[ Even in states with the strictest abortion laws, pregnant people
have a safe, inexpensive option to terminate their pregnancies. But
few know about it.] [[link removed]]

THE ABORTION BACKUP PLAN NO ONE IS TALKING ABOUT  
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Olga Khazan
October 12, 2021
The Atlantic
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_ Even in states with the strictest abortion laws, pregnant people
have a safe, inexpensive option to terminate their pregnancies. But
few know about it. _

, Atlantic

 

So many states have restricted access to abortion so severely that
people in large swaths of the country feel they have no options if
they want to terminate a pregnancy. But technically, those who want an
abortion still have options. It’s just that few have heard of them.

Pregnant people in Texas, or in any other U.S. state, can visit an
array of websites that will mail them two pills—m
[[link removed]]ifepristone
and misoprostol
[[link removed]]—that
will induce a miscarriage when used in the first trimester of
pregnancy and possibly even later. The so-called self-managed abortion
is therefore an option at least six weeks further into a pregnancy
than the controversial new Texas law’s
[[link removed]] six-week
“heartbeat” cutoff for an abortion at a clinic. Though people
in other states
[[link removed]] have
several websites to choose from, Texans can visit Aid Access
[[link removed]],
a website that provides the pills for $105 or less based on income.

[A chart showing peoples' knowledge of abortion websites]

The Atlantic / Leger

Only 5 percent of Americans have heard of Aid Access, though, and only
13 percent have heard of Plan C [[link removed]], a
website that provides information on different mail-order-abortion
services by state, according to a new _Atlantic_/Leger poll. Some
people may vaguely know that medication abortions exist, but don’t
know the names of the organizations that mail them. However, most poll
respondents said that they weren’t aware of any backup options for
abortion if a clinic is not accessible. The poll surveyed a
representative sample of 1,001 adults across the country from
September 24 to September 26, and its results mirror my experiences
interviewing two dozen random young Texans recently
[[link removed]]:
None had heard of Aid Access, and the few who had heard of Plan C were
confusing it with Plan B, the morning-after pill.

The results also jibe with the experiences of Plan C’s founders.
Though they’ve seen a large increase in web traffic, particularly
from Texas, since Texas’s abortion restrictions went into effect,
“we know that the biggest challenge is to try to get this word
out,” says Francine Coeytaux, one of the site’s co-founders. The
doctor behind Aid Access, Rebecca Gomperts, told me that according to
her own research, 60 percent of her clients did not know about
abortion pills before they found her service.

Nationwide, opponents of abortion rights appear to be winning. Though
a federal judge temporarily blocked enforcement of the new Texas
“heartbeat” law, Texas appeal
[[link removed]]ed
[[link removed]],
and the law remains in effect—at least for now. Texas Governor Greg
Abbott recently signed another bill
[[link removed]] that
narrows the window for medication abortions from 10 weeks to seven
weeks and bans the mailing of abortion-inducing medications. The
Supreme Court is composed predominantly of abortion-rights opponents,
and states have enacted 106 different restrictions on abortion this
year, the most in one year since 1973, according to
[[link removed]] the
pro-abortion-rights Guttmacher Institute.

Many people in these states, upon getting pregnant, will simply track
down a mail-order-abortion service through the internet. But the
picture is more worrisome for those who lack internet access or
proficiency. “Being in that state of desperation and feeling like
you have no options” exacts a mental toll, says Abigail Aiken, a
University of Texas professor who has researched self-managed
abortion. Some number of those people might harm themselves
[[link removed]] in
a misguided attempt to end the pregnancy. “It would be remiss of us
to underestimate the lengths people will go to sometimes when they
can’t access the care they really need,” Aiken says.

Abortion pills work best
[[link removed]] in
the first trimester of pregnancy, but it takes time to find the
service and order the pills, and for them to arrive and make their
way through customs
[[link removed]].
This is one reason Aid Access is now allowing people who aren’t
pregnant to order the pills to have on hand and use later if they
experience an unwanted pregnancy. The pills don’t expire for about
two years.

Aiken wants Texas schools to start teaching about abortion as part of
health class. However, this is unlikely to happen in a state that
still does not mandate
[[link removed].] any
kind of sex education.

Coeytaux, from Plan C, suggests that something darker is at work: that
abortion clinics and funds are not sufficiently promoting self-managed
abortion, either out of a lack of trust or because they fear it will
quell the sense of emergency over the war on reproductive rights.
Indeed, when I visited the website of one Texas abortion fund
recently, it said, “We do not provide advice on self managed
abortion care.” (The fund did not respond to a request for comment.)
Whole Woman’s Health, an abortion clinic with sites in Texas, does
have a page
[[link removed]] on
self-managed abortion, but in an email, its CEO, Amy Hagstrom Miller,
said that because Texas does not allow the dispensing of abortion
pills by mail, medical professionals “cannot advise Texans how to
obtain self-managed abortion medications in Texas.”

The struggle for abortion rights has been about proving that
restrictions are an “undue burden” for women—a burden that
mail-order abortions arguably lessen. “The strategy of the lawyers
and the providers and everybody who’s fighting for our rights … is
‘_Oh my God, look what happened. In Texas, there are no options
anymore_,’” Coeytaux says. “If you come along and say, ‘Maybe
your problems of access have just been solved, because you don’t
have to travel, you don’t have to pay that much,’ that undermines
the _Oh my God, this is really terrible_.”

Of course, other factors might be discouraging people from pursuing
self-managed abortions. The procedure involves
[[link removed]] severe
cramping and heavy bleeding, and in the states that are most hostile
to abortion rights, women who self-induce their own abortions must
rely on hotlines and text support from faraway doctors if they get
scared or experience complications. Aid Access is based in Austria,
beyond the reach of Texas law enforcement and the new
abortion-medication measure, but the site still inhabits a legal gray
area: Five states
[[link removed]] have
criminalized managing one’s own abortion, and about two
dozen people
[[link removed]] have
been prosecuted for self-managing an abortion since 2000.
Mainstream medical research
[[link removed]] generally
[[link removed]] suggests
that self-managed abortions are safe and effective, but
anti-abortion-rights groups vehemently disagree and have
published their own reports
[[link removed]] saying
they are dangerous. Whatever the reason, far fewer women in the U.S.
have medication abortions than in some other countries: Medication
abortions accounted for 40 percent
[[link removed]] of
all U.S. abortions in 2017, compared with more than 90 percent
[[link removed]] in
Finland and more than 80 percent in Mexico City, according to the
Guttmacher Institute.

Sites like Aid Access are quickly becoming the sworn enemies of
abortion opponents. “At a minimum, the FDA should warn women, as it
has in the past, that it is not safe to use imported drugs bought off
the internet that have not undergone agency scrutiny and evaluation as
to purity, safety, and efficacy,” Randy O’Bannon, the director of
research at National Right to Life, told me via email. “And those
entities illegally importing and selling those unauthorized drugs
should be prosecuted for those violations and they should certainly be
held criminally and financially responsible for any injuries
associated with their products.”

Aiken and others, though, doubt American laws will affect Aid Access,
because the organization already operates in countries where abortion
is illegal. When I asked Gomperts if she feels like she’s under
threat from the Texas laws, she said, “Aid Access is serving women
who need access to safe abortions. It doesn’t matter where they live
or what the legal situation is in that country.” Unfortunately, few
Americans know that she’s available to serve them.

Olga Khazan [[link removed]] is a
staff writer at _The Atlantic _and the author of _Weird: The Power
of Being an Outsider in an Insider World
[[link removed]]._

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