Abortions at Home? With Doctor Supervision, Yes

Susan Yanow and Kinga Jelinski

Medication abortion is a safe, straightforward option for ending an early unwanted pregnancy, and could be made more available and less expensive if home use were an option.

Why do we need to see a
doctor to swallow a pill?
 

 

Recent articles in the New
York Times have focused on women self-inducing abortion using misoprostol. 
The safe use of medication abortion by women raises the larger issue
of how the approved use of mifepristone/misoprostol now available at
many clinics could be simplified to increase women’s access to abortion
in the U.S. 

In 1988 mifepristone/misoprostol
for abortion before 9 weeks was approved in France and China, and by
2002 was approved in 29 additional countries. This combination of medications
allows women to induce a miscarriage rather than have a suction procedure
with a physician (Nine more countries approved the drugs for early
abortion between 2002 and 2008). The promise of medical abortion
was increased access for women, because there would be less need for
a physician who had the hard-to-obtain training in suction abortion. 
However, in most countries women are required to visit a clinic or doctor’s
office to take the first dose of the medication regimen, and return
for a follow up visit to confirm that the abortion was complete. 

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As early as 2002, well-respected
researchers were questioning the over-medicalization of the procedure,
citing evidence that most women can safely and effectively handle the
medical abortion process themselves, effectively and safely. 
In countries with legal access to abortion, these researchers speculated
that putting the medication into women’s hands would allow greater
control, comfort, and convenience as well as a lower over-all cost for
the procedure. 

Since 2006, Women on Web (WoW)
has put this theory into action.  Through an Internet helpline
which is staffed 18 hours a day, seven days a week, in six languages,
WoW arranges for women to complete an online consultation which is reviewed
by a physician.  If there are no counterindications and the woman
is within the gestational age that a medication abortion can be effective,
the physician arranges with a consultant to ship 200 mg. of mifepristone
and 600 mcg of misoprostol.  Throughout the abortion process, women
have Internet access to skilled counselors to answer any questions or
concerns, medical or emotional, that arise before, during or after the
abortion. 

WoW collects evaluations from
women who use the service, and the results have been overwhelmingly
positive. This is remarkable evidence of the safety of home use of medication
abortion, as many of the women who contact WoW have low literacy rates
and/or are communicating in a language that is not their native tongue. 
Women from over 100 countries where there is no access to safe abortion
have successfully used the service to end an unwanted pregnancy, and
have expressed great satisfaction with the results and gratitude at
being able to safely take control of their reproductive lives, guided
by internet support. 

In many countries, the battle
for safe abortion started with women empowering themselves by learning
about medicine and creating self-help groups.  Women in countries
where abortion is legal have something to learn from women who have
used WoW – medication abortion is a safe, straightforward option for
ending an early unwanted pregnancy, and could be made more available
and less expensive if home use were an option.

News Politics

NARAL President Tells Her Abortion Story at the Democratic National Convention

Ally Boguhn

Though reproductive rights and health have been discussed by both Democratic Party presidential nominee Hillary Clinton and Sen. Bernie Sanders (I-VT) while on the campaign trail, Democrats have come under fire for failing to ask about abortion care during the party’s debates.

Read more of our coverage of the Democratic National Convention here.

Ilyse Hogue, president of NARAL Pro-Choice America, told the story of her abortion on the stage of the Democratic National Convention (DNC) Wednesday evening in Philadelphia.

“Texas women are tough. We approach challenges with clear eyes and full hearts. To succeed in life, all we need are the tools, the trust, and the chance to chart our own path,” Hogue told the crowd on the third night of the party’s convention. “I was fortunate enough to have these things when I found out I was pregnant years ago. I wanted a family, but it was the wrong time.”

“I made the decision that was best for me — to have an abortion — and to get compassionate care at a clinic in my own community,” she continued. “Now, years later, my husband and I are parents to two incredible children.”

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Hogue noted that her experience is similar to those of women nationwide.

“About one in three American women have abortions by the age of 45, and the majority are mothers just trying to take care of the families they already have,” she said. “You see, it’s not as simple as bad girls get abortions and good girls have families. We are the same women at different times in our lives — each making decisions that are the best for us.”

As reported by Yahoo News, “Asked if she was the first to have spoken at a Democratic National Convention about having had an abortion for reasons other than a medical crisis, Hogue replied, ‘As far as I know.'”

Planned Parenthood Federation of America President Cecile Richards on Tuesday night was the first speaker at the DNC in Philadelphia to say the word “abortion” on stage, according to Vox’s Emily Crockett. 

Richards’ use of the word abortion was deliberate, and saying the word helps address the stigma that surrounds it, Planned Parenthood Action Fund’s Vice President of Communication Mary Alice Carter said in an interview with ThinkProgress. 

“When we talk about reproductive health, we talk about the full range of reproductive health, and that includes access to abortion. So we’re very deliberate in saying we stand up for a woman’s right to access an abortion,” Carter said.

“There is so much stigma around abortion and so many people that sit in shame and don’t talk about their abortion, and so it’s very important to have the head of Planned Parenthood say ‘abortion,’ it’s very important for any woman who’s had an abortion to say ‘abortion,’ and it’s important for us to start sharing those stories and start bringing it out of the shadows and recognizing that it’s a normal experience,” she added.

Though reproductive rights and health have been discussed by both Democratic Party presidential nominee Hillary Clinton and Sen. Bernie Sanders (I-VT) while on the campaign trail, Democrats have come under fire for failing to ask about abortion care during the party’s debates. In April, Clinton called out moderators for failing to ask “about a woman’s right to make her own decisions about reproductive health care” over the course of eight debates—though she did not use the term abortion in her condemnation.

News Politics

Congresswoman Pushes Intersectionality at Democratic National Convention

Christine Grimaldi

Rep. Bonnie Watson Coleman (D-NJ) charges that reproductive health-care restrictions have a disproportionate impact on the poor, the urban, the rural, and people of color.

Read more of our coverage of the Democratic National Convention here.

The members of Congress who flocked to the Democratic National Convention in Philadelphia this week included a vocal advocate for the intersection of racial and reproductive justice: Rep. Bonnie Watson Coleman (D-NJ).

Watson Coleman’s longstanding work in these areas “represented the intersection of who I am,” she said during a discussion in Philadelphia sponsored by the Center for Reproductive Rights and Cosmopolitan. Reproductive health-care restrictions, she stressed, have a disproportionate effect on the poor, the urban, the rural, and people of color.

“These decisions impact these communities even more so [than others],” she told Rewire in an interview. “We don’t have the alternatives that middle-class, suburban, white women have. And we’d rather they have them.”

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Watson Coleman has brought that context to her work in Congress. In less than two years on Capitol Hill, she co-founded the Congressional Caucus on Black Women and Girls and serves on the so-called Select Investigative Panel on Infant Lives, a GOP-led, $1.2 million investigation that she and her fellow Democrats have called an anti-choice “witch hunt.”

Coleman said she’s largely found support and encouragement among her fellow lawmakers during her first term as a woman of color and outspoken advocate for reproductive rights.

“What I’ve gotten from my Republican colleagues who are so adamantly against a woman’s right to choose—I don’t think it has anything to do with my being a woman or an African American, it has to do with the issue,” she said.

House Republicans have increasingly pushed anti-choice policies in advance of the ongoing August recess and November’s presidential election. The House this month passed the Conscience Protection Act, which would give health-care providers a private right of action to seek civil damages in court, should they face supposed coercion to provide abortion care or discrimination stemming from their refusal to assist in such care.

Speaker Paul Ryan (R-WI) lauded passage of the bill and the House’s thus-far unsuccessful effort to prove that Planned Parenthood profited from fetal tissue donations—allegations based on widely discredited videos published by the Center for Medical Progress, an anti-choice front group that has worked closely with GOP legislators to attack funding for Planned Parenthood.

On the other side of the aisle, Watson Coleman joined 118 other House Democrats to co-sponsor the Equal Access to Abortion Coverage in Health Insurance Act (HR 2972). Known as the EACH Woman Act, the legislation would overturn the Hyde Amendment and ensure that every woman has access to insurance coverage of abortion care.

The Hyde Amendment’s restriction of federal funding for abortion care represents a particularly significant barrier for people with low incomes and people of color.

The Democratic Party platform, for the first time, calls for repealing the Hyde Amendment, though the process for undoing a yearly federal appropriations rider remains unclear.

For Watson Coleman, the path forward on getting rid of the Hyde Amendment is clear on at least one point: The next president can’t go it alone.

“The president will have to have a willing Congress,” she said. She called on the electorate to “recognize that this is not a personality contest” and “remove some of those people who have just been obstructionists without having the proper evidence.”

In the meantime, what does a “willing Congress” look like for legislation with anti-choice roadblocks? A majority voting bloc helps, Watson Coleman said. But that’s not everything.

“There are lots of bills that Republicans will vote for if their leadership would simply bring them up,” she said.