In post-Roe era, study finds more Americans are self-managing their abortions

According to a new study, the percentage of people who say they’ve tried to end a pregnancy outside of the medical system has gone up since the Supreme Court overturned Roe v. Wade two years ago. John Yang speaks with Shefali Luthra, reproductive health reporter for The 19th News, for more.
John Yang:
A new study says that since the Supreme Court overturned Roe v Wade two years ago, the percentage of people who say they’ve tried to end the pregnancy outside the medical system has gone up. The study from a University of California San Francisco research group called Advancing New Standards in Reproductive Health offers new details on who appears to be most affected by new abortion restrictions.
Shefali Luthra is reproductive health reporter for The 19th News and she’s the author of “Undue Burden: Life and Death Decisions in Post-Roe America.”
First of all, Shefali, the term they use in the study is self-managed abortions. They say it’s trying to end a pregnancy outside the medical system. What are they talking about? What does that mean?
Shefali Luthra, The 19th News: I think this is a really important point to clarify, because self-managed abortion is quite broad, and there are all sorts of mechanisms people can use, and have used for decades, even centuries, to try to end a pregnancy without the support of a healthcare provider, whether that’s a physician or a nurse or what have you.
And so in this paper, they looked at people who use methods that may or may not work things like herbal supplements. They looked at things like trying to inflict harm upon oneself to end a pregnancy. And they also looked upon using a medication independently, without the supervision of a physician, which can be quite safe and very effective, but is considered self-managed abortion.
And what we’ve seen is that this broad array of ways in which people try and end pregnancies on their own, it’s always existed and has always been a means used by people who don’t feel comfortable in or feel safe in or have access to reproductive health care through the medical system.
But it’s also becoming more common now because of abortion bans and because there are people who, when they want to end a pregnancy, will end one no matter what, but may not have the means to, for instance, travel outside of their state to a place where abortion is legal.
John Yang:
What does this tell us about the evolution of post-Roe America? What does this tell us?
Shefali Luthra:
I think the most important thing it tells us is that when people want abortions, they will try to get them. Many of them will be successful. Others will not be. We saw in the study increases across the board, in different mechanisms people use to end pregnancies. We saw, you know, a lot more people using herbal supplements, which may or may not work. They’re not always very well researched, so we can’t say for sure, we saw more people using self-harm.
We also saw more people using medications that they obtained independently to end pregnancies. People are going to great lengths to try and access care, and that means that our abortion landscape keeps changing. As a result, it creates this almost Whack-a-Mole kind of game between people who want to restrict abortion and those who are desperately trying to find new ways to get it.
John Yang:
Those changes that’s going to continue to develop and evolve over time. We’re not frozen in time here.
Shefali Luthra:
We are absolutely not frozen in time. You can look at the ongoing presidential campaign, where abortion is very much front and center, because the two parties are quite different on this issue. The Republican Party is largely allied and aligned with organizations that want to ban abortion that, you know, pushed for decades to get Roe v Wade overturned and are now pushing for more restrictions that will impair access to the procedure and to care nationwide.
On the other side, we have the abortion rights movement and health care providers that are largely allied with Democrats that are trying to find ways to strengthen abortion access where possible, even within the reality knowing that getting something like Roe v Wade’s protections anytime soon isn’t that likely.
John Yang:
Did the study say anything about how many of these people who tried self-managed abortions reported complications had to go to physicians because of complications?
Shefali Luthra:
It was quite low, very few people went to the emergency room out of the hospital, which is good news, because what it shows is that the concern that many folks had when Roe was overturned, that people would resort to, you know, the apocryphal back alley coat hanger abortion. That’s not quite bearing out. People are finding ways that are safe and effective.
One number I was really struck by was the percentage of people who used medication, in particular, mifepristone, misoprostol, maybe a combination of the two. And that went up by several percentage points. It was a significant increase, and that underscores that people are finding ways that are medically safe, medically effective, that have low risk and low complication.
At the same time, I don’t want just to be naive to the fact that people are facing medical risk in other ways, often through being denied access to pregnancy related care when they experience complications cases where abortion is a necessary form of medical treatment, but when people are trying to manage their own abortions, some are experiencing danger, are experiencing harm, but many are finding a way that is quite safe and quite healthy to do so.
John Yang:
What did the study say about who is disproportionately seeking these self-managed abortions, and what does that tell us about who is most affected by these new abortion restrictions?
Shefali Luthra:
We see a disproportionate share of black Americans and LGBTQ plus Americans being the ones to get abortions outside the medical system. The study doesn’t break down, for instance, whether people in those demographics are more likely to get more effective means of self-managed abortion or less effective ones, that’s a little bit too granular.
But this does tell us something that has been becoming clear for quite a while. I have had so many researchers, scholars, doctors, healthcare providers, say to me, this is increasingly a story of inequality, and it always was. Abortion bans hurt everyone, but they hurt people unequally.
The fall of Roe v Wade is a massive change. It has implications across America. People aren’t untouched by this, no matter their race, their class, frankly, their gender, but the impacts are unequal, and they are heightened for people who are traditionally marginalized by our health care system regardless.
John Yang:
Shefali Luthra of the 19th News, thank you very much.
Shefali Luthra:
Thank you for having me.