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Since Roe V. Wade was overturned last summer, it’s harder than ever to access abortion services. But it’s never been easy in the rural midwest and southern states, even when Roe was the law of the land. We sat down with staff at All Options Pregnancy Resource Center in Bloomington, Indiana to talk about how they handle an increase in need for funding the rising cost of abortion.
They do a lot, but there’s one thing they can’t do. They can’t talk to clients about self-managed abortion, even though experts at the World Health Organization say it’s safe and effective.
While abortion is debated in the American court system, we talk with researcher Dr. Melissa Madera to learn about the ways folks are getting access to abortion pills, what to expect from a self-managed abortion and what people should know about the risk of criminalization.
Image Credit: The diaper distribution room at All Options Pregnancy Resource Center in Bloomington, IN; Amy Gastelum
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The Making Contact Team
Music Credits:
- Lexin Music “Cinematic Documentary”
- HoliznaCC0 “Whatever“
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TRANSCRIPT
Self Managed Abortion: Medicine of the Future?
Show Opener: Making, making contact, making, making contact.
Amy Gastelum: This week on Making Contact, we’re talking about self-managed abortion. Experts at the World Health Organization have said it’s safe and effective for people to manage their own first trimester abortions without clinicians using the pills, Mifepristone and Misoprostol.
Dr. Manjulaa Narasimhan: The WHO’s definition is that self-care is the ability of individuals, of families, of communities to protect their own health, prevent disease, maintain health, and this can be done with the support of a health worker or also by themselves.
Amy Gastelum: But concern about legal repercussions is keeping some in conservative states from talking about abortion resources openly.
Jessica Marchbank: We can’t and won’t make referrals for how to obtain medications and we can’t and won’t give any instructions on how to do a self-managed abortion. Um, this is because the legal situation is complicated and we are not medical experts.
Amy Gastelum: Despite restrictive laws, activists and scholars and regular folks are working to reach the people who need it most.
Dr. Melissa Madera: PlanCPills.org. This team has been working on making sure that people know how to access, uh, abortion pills online and to manage their abortion safely. Um, and It’s the most comprehensive guide to abortion pills on the interwebs. So, They give you information on where to get pills, how to order them, and information about legalities, which is really important.
Amy Gastelum: Stay with us.
Amy Gastelum: Before we start, I want to say that this story is about post Roe access to abortion, a topic that is constantly evolving. This story is being produced for broadcast in April, 2023. Things may have changed by the time you hear it.
Jessica Marchbank: Hi, this is Jess from All Options and the Hoosier Fund.
Amy Gastelum: Jessica Marchbank is the State Programs Manager at All Options Pregnancy Resource Center in Bloomington, Indiana. She has a small office with a large computer screen. She’s answering text messages from people who need help. Right now, she’s following up on the phone with someone who needed funding for an abortion.
Jessica Marchbank: Oh, good. Are you all set? You don’t need any additional financial assistance? Okay. Oh, that’s fantastic. I’m really, really happy to hear that. If anything changes, don’t hesitate to get in touch and we’ll be here, okay? You are very welcome. Take care. Bye-bye. Bye-bye. Well, that’s an unusual instance when we are ready to offer someone money and they say somebody else already gave me money. I’m good. That’s great.
Amy Gastelum: All Options really means all options. This is a place people come for referrals to baby clothes, breastfeeding support, adoption services, help with infertility and for abortion funding. The storefront of the building sits on a busy road in southern Indiana. It’s packed floor to ceiling with diapers. Last year they distributed 140,000 diapers to Bloomington parents.
Jessica Marchbank: I sort of jokingly say sometimes my day is all about abortions and diapers, and sometimes they’re the same people.
Amy Gastelum: Okay, so last summer after Roe v. Wade was overturned, Jessica started getting more calls and texts. It went from about 30 per week to more like 60. More people needed help paying for their abortions. It’s gotten more expensive and because of restrictive laws, people are having to travel more for services. And here’s the thing, the world’s leading health experts say there is a safe, effective, convenient, and inexpensive method to have an abortion. But All Options, staff can’t talk about it. They can’t tell people how to get and use the medications, Mifepristone and Misoprostol so they can manage their abortions at home. We’re gonna talk more about self-managed abortion, but first, stick with me for some background.
After Roe, Indiana was the first state in the nation to create and pass a new law banning abortion. But it was only a week before plaintiffs, including All Options, sued the state. They were granted an injunction which stopped the ban from going into effect.
Jessica Marchbank: Which means, abortion in Indiana right now is, is just as it was one year ago, under, under Roe and, um, how things were one year ago. So that means, um, generally you can get an abortion in Indiana up to 13 weeks, six days.
Amy Gastelum: But the judge in the case could make a decision at any moment. Meanwhile, if you’re more than 14 weeks pregnant, you need to travel out of Indiana for services, usually to Illinois. And while we send residents to Illinois, people from Ohio and Kentucky are coming here for abortions because their laws are even more restrictive.
Jessica Marchbank: The legal status in both Kentucky and Ohio has been just a nightmare um,
Amy Gastelum: Just with the back and forth, all over the place?
Jessica Marchbank: And is it legal? Is it not? Currently in Kentucky, um, abortion is not happening. The closest clinic in Indiana for someone say in, in Louisville, is gonna be bloomington. It’s not exactly accessible for a lot of people.
Amy Gastelum: That’s like a three hour drive. It made me wonder if people calling from hundreds of miles away ever ask about self-managed abortion for an early pregnancy. She said out of the last 500 calls she’s gotten, Jessica’s probably been asked about self-management three times.
Jessica Marchbank: Generally, people are just not asking about self-managed abortion. Not nearly as much as I would have thought given all the legal restrictions. I, um, I need to make sure I have our specific language. We are very careful in what we say.
Amy Gastelum: Jessica’s pulling up a document on her big screen.
Jessica Marchbank: We can’t and won’t make referrals for how to obtain medications and we can’t and won’t give any instructions on how to do a self-managed abortion. Um, this is because the legal situation is complicated and we are not medical experts.
Amy Gastelum: I see that you’re reading literally …
Jessica Marchbank: mm-hmm.
Amy Gastelum:… from a form that’s guidelines and protocols around this.
Jessica Marchbank: Yeah. Right. So, um, if someone asks us point blank, how do I get abortion pills online? Um, can you help with that? We first affirm that it sounds like they’re being thoughtful and wanting to explore all of their options, and we’ll say that some folks have chosen to do a self-induced or self-managed abortion by ordering pills online or through the mail. We do caution them that ordering them through the mail is considered to be outside the purview of licensed medical care in the United States, and some people who have ended their own pregnancies have been arrested and charged with crimes. We don’t say this to scare people. We don’t want to be scaring people, but we want to make sure that they have all of the information.
Amy Gastelum: It’s harder than ever to get an abortion, but it’s the worst for people living in the rural south and Midwest. And even when Roe was the law of the land, it still wasn’t easy there. Loretta Ross is a founder of the Reproductive Justice Movement. Last year, while everyone was confused about what to do, she reminded people of the long view. This is from a virtual Ted Talk:
Loretta Ross: I think the main thing I’d like the audience to remember is that from time immemorial women have been doing what is ever necessary to protect our bodies, to raise our children, to ensure good futures for ourselves. I wanna urge people to always see a post Roe world as something that we’ve always been facing. And as a Black woman, I wanna say in particular, we have never had confidence in the Supreme Court or the US government to protect our human rights. And so, what we are going to do is make sure that we center the most vulnerable in the center of our lens. We’re going to do whatever is necessary, in order to get their human rights protected.
Dr. Melissa Madera: Yes, Roe gave us the legal protection to get an abortion, to have an abortion, but, so many people did not have real access to abortion.
Amy Gastelum: Dr. Melissa Madera is a researcher and consultant on lots of projects related to abortion access. She says, people who have the hardest time getting care are those who live far from a city, are marginalized by gender identity, race, or immigration status.
Dr. Melissa Madera: And many people, many, many, many people do not have the financial ability to access abortion. Um, so we have to really think about that. Yes, Roe gave us legal access to abortion, but it didn’t actually give us all access to abortion all the time, whenever we needed it.
Amy Gastelum: A lot of people in this movement are talking about, um, this being kind of a chance to make something that’s actually better than Roe, and I’m wondering if you can speak to what was wrong with Roe and why we need a something better.
Dr. Melissa Madera: Right now in the middle of this sort of like terrible time, it’s even hard to think about how we can make it better, right? Um, it’s gonna take a really long time to figure that out. Um, but I think what’s really important to think about is that we need multiple avenues to abortion care. Not one way is the right way for everyone, right? Um, and even in states where abortion is still accessible, um, and I hate using the word legal or you know, talking about legalities because I don’t wanna give the law any real legitimacy cuz it’s not legitimate. Like it, this is this is not legitimate, this is not, um, this is, this should not have happened, right? And so I think what’s really important to think about is like, We need various ways, various avenues for people to access abortion, and we should start thinking about how do we construct that for the day in which everyone in every state will be able to access abortion or have legal access to abortion. Again, using the word legal. Um, you know, in the future. But even now, there are various ways for people to access care. Um, and there’s, there should always be various ways, right?
Amy Gastelum: One of these ways is through self-managed abortion. People giving themselves an abortion has always been a thing. Folks have used herbs, teas, and other methods passed down from families and cultural traditions for generations. Some of those traditions are still used today, but more and more people are using the prescription medications Mifepristone and Misoprostol. This is how it works:
Medication Abortion Explainer Video from International Planned Parenthood Federation: Medical abortion, often referred to as the abortion pill, is a safe and effective way of ending a pregnancy. The pill is usually taken within the first 12 weeks of gestation. The whole process can take up to two weeks to complete, although most women feel normal again after just two days.
What can you expect from a medical abortion? Misoprostol causes cramping and bleeding to empty the uterus. It can feel like a heavy period, and it’s not uncommon to pass large blood clots during the process. Side effects can include diarrhea and vomiting, tiredness, mild fever or chills, headaches and dizziness to ease pain and discomfort.
Some of the following may help: staying at home or in a comfortable space when taking the pills, taking ibuprofen or painkillers before the procedure, having a hot bath or shower, ensuring a friend or family member is present to help reassure and comfort you. Having an emergency plan in place for any potential complications. Within 24 to 48 hours, most women feel fine to return to their daily routine.
Amy Gastelum: Using these pills to end a pregnancy is not new. The Food and Drug Administration first approved them more than 20 years ago in 2000. Before that, abortions were done as a procedure, kind of like a vacuum, removing the contents of the uterus. These procedures are still available if you have access to a provider. But, since they were approved, the pills have been used more and more. In 2020, more than half of all abortions in the US were done with these pills.
So before Pandemic Lockdowns, a pregnant person would take the Mifepristone at the clinic with the provider there and then go home to take the Misoprostol.
Most of the process was done without very much involvement by a healthcare provider. They just hand you a pill. Then in April, 2021, the process got even more independent from providers when the FDA allowed clinicians to mail the pills to clients to avoid covid. These changes allowed simplified access to the medications, but you still had to make an appointment to get the pills, complete a visit and pay on average $560, even though you take the pill and go through most of the process at home, alone.
But last spring, something wildly important happened. The World Health Organization said people could use these pills to end a pregnancy in the first 12 weeks without the guidance or involvement or cost of a medical provider.
Dr. Manjulaa Narasimhan: The world, as we know, has seen increased pressures from pandemics, from conflicts, from climate change, and these situations have further propelled the need for self-care interventions and this includes the rational delegation of tasks to, to laypersons so that they can manage their health.
Dr. Manjulaa Narasimhan works in the WHO’s Department of Sexual and Reproductive Health. She says, worldwide, increasing instability from climate change and conflicts leaves people cut off from healthcare providers. She says, self-managed care for all kinds of diseases and health issues is the medicine of the future.
Dr. Manjulaa Narasimhan: But we need to be mindful that we do this in a way that is equitable, and it really will require transforming the power dynamics that we have in health service delivery, in the health systems.
Amy Gastelum: She’s talking about the thing that Dr. Madera and Loretta Ross brought up. As self-managed care becomes more widespread, it has to be made available to the most vulnerable people: people in rural areas, Black and brown people, gender non-conforming people, undocumented people. What do they need? How do they get access? They say that should be the central question.
SHOW BREAK
I’m Salima Hamirani. You’re listening to Making Contact and a story about self-managed abortion in the United States. If you like today’s show and want more information, or if you’d like to leave us a comment, visit us at radioproject.org where you can access today’s show and all of our prior episodes. And now, back to the show with Amy Gastelum Gastelum.
Amy Gastelum: Hey, welcome back to the show. In the second half, we’re gonna talk about how people are finding out about self-managed abortion and how they’re doing it. Melissa Madera, the American researcher, we heard from earlier- she says, managing an abortion without a provider has been happening around the world for a long time. But it’s new territory for a lot of Americans, so she led a study that asked people to talk about what it was like for them.
Dr. Melissa Madera: For some people, they wanna use these pills and they are like, oh, I know it’s safe and I can do this on my own. Some people are like, well, I don’t really want to do that. Um, and so, one of the most important things to me is like, we need to trust people, right? To make the right decision that is good for them based on their own circumstances, right? And we need to respect that and give them all the options so they can do the right thing for them.
Amy Gastelum: Unlike the WHO, American Health leaders at the American College of Obstetrics and Gynecology, or ACOG, they don’t have a collective message about self-managed abortion. They’re against criminalizing people for managing their own abortions, but they don’t say much beyond that. This leaves Americans in the dark and it makes real healthcare, people’s bodies, political bargaining chips.
Right now in the US, Mifepristone is a hot potato shifting between courts and business deals among the powerful, leaving Americans vulnerable. In Texas, a judge recently ruled in favor of a physician-led anti-abortion activist group to overturn the FDA’s approval of Mifipristone. Washington State was ready for the Texas ruling, and a judge there opposed the decision. This created a standoff. Ultimately, it means Mifepristone, whether for self-management or even with the involvement of a clinician, may not be available to all Americans in all states. Meanwhile, as Loretta Ross predicted, organizations have created ways to bypass providers and sometimes legal restrictions. One of those routes is Plan C Pills. Dr. Melissa Madera, who we heard from earlier, is a Special Projects Consultant for the organization. Plan C Pills offers a website where people can search by state to find abortion pills by various means.
Dr. Melissa Madera: PlanCPills.org.
Amy Gastelum: Okay, I’m gonna go to it right now. Plan C pills dot org. So I searched Mississippi and I can see that there are several ways people get abortion pills in Mississippi, even if state laws restrict clinic-based care. We’ve got Aid Access, Community Support Networks, online pharmacies and mail forwarding. And if you click on that, um, there’s also some information about the legality of using these services. So, so it’s, it’s got you covered. Plan C pills has you covered for how to get access in whatever state you’re in. Which, which, that’s new to me. How long has this been up and running, do you know?
Dr. Melissa Madera: Oh, since 2015.
Amy Gastelum: I have to admit, this was a shock to me. I’ve been a mother/baby, public health nurse since 2008, and I had never heard of plan C pills before I started reporting this story. Not from doctors, not from colleagues, and never from leadership anywhere I’ve worked.
Dr. Melissa Madera: Before, um, the access issues got the worst, which is right now, um, seven years ago they were seven, eight years ago, right? We’re in 2023 now. Um, they were thinking, the, the co-founders were thinking like, how can we let people know more about how to get abortion pills online? Because people have been doing this and using abortion pills on their own, self-managing, um, in other countries for many, many years. So the thought was, oh, this, this is something that’s happening globally. People in the US should also know about it because we all know that even though we have, we or we had, um, the right to an abortion, many people didn’t have access to abortion. So the question is, how can we get more access to people? And abortion pills is one of those ways. Um, so yeah, it’s been a long time, um, that this team has been working on making sure that people know how to access, uh, abortion pills online and to manage their abortion safely. Um, and it’s the most comprehensive guide to abortion pills on the interwebs. Uh, so , you can go online and search very specifically for your state. Um, and as you said, they give you information on where to get pills, how to order them, and information about legalities, which is really important. And then resources around if you have questions about, um, the medical aspects of things while you’re self-managing, if you have questions about the legal aspects of things, also resources for those.
Amy Gastelum: Abortion access is still piecemeal and complex, but there’s a network helping people get access. There’s plan C pills, Abortion on Our Own Terms, the ReproLegal Helpline, and lots more. These groups are helping people get access to self-managed abortion and protection from criminalization.
Back at All Options, Jessica Marchbank Marchbank says that while more people are in need, a lot of the community has come forward to pitch in.
Jessica Marchbank: Starting really with the Supreme Court leak that happened in May, um, that led to a lot of increased donations, which was fantastic. We’re able to support more people. So starting in April, my weekly budget for the abortion fund was about $4,000, which feels like a lot of money, but it meant that every week there were a bunch of people we could not support. The additional donations has allowed us to spend more money, which means we say yes to, like if they live in Indiana or if they’re coming into Indiana, they’re gonna get some form of money from us, um, 100% of people and we would not have been able to do that with our previous budget. We also have had a huge outpouring of people who wanna help with driving people to appointments or basically help in some way help people access abortion and that’s, that has been heartwarming for sure. There have been a lot of little pop-up donation events. Um, somebody did a Buffy Prom last weekend and raised $4,000 for us.
Amy Gastelum: Just randomly, like a random person?
Jessica Marchbank: We didn’t even, yeah, they didn’t reach out to us to ask us for help. I sent them some goodies, um, t-shirts and stuff, but yeah, they just said, we’re gonna do this, and the proceeds are gonna go to All Options. Fantastic. So, you know, that has been, that has been a bright spot and, and there has been a lot more awareness about what we’re doing here, mostly in a good way, and that does give me hope.
Amy Gastelum: New helpers have been showing up even today.
Jessica Marchbank: Hi, Wes?
Wes: Hi. Yeah.
Jessica Marchbank: I’m Jess. Nice to meet you. We’re gonna be a couple more minutes.
Wes: Yeah.
Jessica Marchbank: And then, um, so I think just like hang out up front and I’ll be out there very soon.
Wes: Cool. All right.
Jessica Marchbank: Thank you. New volunteer. Yay.
Amy Gastelum: The new volunteer, Wes, stands in the front room among the diapers, taking it all in.
Wes: I didn’t really know this. I don’t have kids, but one in three families in the state, like don’t have the kind of diapers that they need. Um, and so that’s, that’s a big issue and something that is like so impactful for children, um, and families.
Amy Gastelum: Jessica walks Wes and me around the room to explain how the diaper distribution works. We land at a giant desk,
Jessica Marchbank: Um, let’s see. So we have an online order form. People can get supplies once a month, so, um, Depending on how many children they have, they might get anywhere between 75 to 125 diapers.
Wow. Mm-hmm.
Amy Gastelum: So Wes was not exactly the person I was expecting to see here as a volunteer. And so I’m wondering like how you found out about this, like what happened to make you want to do this and, and, and kind of how it’s feeling?
Wes: Um, I just think that the state of Indiana can be pretty regressive when it comes to reproductive rights and I’m hoping to volunteer and just see in what way I can give back or understand that reproductive justice extends beyond plan B contraception. I have two older sisters, both of them, um, have, you know, had pregnancy scares and, and been worried about their reproductive rights being taken away. The overturning of Roe is not something that only affects, um, women or people that can have children. Um, it’s something that affects men as well, um, and people that can’t have children. And it affects our communities in a very direct way. Um, and we all need to get involved and this is not something that we can leave up to the legislature to do the right thing. And you can write them and you can email them, and you can campaign and all of that is good. But there are families in need here in our community and we need to help them. So that’s why I’m involved.
Amy Gastelum: Wes is not an anomaly. Recent polls show most people in Indiana believe abortion should be legal in all or most cases, but we tend not to talk openly about abortion. Back in her office, Jessica says that should change.
Jessica Marchbank: Many things need to happen to deal with the stigma and our cultural shame around abortion. Um, but I think the first level is breaking down the, the silence. I know that every person I’ve talked to who has shared their story with me has felt the sense of relief and affirmation that really we all deserve. And I think the more people tell their stories, any stories, maybe it’s about having a miscarriage or many miscarriages, or maybe it’s about having babies and then realizing they’re in over their heads, um, and wanting to talk about that openly and, and similarly about having an abortion or having three abortions. Um, that’s not my business, but it should be my business to accept them.
Amy Gastelum: Whatever happens with the Indiana law, All Options will be here. Jessica turns back to her big screen.
Jessica Marchbank: I’m gonna send this message real, another message real quick.
(typing sounds)
for Making Contact, I’m Amy Gastelum.
