine the gestational age using menstruation trackers and online calculators.
The United States was not included in the list of countries where the project works for a long time, because abortion is formally allowed there – but in the spring of 2018 Women on Web launched the Aid Access site for a similar mailing in the States. In six months, the pills were sent to approximately 600 women. The creator of the project, Rebecca Gomperts, claims that she does not violate the laws, because the import of drugs for personal use is completely legal. The FDA may have a different opinion – the agency has launched an investigation of the situation in search of violations of the law. Mifepristone (one of the drugs for medical abortion), according to FDA regulations, cannot be sold in pharmacies or anywhere else – the patient can only get it in a clinic or hospital. The agency’s website warned that it was not worth buying mifepristone on the Internet.
In a recent Guttmacher Institute report says that the FDA imposed restrictions on the distribution of mifepristone is not justified: the drug is safe enough to be sold in pharmacies. Removing restrictions would make abortion more affordable for both those who cannot pay for a doctor’s appointment or insurance, and for residents of certain states: right now, 34 states ban the supply of the drug to general practitioners (that is, it can only be used by obstetricians-gynecologists). At the same time, the WHO recommendations say that a safe medical abortion can be performed even under the supervision of a paramedic or qualified nurse. Another 19 states require the doctor to be with the patient while taking medication.
Pills and the death penalty
Unfortunately, even if Aid Access does not formally break the law, women can suffer from serious charges: in some states, self-abortion is equal to willful homicide and can face a long prison sentence, if not the death penalty . Jodie Picoult’s new book A Spark of Light describes a similar situation: a seventeen-year-old heroine is looking for an opportunity to have an abortion without exceeding the permissible gestational age . Once in the clinic, she discovers that she had to bring permission from her parents, since she is not eighteen; she is explained that she can do without him if the court issues a special document. The trial will have to wait another two weeks, time is running out, and she orders the abortion pills online. After taking the pills, severe bleeding develops, and the girl regains consciousness in a hospital ward – and in handcuffs. She faces a trial for murder. The author emphasizes the terrible irony: until the age of 18, you cannot make a decision about an abortion without the participation of your parents, but a fetus that is not viable outside the uterus already has more rights than you do.
Decriminalizing home medical abortion means removing a number of other restrictions: a mandatory waiting period (the time a woman is given “to think about her decision”), mandatory ultrasound, parental consent (as in the case described above). The financial issue is also critical. In 2014, the average cost of an early abortion (up to 9 weeks) was $ 535, and not everyone has insurance that covers the procedure. To this price should be added travel and hotel costs: one or two abortion clinics for an entire state is a common situation.
Distortion of information
In search of such a clinic, women often end up in some “crisis centers for pregnant women.” Unfortunately, they have nothing to do with real medicine and assistance – these are information centers created by the anti-abortion movement. Worst of all, the information they provide is false and not based on scientific evidence. Patients are told that the fetus will feel terrible pain (although there is no pain sensitivity until 24 weeks ) or that the psychological consequences for the woman herself will be irreversible (although, according to research, the psychological consequences of refusing an abortion are much worse). It happens that at the first ultrasound scan (and they are carried out in such centers for free), the woman is told that nothing is visible and it is impossible to determine the gestational age, offering to come again. On the next visit, it turns out that the gestational age is already too long.
Supporters of the pro-life movement (pro-life, “for life”) use psychological pressure: they call the embryo a child and appeal to the emotions of a woman. They distort the data, and there are no links to well-conducted (or any) research on the websites of these organizations. And that’s not all: sometimes the activity of prolifers takes on the character of extremism.
Attacks on doctors and shooting in clinics
From 1993 to 2015, prolife activists in the United States were guilty of twelve episodes of shooting and attacks on doctors (at work and at home), at least ten people were killed, and several more were injured. There are hundreds of less serious crimes by anti-abortion extremists, and their number is growing: in 2017, the manifestations of aggression became many times more than in 2016. So, last year , 823 illegal penetrations into private territory were registered , 1704 cases of creating obstacles (so that people could not get into the clinic) and 104 blocking the entrances to the clinic, 62 cases of threats, including death, 1156 calls or messages with threats. The number of pickets and demonstrations approached 80 thousand. Paradox: people who call themselves fighters for life are ready to kill and kill.
It is worth saying that it was precisely because of such attacks that the law on freedom of access to clinics (Freedom of Access to Clinic Entrances, FACE) came into force in 1994 , after which the activity of extremists decreased slightly. Her current increase may be due to the fact that Trump repeatedly mentioned reproductive medicine during the election campaign – and prolifers felt support at the highest level. The National Abortion Federation explicitly calls some of the prolife activist groups terrorists. Those, in turn, find new, more advanced, ways to act – for example, they hack into the sites of abortion clinics in order to change the specified address, phone number or write that the clinic was closed for repairs.
Problems with education
World experience shows that there is only one effective way to reduce the number of abortions – to reduce the number of unwanted pregnancies. This means sex education from a relatively early age, the availability of contraception and support for women, regardless of their choice. Oddly enough, it is prolifers who usually advocate a complete ban on sex education in schools – although it would be logical to hand out handfuls of condoms to keep teenage pregnancies as few as possible. The heroine of Picolt’s book, which is described above, became pregnant when she was not using contraception: her friends explained that “you cannot get pregnant after the first time.”
The statement that the prohibition of abortion leads to criminal abortion used to be quite unambiguous: yes, without being able to undergo a procedure with a doctor, women resorted to dubious and often deadly methods. But that is changing, and with companies like Women on Web and Aid Access, safe and effective tools are available, along with online consulting. The problem is that such abortions, while not responding to the usual concept of “criminal”, are still criminalized. Guttmacher Institute analysts point out that punishment is completely unproductive practice. It affects not only women who need to terminate their pregnancy, but also those who have miscarried – they can be accused of home abortion.