Analysis Abortion

In Our Own Hands: What U.S. Women Can Learn from Self-Use of Medication Abortion Worldwide

Francine Coeytaux & Leila Hessini

There is much we can learn from our sisters in the Global South who, rather than trying to gain access to services that all too often do not exist or fail to treat them well, are obtaining pills to induce abortion and taking them at home without seeing a health provider.

Correction: A version of this article incorrectly noted that “Misoprostol is typically sold in tablets of 200 mcg; four tablets are taken by mouth to initiate an early abortion, followed by four more 12 hours later if required.” In fact, Misoprostol is typically sold in tablets of 200 mcg; four tablets can be taken by mouth to initiate an early abortion, followed by four more pills every three hours for a maximum of three doses. We regret the error.

Every day in the United States, abortion is under attack. Even when the news is positive, as in the recent dismissal by the Supreme Court of an Oklahoma law effectively banning medication abortion, we are still faced with the immediate and long-term implications of anti-choice groups and legislators systematically eliminating the health services women need.

There is much, however, that we can learn from our sisters in the Global South who have become active agents in securing their own reproductive health and autonomy. Women living in countries where abortion is legally or socially restricted have come up with a creative way to meet their needs: Rather than trying to gain access to services that all too often do not exist or fail to treat them well, they are obtaining pills—primarily misoprostol, also known as Cytotec—from pharmacists or informal markets and taking them at home without ever seeing a health provider. Because misoprostol is safe and effective, the use of pills to end pregnancy without formal medical guidance has significantly increased access to safe abortion for many women, especially poor, rural, and young women who are chronically under-served. And it allows women to be in control of the process.

Women in the United States have also been taking matters into their own hands. Over the past several years, there have been reports of home use of misoprostol by immigrants from countries where such use is more common practice. And recent articles describing the severe restrictions being imposed on abortion services in Texas attest to the fact that women who can no longer access clinic-based services are going to Mexico to obtain misoprostol, where it is available in pharmacies without a prescription. Given the rapidly dwindling access to abortion providers in large swaths of the United States, this practice is likely to increase.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

But because the drug distribution system in the United States is well regulated, gaining access to the pills is more difficult than in countries in the Global South. And obtaining information about the correct use of misoprostol for abortion can also be challenging, particularly in states where abortion is stigmatized and providing information is outright illegal. There is a lot we can learn from the solid body of evidence and experience from across the globe to increase public knowledge about the correct and safe use of various abortion pills and to ensure women’s access to quality products even in extremely restrictive settings.

Misoprostol and Women’s Agency

Women have been having abortions since time immemorial. The criminalization of abortion, however, is a more recent phenomenon, dating back to the 19th century, and supported by patriarchal social norms linked to female domesticity and motherhood, and a desire to control female sexuality.

In this context, women’s self-care is nothing new. Women have been fighting systems designed to limit their rights and protect the status quo for centuries, and those women who are most likely to be ignored by health systems have advanced some of the most innovative strategies for meeting their own needs.

One key advance has been abortion with pills, also known as medication abortion. Misoprostol, a pill available over-the-counter in many countries, provides a safe, low-cost, and easy-to-use method to terminate early pregnancies. In fact, self-use of misoprostol for abortion began in the 1980s, when women in Brazil, living under very restrictive abortion laws, realized they could take advantage of the contraindications of an otherwise readily available drug. The label on Cytotec (the trade name for misoprostol), a drug sold over-the-counter in Brazil to treat gastric ulcers, included a warning that it might induce abortion in pregnant women. Recognizing that this could serve their needs when faced with an unwanted pregnancy, women in Brazil began to use it and passed on their knowledge through word-of mouth, woman-to-woman. Since then, word has spread widely across borders and continents, and we now have global evidence that misoprostol is being used by women in many countries where abortion is restricted, including the United States.

Since this discovery by women of the “other use” of misoprostol, much research has been done to prove the safety and efficacy of misoprostol for abortion. Misoprostol is very effective in the termination of early pregnancies—up to nine weeks—and has an efficacy rate of 85 percent. Numerous studies have shown that women can use this life-saving drug safely and effectively by themselves, provided they have accurate information about its use. Misoprostol is typically sold in tablets of 200 mcg; four tablets can be taken by mouth to initiate an early abortion, followed by four more pills every three hours for a maximum of three doses. (Gynuity Health Projects and Women on Waves have posted clear guidelines for how to use misoprostol on their websites.) When combined with another drug—mifepristone—the efficacy of complete abortion approaches 98 percent. But while mifepristone followed by misoprostol is now the “gold standard” in countries where medication abortion is available, its use is limited for self-care because mifepristone is only registered in countries where abortion is legal.

Sharing Accurate and Trusted Information

So what tools do women in the United States need to safely and successfully terminate an unintended pregnancy on their own? To begin, women need:

  • Accurate information about misoprostol—its efficacy, safety, and how its use can enable women to be active agents in securing their own reproductive health and autonomy.

  • Trusted networks of friends, family, health professionals, and others who can be relied on to provide accurate information.

  • Access to affordable supplies of quality misoprostol (and/or other safe abortion pills, such as mifepristone).

  • Access to back-up health care and support should they need or want it.

Imparting information about the correct use of misoprostol for abortion and how to obtain the pills can be challenging, particularly in places where abortion is stigmatized and/or outright illegal. Successful approaches that have been developed in other countries where abortion is restricted include:

  • Ensuring access to medication abortion information and drugs over the internet. Women on Web provides virtual counseling and mail delivery of medication abortion in countries where it is not accessible.

  • Demystifying and democratizing medication abortion by sharing information with women where they work, reside, and socialize. In Nepal, information is shared at women’s hair salons, factories where they live and work, and during soap operas aired over the radio.

  • Training community health workers to distribute medication abortion information and pills, thus reaching a wider range of women. In Kenya and Ethiopia, research has shown that community health workers are often a first and trusted access point for women.

  • Sharing women’s knowledge and expertise related to abortion. In the Philippines and Mexico, networks have been created to share women’s knowledge and provide support to others.

  • Creating hotlines to share information about multiple uses of misoprostol. Such hotlines—often used by young women who may prefer anonymity—have been set up in countries where abortion is restricted, like Chile, Ecuador, and Indonesia.

  • Using mHealth technologies to deliver information to women on medication abortion. In South Africa, Ipas is partnering with a technology-based solutions company to send free, informational SMS text messages to women who have chosen to have a medication abortion and want to receive support and follow-up information.

  • Establishing women-centered pharmacies where medication abortion is available and affordable. The Women’s Promotion Center in Tanzania set up its own pharmacy due to the lack of distribution sites in that country.

  • Educating journalists to document the harms of legal and social restrictions on abortion. In Nicaragua, a prize is awarded annually to journalists and social communication students for outstanding writing on the topic of abortion.

Adapting These Strategies for the United States

Many of these strategies could be adapted to assist women in the United States to take advantage of the benefits offered by misoprostol: its simplicity of use, its low cost, and, most important, the fact that women can take it themselves, without medical assistance. There are many opportunities for reproductive health and rights advocates to come together to ensure that women in the United States who use misoprostol (or other abortion pills) do so safely and effectively. Misoprostol has the potential to reduce the barriers to abortion care that we face in the United States today by facilitating women’s agency and autonomy.

The lessons from our sisters who have created networks of knowledge around misoprostol are there for us to learn from; the evidence on its efficacy is in. Are we ready to use these tools in the United States to give women what they need—to take matters into their own hands?

Analysis Abortion

From Webbed Feet to Breast Cancer, Anti-Choice ‘Experts’ Renew False Claims

Ally Boguhn & Amy Littlefield

In a series of workshops over a three-day conference in Herndon, Virginia, self-proclaimed medical and scientific experts renewed their debunked efforts to promote the purported links between abortion and a host of negative outcomes, including breast cancer and mental health problems.

Less than two weeks after the Supreme Court rejected the anti-choice movement’s unscientific claims about how abortion restrictions make patients safer, the National Right to Life Convention hosted a slate of anti-choice “experts,” who promoted even more dubious claims that fly in the face of accepted medical science.

In a series of workshops over the three-day conference in Herndon, Virginia, self-proclaimed medical and scientific experts, including several whose false claims have been exposed by Rewire, renewed their efforts to promote the purported links between abortion and a host of negative outcomes, including breast cancer and mental health problems.

Some of those who spoke at the convention were stalwarts featured in the Rewire series “False Witnesses,” which exposed the anti-choice movement’s attempts to mislead lawmakers, courts, and the public about abortion care.

One frequent claim, that abortion increases the risk of breast cancer, has been refuted by the National Cancer Institute, the American Cancer Society, and the American Congress of Obstetricians and Gynecologists. But that hasn’t stopped “experts” like Dr. Angela Lanfranchi, a breast cancer surgeon and anti-choice activist, from giving court testimonies and traveling around the world spreading that brand of misinformation.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

During a Thursday session titled “The Abortion-Breast Cancer Link: The Biological Basis, The Studies, and the Fraud,” Lanfranchi, one of Rewire’s “False Witnesses,” pushed her debunked talking points.

Throughout the presentation, which was attended by Rewire, Lanfranchi argued that there is “widespread fraudulent behavior among scientists and medical organizations to obfuscate the link” between abortion and breast cancer.

In a statement, the irony of which may have been lost on many in the room, Lanfranchi told attendees that sometimes “scientists in the pursuit of truth can be frauds.” Lanfranchi went on to point to numerous studies and texts she claimed supported her theories and lamented that over time, textbooks that had previously suggested a link between abortion and breast cancer in the ’90s were later updated to exclude the claim.

Lanfranchi later pivoted to note her inclusion in Rewire’s “False Witnesses” project, which she deemed an “attack.” 

“We were one of 14 people that were on this site … as liars,” said Lanfranchi as she showed a slide of the webpage. “Now when people Google my name, instead of my practice coming up,” Rewire’s story appears.

Priscilla Coleman, another “False Witness” best known for erroneously claiming that abortion causes mental health problems and drug abuse, similarly bemoaned her inclusion in Rewire’s project during her brief participation in a Thursday session, “The Conspiracy of Silence: Roadblocks to Getting Abortion Facts to the Public.”

After claiming that there is ample evidence that abortion is associated with suicide and eating disorders, Coleman suggested that many media outlets were blocking the truth by not reporting on her findings. When it came to Rewire, Coleman wrote the outlet off as a part of the “extreme left,” telling the room that “if you look deeply into their analysis of each of our backgrounds, a lot of it is lies … it’s bogus information.”

An extensive review conducted by the American Psychological Association in 2008, however, found “no evidence sufficient to support” claims such as Coleman’s that “an observed association between abortion history and mental health was caused by the abortion.”

Rounding out the medical misinformation pushed in that session was Eve Sanchez Silver, the director and founder of the International Coalition of Color for Life. According to the biography listed on her organization’s website, Silver bills herself as a “bioethicist” who focuses on “the Abortion-Breast cancer link.”

Silver, who previously worked at the Susan G. Komen Foundation but left, she said, after finding out the organization gave money to Planned Parenthood, spent much of her presentation arguing that abortion increases the risk of breast cancer. She also detailed what she referred to as the “Pink Money Cycle,” a process in which, as she explained, money is given to Komen, which in turn donates to Planned Parenthood. As Silver told it, Planned Parenthood then gives people abortions, leading to more cases of breast cancer. 

The seemingly conspiracy-driven theory has popped up in several of Silver’s presentations over the years.

Though Komen does in fact provide some funding to Planned Parenthood through grants, a July 2015 press release from the the breast cancer organization explains that it does “not and never [has] funded abortion or reproductive services at Planned Parenthood or any grantee.” Instead, the money Planned Parenthood receives from Komen “pays for breast health outreach and breast screenings for low-income, uninsured or under-insured individuals.”

On Saturday, another subject of Rewire’s “False Witnesses” series, endocrinologist Joel Brind, doubled down on his claims about the link between abortion and breast cancer in a workshop titled “New American Export to Asia: The Cover-Up of the Abortion-Breast Cancer Link.” 

Brind described the Indian subcontinent as the ideal place to study the purported link between abortion and breast cancer. According to Brind, “The typical woman [there] has gotten married as a teenager, started having kids right away, breastfeeds all of them, has lots of them, never smokes, never drinks, what else is she going to get breast cancer from? Nothing.”

When it came to research from Asia that didn’t necessarily support his conclusions about abortion and breast cancerBrind chalked it up to an international cover-up effort, “spearheaded, obviously, by our own National Cancer Institute.”

Although five states require counseling for abortion patients that includes the supposed link between abortion and breast cancer, Brind told Rewire that the link has become “the kind of thing that legislators don’t want to touch” because they would be going “against what all of these medical authorities say.” 

Brind also dedicated a portion of his presentation to promoting the purported cancer-preventing benefits of glycine, which he sells in supplement form through his company, Natural Food Science LLC. 

“If I sprain my ankle it doesn’t swell up, the injury will just heal,” Brind claimed, citing the supposed effects of glycine on inflammation. 

In a Thursday session on “the rise of the DIY abortion”, panelist Randall O’Bannon questioned the U.S. Food and Drug Administration’s (FDA) March update to regulations on mifepristone, a drug also known as RU-486 that is used in medical abortions. Noting that the drug is “cheap,” O’Bannon appeared to fret that the new regulations might make abortion more accessible, going on to claim that there could be “a push to make [the drug] available over the counter.”

O’Bannon claimed there are “documented safety issues” associated with the drug, but the FDA says mifepristone is “safe and effective.” A 2011 post-market study by the agency of those who have used the drug since its approval found that more than 1.5 million women had used it to end a pregnancy in the U.S. Of those women, just roughly 2,200 experienced an “adverse event.” According to the Association of Reproductive Health Professionals, mifepristone “is safer than acetaminophen,” aspirin, and Viagra.

Speculating that misoprostol, another drug used in medication abortions, was less effective than medical experts say, O’Bannon later suggested that more embryos would “survive” abortions, leading to an “increased numbers of births with children with club feet, webbed toes, and fingers [and] full and partial facial paralysis.”

According to the World Health Organization, “Available data regarding a potential risk of fetal abnormality after an unsuccessful medical abortion are limited and inconclusive.”

Commentary Media

David Daleiden Is Not an Investigative Reporter, Says New Legal Filing Confirming What We Knew Already

Sharona Coutts

An amicus brief filed in a federal court case provided an opportunity for journalists to state in clear terms why David Daleiden's claims to be an investigative reporter endanger the profession and its goal: to safeguard democracy by holding the powerful to account and keeping the public informed.

Last week, 18 of the nation’s preeminent journalists and journalism scholars put their names to a filing in a federal court case between the National Abortion Federation and the Center for Medical Progress, the sham nonprofit set up by anti-choice activist David Daleiden.

From the minute he released his deceptively edited videos, Daleiden has styled himself as a “citizen” or “investigative journalist.” Indeed, upon releasing the footage, Daleiden changed the stated purpose on the website of the Center for Medical Progress to be about investigative reporting instead of tissue brokering, as he had earlier claimed.

The amicus brief provided an opportunity for journalists to state in clear terms why David Daleiden’s claims to be an investigative reporter endanger the profession and its goal: to safeguard democracy by holding the powerful to account and keeping the public informed.

“By calling himself an ‘investigative journalist,’ Appellant David Daleiden does not make it so,” the journalists and academics wrote. “We believe that accepting Mr. Daleiden’s claim that he merely engaged in ‘standard undercover journalism techniques’ would be both wrong and damaging to the vital role that journalism serves in our society.”

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

The signatories included former and current professors and deans from the nation’s top journalism schools, who have collectively trained hundreds, if not thousands, of reporters. They included women and men with storied careers in investigative journalism, whose credentials to speak with authority about what journalism is and how we do it cannot be doubted.

Their message is clear: David Daleiden is not an investigative journalist, and what he did is, in fact, at odds with the fundamentals of our craft.

Daleiden’s motivation for claiming the status of an investigative reporter is clear. In order to avoid financial ruin and potential jail time, he seeks to cloak himself in the protection of the First Amendment, arguing that everything he did was in his capacity as a reporter, and that the Constitution protects him as a member of the free press.

In so doing, Daleiden threatens to inflict yet more damage than his campaigns have already done, this time to the field of journalism. For if the court were to accept Daleiden’s claims, it would be endorsing his message to the public—that journalists routinely lie, break the law, get people drunk in order to elicit information, and distort quotes and video footage so dramatically that people appear to be saying the exact opposite to what they said. What hope would reporters then have of preserving the already tenuous trust that the public places in our word and our work?

This is not the first time some of the nation’s most decorated reporters have carefully reviewed Daleiden’s claims and the techniques he used to gather the footage for his videos, and concluded that he is not a reporter.

Last month, the Columbia Journalism Review published an article titled “Why the undercover Planned Parenthood videos aren’t journalism,” which was based on the results of a collaboration between the Los Angeles Times and the University of California, Berkeley’s graduate program in journalism.

That study was led by Lowell Bergman, a legendary investigative reporter whose career over the past few decades has been symbiotic with the evolution of the field. Bergman’s team and the LA Times concluded that:

Daleiden, head of the Irvine-based Center for Medical Progress, and his associates contend that they were acting as investigative journalists, seeking to expose illegal conduct. That is one of their defenses in lawsuits brought by Planned Parenthood and other groups, accusing them of fraud and invasion of privacy.

But unpublicized footage and court records show that the activists’ methods were geared more toward political provocation than journalism.

The team found what we already knew: Daleiden and his co-conspirators attempted to plant phrases in their targets’ mouths in the hopes of making them sound bad, hoping to drum up “political pressure,” according to a memo obtained by Bergman’s group that Daleiden wrote to his supporters. The activists’ use of fraud was so extensive and enthusiastic, and their deliberate splicing of videos so manipulative and dishonest, that they in no way reflected the methods or goals of real reporters.

The brief submitted in the NAF lawsuit last week echoes these findings and resoundingly makes the same point: Daleiden is not an investigative reporter. The main arguments in the brief boil down to the following, which can be understood as the pillars of investigative journalism:

  • Reporters do not falsify or distort evidence. Daleiden spliced and manipulated his videos and transcripts to give the false impression that they captured illegal conduct. A reporter’s job is to uncover and convey the truth, not to concoct false claims and peddle them as facts.
  • Reporters must use deception as a last resort, not a first resort, if they use it at all. Any use of deception—even in the service of obtaining the truth—tends to undermine the public’s trust in any of the reporter’s work. For this reason, even investigations that have uncovered serious abuses of power are often criticized, if not condemned, by the profession if they have obtained their information through deceptive means. As the brief noted, in 1978, the Chicago Sun-Times was barred as a finalist from the Pulitzer Prize because the truth it exposed was obtained through elaborate deception—Sun-Times reporters opened a bar called The Mirage for the purposes of documenting very real public graft. No one doubted that the evidence they found was both true and of great public importance. But, led by Ben Bradlee, the journalism establishment rejected the Sun-Times’ use of deception because of the long-term damage it would cause to the profession.
  • Reporters follow the law. Daleiden and his co-conspirators created fake government identification which they used to gain access into private events. No legitimate news organization would permit their reporters to take such steps.
  • Reporters do not deceive subjects into making statements to support a “predetermined theory.” Daleiden used alcohol to try to manipulate subjects into using words and phrases that he believed would sound bad on tape. Real journalists try to report against their own biases, instead of manufacturing evidence to prove their own theories.
  • Reporters seek to highlight or prevent a harm to the public. Daleiden caused great harm but exposed none.

A point that wasn’t mentioned in the legal filings is that Daleiden failed to follow a rule that student journalists learn in their first weeks of school: You must afford the subject of your reporting a full opportunity to respond to the allegations made against them. Daleiden’s videos came as a surprise attack against Planned Parenthood and NAF (but not, apparently, to certain Republican members of Congress). No reputable reporter would conduct herself in such a fashion. That is an ambush, not an article.

To many readers, these arguments may seem academic. But the reality is that real reporters take their obligations more seriously than the public might realize, to the point of risking—and sometimes losing—their lives in the service of this job, which many consider to be a calling.

One of the best investigative reporters of my generation, A.C. Thompson of ProPublica, recently reported on a group of assassins that operated on U.S. soil in the 1980s, who murdered Vietnamese-American journalists for political reasons.

To report that story, Thompson attended events held by members of the groups he believed to be linked to—or were actual parts of—these networks of killers. He did phone interviews with them. He met with them in person. And he did all of that on camera, using his real name.

Make no mistake: Thompson potentially put his life at risk to do this work, but he did it because he believed that these men had been able to murder his fellow reporters with impunity, and with possible—if tacit—support from the U.S. government.

Contrast that to Daleiden’s conduct. As noted in the legal brief:

Daleiden may think Planned Parenthood kills babies, but there was no risk whatsoever that its managers would have killed him, or even slapped him, if he approached them openly.

Daleiden’s arguments are, in some ways, the natural extension to the existential crisis that gripped journalism more than a decade ago, with the rise of blogging. What followed was a years-long debate over who could be labeled a “journalist.” The dawn of smartphones contributed to the confusion, as nearly anyone could snap a photo and publish it via Twitter.

It is therefore a tonic to read these clear defenses of the “what” and “why” of investigative journalism, and to see luminaries of the field explaining that journalism is a discipline with norms and rules. When these norms are articulated clearly, it is easy to show that Daleiden’s work does not fall within journalism’s bounds.

At times like this, the absence of David Carr’s raspy voice makes itself painfully felt. One can only imagine the field day he would have with Daleiden’s pretensions to be committing acts of journalism. Judging by this legendary exchange between Carr and Shane Smith, one of the founders of VICE news, from Page One, the 2011 documentary about the New York Times, Carr would not have minced words.

The exchange came after Smith’s self-aggrandizing assessment of his team’s work covering Liberia—where they uncovered cannibalism and a beach that locals were using as a latrine—and then mocked the New York Times’ coverage of the country.

Here’s Carr:

Just a sec, time out. Before you ever went there, we’ve had reporters there reporting on genocide after genocide. Just because you put on a fucking safari helmet and went and looked at some poop doesn’t give you the right to insult what we do.

To paraphrase: Just because Daleiden got some hidden cameras and editing software, and called himself a reporter, doesn’t mean he was doing journalism.

It’s important that both the public and the courts recognize that reality.

Disclosures: A.C. Thompson is a former colleague of the author. The author also appeared, extremely briefly, in the Page One documentary.