Analysis Abortion

Changing the Way People Think About Self-Induced Abortions

Andrea Grimes

As reproductive health-care access diminishes in Texas, more women are coming together to share information about the drug misoprostol and the protocols for its use to induce abortions.

Click here to read more of Rewire‘s coverage of the World Health Organization protocols for misoprostol’s use to induce abortions.

It costs less than a dollar to walk across the bridge to Nuevo Progreso, a small Mexican town just outside of McAllen, Texas, that caters to what locals call “snow birds”—mostly white Texan retirees, who drive their RVs and campers down south to warm up in the winter time and take advantage of the affordable prices in Mexican drugstores.

Driving across isn’t much more expensive; parking on the narrow streets is really the hard part. Huge, warehouse-style markets sell everything from shot glasses, to rocking chairs, to blue jeans, to life-size metal parrots that make for some fantastic patio decor. Many also include pharmacies in the rear of the store. They accept American dollars and most of the clerks speak English. If they don’t, it’s easy enough to communicate by writing a note or showing a prescription slip.

The day I walked over to Nuevo Progreso with my husband, it was pouring. The sidewalks of the town were soaked, and we dodged puddles and gutter-showers looking for a place to grab some chips and salsa and a couple micheladas. The streets were busy, despite the weather, but plenty of folks had settled into the cantina inside the main drag’s sprawling market.

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Once we were inside too, I approached the man behind the counter of the pharmacy. “Cytoteca?” I asked, using the brand name for misoprostol.

The pharmacist didn’t blink an eye, telling me it was $128. I didn’t go there to haggle, but I couldn’t help myself—I’d heard reports that pharmacies sold misoprostol for about a third of that.

“That’s too much!” I said.

He shrugged, pointing to a box on the shelf behind him. “The generic? Miso? Only $40.”

It would cost $40 for 28 200-milligram misoprostol pills—enough, according to the World Health Organization (WHO) protocols for its use, to induce two pregnancy terminations.

When most people think of self-induced abortions, at least here in the United States, they probably think of the decades-old, pre-Roe v. Wade horror stories, involving back alleys and coat hangers. But these pills, available from Mexican pharmacies for a tenth of the cost of a clinical abortion, are changing the way people talk and think about the procedure.

Miso’s History as an Abortifacient

Misoprostol—commonly referred to as miso—is in a class of medicines called prostaglandins. It’s an anti-ulcer medication with a variety of medical indications, and it’s often used to treat people who have arthritis. Obstetricians also use it in labor and delivery to soften the cervix and reduce hemorrhaging.

“The action of all the prostaglandins is to cause cervical maturation or softening or opening of the cervix as well as uterine contractions,” explained Dr. Dan Grossman, a gynecologist, abortion provider, and researcher with Ibis Reproductive Health in San Francisco. But, Grossman told me, it’s also “kind of unique among the prostaglandins because it’s orally active. It can be taken as a pill.” Other prostaglandins need to be given by injection.

Miso pills are, according to Dr. Grossman, also “very stable.” They aren’t especially sensitive to heat, and they don’t need to be refrigerated. They’re also affordable.

And, Grossman said, if it’s taken in the correct dosage by the right means, misoprostol is “among the most effective ways” to end early pregnancy “if a person doesn’t have access to a clinic-based abortion.”

Because of this, doctors and researchers have long advocated for the use of misoprostol for pregnancy termination as a harm reduction strategy—a term that public health experts use to describe efforts to reduce the negative consequences of certain human behaviors, in this case self-induced abortions—in countries where abortion is illegal and, as a result, severe complications and mortality rates from abortion attempts are very high.

But it wasn’t doctors and medical researchers who first began spreading the word that miso could be used to safely induce abortion when and where legal clinical options weren’t available; it was South American women.

Misoprostol became available over-the-counter in Brazil in 1986, and women there quickly realized it could be used as an abortifacient. According to the World Health Organization, “women’s use of misoprostol in Brazil decreased the severity of unsafe abortion complications, and to some extent also decreased the number of women admitted to hospital.”

The drug has advantages over more invasive means of self-induction. When not performed by a professional with sterilized instruments, inserting foreign bodies through the vagina into the cervix carries a significant risk of infection and perforation of the internal organs.

Miso use, according to the WHO protocols, carries an extremely low complication rate when it is taken by people who don’t have IUDs, who can confirm they are less than 12 weeks pregnant, and who know they do not have contra-indicating medical conditions that may cause them to bleed excessively. Still, the WHO cautions that people who use misoprostol to induce abortion should not do so alone, and should not do so if they cannot travel to a hospital within a couple of hours in case of complications.

The WHO guidelines advise that the medication can be taken in three doses of four pills, spaced three hours apart. The pills are dissolved under the tongue. A person who takes the medication this way may expect to have a low-grade fever, nausea and vomiting, or diarrhea in addition to cramps and, in 80 to 90 percent of cases, the termination of their pregnancy.

Misoprostol use according to WHO protocols is nearly undetectable, and its effects mirror that of spontaneous abortion, or miscarriage, which happens in an estimated 10 to 20 percent of known pregnancies. In countries where people can be prosecuted for attempting to self-induce abortions, those who can present at a doctor’s office or emergency room with the symptoms of a miscarriage can more easily escape detection by the authorities than those who may have remnants of objects left behind inside their bodies.

“While there’s a very small chance of excessive bleeding, similar to a miscarriage, usually the worst thing that can happen is it doesn’t work,” said Laura (not her real name), who has traveled around the world sharing the WHO’s protocols for misoprostol use for inducing abortion in places where clinical abortion care is illegal or inaccessible.

Laura has recently turned her attention to Texas, in part because of the state’s draconian laws that have severely reduced abortion care access in recent years. While the WHO protocols for miso-induced abortions are “not a panacea for the whole country,” Laura told me, the availability of reliably sourced medication in Mexico makes Texans uniquely positioned to be able to access a self-induction method that is more effective than herbal teas and supplements and far less risky than doing violence to their own bodies by inserting foreign objects into their vaginas, getting partners to punch them in their stomachs, or using bleach or turpentine douches. Laura told me she considers it an “ethical obligation” to share the WHO protocols with Texans.

Laura shared the WHO protocols with me last year. The work she does sharing this information is totally legal—as legal as sharing a recipe for cupcakes, or a pattern for a dress. The information itself is publicly available. She did not provide miso to me, or tell me that I—or anyone—should use the protocols to induce abortion. She is careful to impart all the information in a restrained, passive, third-person voice, and she advises others to do the same.

Diminishing Options

Today, self-induced abortion is “rare,” according to Dr. Grossman, who, along with his colleagues at Ibis and the University of Texas Policy Evaluation Project, has conducted some of the country’s leading research on self-induction and misoprostol use, particularly in Texas.

A 2008 nationally representative survey by Dr. Rachel Jones at the Guttmacher Institute estimated that about 2.6 percent of abortion patients seeking clinical abortion care had reported “ever taking something to self-induce abortion.” But in Texas, the frequency of self-induction attempts appears to be higher: In a 2012 study that Grossman and his colleagues conducted in the state, 7 percent of abortion patients reported trying to end their current pregnancies on their own before going to a clinic. In South Texas’ Rio Grande Valley, that number was 12 percent. Most of those women reported using herbal means to attempt to end their pregnancies; miso use was the second most common method reported.

According to the study:

The confluence of extremely limited access to abortion in the context of poverty, access to misoprostol from Mexico, as well as familiarity with the practice of self-induction in Latin America, makes it particularly likely that self-induction will become more commonplace in Texas.

Indeed, people living in the Rio Grande Valley, one of the most economically strained areas of the country, have long lacked access to a range of affordable health-care options, including abortion care. Today, just one reproductive health clinic remains there, open only because federal judges have allowed the Whole Woman’s Health facility in McAllen to temporarily provide abortion care.

Certainly, said Grossman, “some of these women are being forced to do this on their own because they can’t [access clinical abortion care].”

“If any women are [self-inducing abortion], that’s too many women,” Grossman told Rewire. “Women should be able to access safe, high-quality affordable services in a clinical facility if they want to do that.”

Unfortunately, that is not the reality throughout the country. While Roe may have made abortion legal, it did not guarantee that it would be affordable or accessible. And with the passage of the Hyde Amendment just three years after Roe in 1976, lawmakers blocked Medicaid funding for abortion care and made it even harder to obtain for the poorest Americans.

This has become even more true in recent years, as lawmakers draw on model legislation—specifically targeted at abortion providers—written for them by anti-choice groups like Americans United for Life and designed to make abortion care very, very difficult to access.

Texas’ omnibus anti-abortion law, HB 2, is the granddaddy of all such laws. HB 2, which Gov. Rick Perry signed in the summer of 2013, bans abortion after 20 weeks, severely restricts the prescription of medication abortion, requires doctors who provide abortion care to have admitting privileges at local hospitals, and mandates that abortion facilities operate as hospital-like ambulatory surgical centers. Before the law passed, Texas had more than 40 abortion providers. Today, it has a little more than a dozen.

If Texas’ law goes into full effect—it’s currently partially tied up in federal court—the state will have just eight legal abortion providers, located in the four major metropolitan areas in the eastern half of the state. In fact, Texans have already had a glimpse at what that will look like. For a few days in October 2014, the state was able to fully enforce HB 2’s provisions. Overnight, all but a handful of clinics were forced to close their doors. Now, Texans await a federal ruling on the law in the Fifth Circuit Court of Appeals, and legal experts expect the case to ultimately be resolved at the Supreme Court.

In the meantime, Texans are going to incredible lengths to obtain legal abortion care and help others do the same. Texas has three abortion funds—the Lilith Fund, the Texas Equal Access (TEA) Fund, and the West Fund—whose activists work on the ground to help Texans pay for their abortions, in addition to Jane’s Due Process, which assists minors in acquiring a judicial bypass. Others help to fund the gas cards, bus tickets, and hotel rooms they often need in addition to their procedures. For example, Fund Texas Choice (FTC), a nonprofit that helps Texans pay for transportation and lodging costs to travel to legal abortion facilities, reported in February that it hears from 50 or so Texans per month who need help accessing legal abortion.

But FTC and its ilk can only do so much to help, and people seeking abortion care may be limited by their availability to get off work, find child care, or travel out of state. In December, FTC was only able to plan travel for four clients; in January, that number was 18.

When Texans cannot access clinical abortion care, some will have no choice but to carry their pregnancies to term. Others will seek out non-clinical methods of ending their pregnancies. Misoprostol could be a game-changer for those Texans, not only because of its affordability and availability, but because it takes a tremendously important family planning decision out of the domineering control of anti-choice lawmakers and puts it back in the hands of pregnant Texans themselves.

While he clearly advocates for legal, clinical abortion care and access to same, Grossman was frank about the fact that “maybe many women would prefer” to use misoprostol themselves. “The reality is that it may be empowering,” said Grossman, for some people to self-induce abortion, as long as they understand contra-indicators and other prerequisites for being able to take misoprostol safely.

But, said Grossman, in the pro-choice community, “it’s hard to talk about the whole range of views on this topic.”

That’s been my experience, as well—the specter of the back-alley abortion looms large, understandably so, when people speak out against abortion restrictions like the ones in Texas.

Legal abortion care, particularly first-trimester abortion care, is very safe—whether it’s a medication abortion prescribed by a health professional or a surgical abortion performed by one.

Contrast that with the number of people who died from complications resulting from illegal abortions before Roe: Though the actual numbers are impossible to know, the most reliable estimates calculate that anywhere between 5,000 and 10,000 people died per year before the landmark Supreme Court case. This is likely one of the major reasons that many people associate self-induced abortions with danger; they have often led to complications, even death.

The most frequently referenced method of such self-inductions is, of course, the coat hanger, a chilling reminder of the danger and desperation surrounding abortion care before 1973. But it was far from the only one: “Almost any implement you can imagine had been and was used to start an abortion—darning needles, crochet hooks, cut-glass salt shakers, soda bottles, sometimes intact, sometimes with the top broken off,” wrote retired gynecologist Waldo Fielding in the New York Times in 2008.

Pro-choice activists, doctors, and lawmakers often say that anti-choice legislation will merely drive abortion care into back alleys, and to the kinds of dangerous methods described above. That is, in the overwhelming majority of cases, true. But miso could be an exception.

It wasn’t until I learned the WHO protocols myself that I shifted my thinking on self-induced abortion and came to believe that, though it may be trite to say, knowledge is power when it comes to being able to safely end a pregnancy, despite intrusive laws that block access to abortion care.

And power—political power, particularly—is something Texans who believe in safe abortion care haven’t had in a long time.

“This Is About Bodily Autonomy”

Even the most radical folks I spoke with for this story didn’t tell me that they believe miso is automatically the answer to the growing problem of abortion inaccessibility in the United States. Most people said they believed access to clinical abortion is a fundamental human right; that clinical abortion care should be more, not less, accessible; and that it should be fully funded by the government for anyone who needs it. But that dream is a long way from being realized anywhere in the United States, and especially in Texas.

Miso isn’t available to folks who can’t cross the border—that includes unauthorized Texans who can no more travel to Mexico than they can San Antonio, beyond an interior border patrol checkpoint—or who don’t know someone who can.

And it’s difficult for someone to know whether they’re getting the right medication unless they’ve purchased it directly from a pharmacy, which means people who can’t easily cross the border—whether they live in North Texas or Cleveland or New Orleans—must gamble on ordering medication online. Beyond that, it’s simply illegal to possess miso in the United States without a prescription. And breaking the law is breaking the law. Particularly for people of color, and especially for unauthorized residents, falling afoul of law enforcement is a terrible risk.

So far, authorities have reported making just one arrest related to the sale or possession of misoprostol in Texas—of a woman in South Texas who sold abortion-inducing medication at a flea market, in addition to other illegally obtained medications.

No one—and I mean no one—I spoke to for this story told me they believe breaking the law to self-induce abortion is the first, best option for ending an unwanted pregnancy. Everyone I spoke to emphasized their desire to see increased availability and accessibility for legal abortion care. Many volunteer as clinic escorts, helping shield patients from anti-choice protestors who would harass and shame them. They believe, passionately, in clinical abortion care. They also know it simply isn’t an option for some Texans.

The people, particularly Latinas, who are working to spread information about the WHO protocols for misoprostol in Texas are also some of the Texans who are doing the most work, both in the capitol and on the ground, to combat Texas’ oppressive anti-abortion law and to help Texans access legal abortion.

Melissa Arjona, a reproductive justice activist who lives in the Rio Grande Valley, shares the WHO protocols with small groups in her community and, like me, learned the protocols from Laura last year.

“It’s a good thing, being next to Mexico, because you hear about people ordering pills in the mail and you don’t know if it’s real or not,” she said. “Here, it’s really easy access, it’s something that allows people to take it into their own hands.”

The complicated reality is that for some people, using misoprostol to induce abortion outside of a clinical setting is a safe, affordable, and accessible alternative to traveling what can sometimes be hundreds of miles to the nearest abortion provider, where even a medication abortion prescription can run into the several hundreds of dollars. This isn’t true everywhere; pills purchased online or on the black market from distributors who may not know (or care) whether they’re selling the real thing can be ineffective at best and dangerous, even potentially fatal, at worst.

But pharmacies on the Mexican side of the southern U.S. border sell the real thing—packaged by the manufacturers—for a fraction of the price of a clinical abortion.

Those Mexican pharmacies have often been demonized in the press when it comes to the subject of abortion—one report claimed that Texans would be “lured” across the border to purchase abortion pills, as if a nefarious, moustachioed villain lay in wait across the Rio Grande. (When I crossed, the only thing that really came close to “luring” me in was the cheap beer.)

In Texas, many abortion providers have stopped prescribing medication abortion—a combination of mifepristone and misoprostol—because the new law requires the drug combination be administered according to 13-year-old FDA guidelines that are limited by a smaller gestational-use window, and less effective than newer, evidence-based regimens.

This essentially leaves Texans seeking legal abortion with one option: surgical procedures. And looking at that $40 box of miso in Nuevo Progreso, I could easily see why someone who couldn’t pay for a $400 surgical procedure at the Valley’s last remaining abortion provider, or an overnight trip to San Antonio to the next-closest legal clinic—assuming they could pass through one of the interior border patrol checkpoints that dot South Texas highways—might opt for these pills, especially as more people in the region learn about them.

Before she learned the WHO protocols, Melissa Arjona told me that it was “kind of scary to think about pills being used that way,” but once she learned about the safety of miso—”backed up by the actual WHO”—she found the information gave her a kind of strength.

“You can give out the information without potentially harming people because the risks are the same as a miscarriage,” she said—excessive bleeding is a potential complication of any miscarriage, whether induced with misoprostol or spontaneous, and infection could potentially occur as a consequence. (For context: The risk of death from childbirth is about 14 times higher than from clinic-provided surgical abortion early in pregnancy.)

She may not have a medical background, and Arjona is careful to emphasize that she’s just “sharing information,” but in a state where tens of thousands of people may soon live hundreds of miles from the closest legal abortion provider, she may also be saving lives by giving Texans the knowledge that their options may not be as limited as anti-choice lawmakers would want to make them. Simply knowing it’s possible to self-induce with miso, said Arjona, is “a lot more empowering.”

So far, Arjona estimates that she’s shared the information with around 100 people, and has developed, along with her fellow Valley activists, a knowledge-sharing model tailored to the needs and culture of their community. She doesn’t use an instructive “training” model; instead, she invites friends and neighbors to join her in their homes for conversations about the WHO protocols.

They may be talking about abortion, said Arjona, but the bigger picture is much more important: “This is about bodily autonomy.”

Analysis Law and Policy

After ‘Whole Woman’s Health’ Decision, Advocates Should Fight Ultrasound Laws With Science

Imani Gandy

A return to data should aid in dismantling other laws ungrounded in any real facts, such as Texas’s onerous "informed consent” law—HB 15—which forces women to get an ultrasound that they may neither need nor afford, and which imposes a 24-hour waiting period.

Whole Woman’s Health v. Hellerstedt, the landmark U.S. Supreme Court ruling striking down two provisions of Texas’ omnibus anti-abortion law, has changed the reproductive rights landscape in ways that will reverberate in courts around the country for years to come. It is no longer acceptable—at least in theory—for a state to announce that a particular restriction advances an interest in women’s health and to expect courts and the public to take them at their word.

In an opinion driven by science and data, Justice Stephen Breyer, writing for the majority in Whole Woman’s Health, weighed the costs and benefits of the two provisions of HB 2 at issue—the admitting privileges and ambulatory surgical center (ASC) requirements—and found them wanting. Texas had breezed through the Fifth Circuit without facing any real pushback on its manufactured claims that the two provisions advanced women’s health. Finally, Justice Breyer whipped out his figurative calculator and determined that those claims didn’t add up. For starters, Texas admitted that it didn’t know of a single instance where the admitting privileges requirement would have helped a woman get better treatment. And as for Texas’ claim that abortion should be performed in an ASC, Breyer pointed out that the state did not require the same of its midwifery clinics, and that childbirth is 14 times more likely to result in death.

So now, as Justice Ruth Bader Ginsburg pointed out in the case’s concurring opinion, laws that “‘do little or nothing for health, but rather strew impediments to abortion’ cannot survive judicial inspection.” In other words, if a state says a restriction promotes women’s health and safety, that state will now have to prove it to the courts.

With this success under our belts, a similar return to science and data should aid in dismantling other laws ungrounded in any real facts, such as Texas’s onerous “informed consent” law—HB 15—which forces women to get an ultrasound that they may neither need nor afford, and which imposes a 24-hour waiting period.

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In Planned Parenthood v. Casey, the U.S. Supreme Court upheld parts of Pennsylvania’s “informed consent” law requiring abortion patients to receive a pamphlet developed by the state department of health, finding that it did not constitute an “undue burden” on the constitutional right to abortion. The basis? Protecting women’s mental health: “[I]n an attempt to ensure that a woman apprehends the full consequences of her decision, the State furthers the legitimate purpose of reducing the risk that a woman may elect an abortion, only to discover later, with devastating psychological consequences, that her decision was not fully informed.”

Texas took up Casey’s informed consent mantle and ran with it. In 2011, the legislature passed a law that forces patients to undergo a medical exam, whether or not their doctor thinks they need it, and that forces them to listen to information that the state wants them to hear, whether or not their doctor thinks that they need to hear it. The purpose of this law—at least in theory—is, again, to protect patients’ “mental health” by dissuading those who may be unsure about procedure.

The ultra-conservative Fifth Circuit Court of Appeals upheld the law in 2012, in Texas Medical Providers v. Lakey.

And make no mistake: The exam the law requires is invasive, and in some cases, cruelly so. As Beverly McPhail pointed out in the Houston Chronicle in 2011, transvaginal probes will often be necessary to comply with the law up to 10 to 12 weeks of pregnancy—which is when, according to the Guttmacher Institute, 91 percent of abortions take place. “Because the fetus is so small at this stage, traditional ultrasounds performed through the abdominal wall, ‘jelly on the belly,’ often cannot produce a clear image,” McPhail noted.

Instead, a “probe is inserted into the vagina, sending sound waves to reflect off body structures to produce an image of the fetus. Under this new law, a woman’s vagina will be penetrated without an opportunity for her to refuse due to coercion from the so-called ‘public servants’ who passed and signed this bill into law,” McPhail concluded.

There’s a reason why abortion advocates began decrying these laws as “rape by the state.”

If Texas legislators are concerned about the mental health of their citizens, particularly those who may have been the victims of sexual assault—or any woman who does not want a wand forcibly shoved into her body for no medical reason—they have a funny way of showing it.

They don’t seem terribly concerned about the well-being of the woman who wants desperately to be a mother but who decides to terminate a pregnancy that doctors tell her is not viable. Certainly, forcing that woman to undergo the painful experience of having an ultrasound image described to her—which the law mandates for the vast majority of patients—could be psychologically devastating.

But maybe Texas legislators don’t care that forcing a foreign object into a person’s body is the ultimate undue burden.

After all, if foisting ultrasounds onto women who have decided to terminate a pregnancy saves even one woman from a lifetime of “devastating psychologically damaging consequences,” then it will all have been worth it, right? Liberty and bodily autonomy be damned.

But what if there’s very little risk that a woman who gets an abortion experiences those “devastating psychological consequences”?

What if the information often provided by states in connection with their “informed consent” protocol does not actually lead to consent that is more informed, either because the information offered is outdated, biased, false, or flatly unnecessary given a particular pregnant person’s circumstance? Texas’ latest edition of its “Woman’s Right to Know” pamphlet, for example, contains even more false information than prior versions, including the medically disproven claim that fetuses can feel pain at 20 weeks gestation.

What if studies show—as they have since the American Psychological Association first conducted one to that effect in 1989—that abortion doesn’t increase the risk of mental health issues?

If the purpose of informed consent laws is to weed out women who have been coerced or who haven’t thought it through, then that purpose collapses if women who get abortions are, by and large, perfectly happy with their decision.

And that’s exactly what research has shown.

Scientific studies indicate that the vast majority of women don’t regret their abortions, and therefore are not devastated psychologically. They don’t fall into drug and alcohol addiction or attempt to kill themselves. But that hasn’t kept anti-choice activists from claiming otherwise.

It’s simply not true that abortion sends mentally healthy patients over the edge. In a study report released in 2008, the APA found that the strongest predictor of post-abortion mental health was prior mental health. In other words, if you’re already suffering from mental health issues before getting an abortion, you’re likely to suffer mental health issues afterward. But the studies most frequently cited in courts around the country prove, at best, an association between mental illness and abortion. When the studies controlled for “prior mental health and violence experience,” “no significant relation was found between abortion history and anxiety disorders.”

But what about forced ultrasound laws, specifically?

Science has its part to play in dismantling those, too.

If Whole Woman’s Health requires the weighing of costs and benefits to ensure that there’s a connection between the claimed purpose of an abortion restriction and the law’s effect, then laws that require a woman to get an ultrasound and to hear a description of it certainly fail that cost-benefit analysis. Science tells us forcing patients to view ultrasound images (as opposed to simply offering the opportunity for a woman to view ultrasound images) in order to give them “information” doesn’t dissuade them from having abortions.

Dr. Jen Gunter made this point in a blog post years ago: One 2009 study found that when given the option to view an ultrasound, nearly 73 percent of women chose to view the ultrasound image, and of those who chose to view it, 85 percent of women felt that it was a positive experience. And here’s the kicker: Not a single woman changed her mind about having an abortion.

Again, if women who choose to see ultrasounds don’t change their minds about getting an abortion, a law mandating that ultrasound in order to dissuade at least some women is, at best, useless. At worst, it’s yet another hurdle patients must leap to get care.

And what of the mandatory waiting period? Texas law requires a 24-hour waiting period—and the Court in Casey upheld a 24-hour waiting period—but states like Louisiana and Florida are increasing the waiting period to 72 hours.

There’s no evidence that forcing women into longer waiting periods has a measurable effect on a woman’s decision to get an abortion. One study conducted in Utah found that 86 percent of women had chosen to get the abortion after the waiting period was over. Eight percent of women chose not to get the abortion, but the most common reason given was that they were already conflicted about abortion in the first place. The author of that study recommended that clinics explore options with women seeking abortion and offer additional counseling to the small percentage of women who are conflicted about it, rather than states imposing a burdensome waiting period.

The bottom line is that the majority of women who choose abortion make up their minds and go through with it, irrespective of the many roadblocks placed in their way by overzealous state governments. And we know that those who cannot overcome those roadblocks—for financial or other reasons—are the ones who experience actual negative effects. As we saw in Whole Woman’s Health, those kinds of studies, when admitted as evidence in the court record, can be critical in striking restrictions down.

Of course, the Supreme Court has not always expressed an affinity for scientific data, as Justice Anthony Kennedy demonstrated in Gonzales v. Carhart, when he announced that “some women come to regret their choice to abort the infant life they once created and sustained,” even though he admitted there was “no reliable data to measure the phenomenon.” It was under Gonzales that so many legislators felt equipped to pass laws backed up by no legitimate scientific evidence in the first place.

Whole Woman’s Health offers reproductive rights advocates an opportunity to revisit a host of anti-choice restrictions that states claim are intended to advance one interest or another—whether it’s the state’s interest in fetal life or the state’s purported interest in the psychological well-being of its citizens. But if the laws don’t have their intended effects, and if they simply throw up obstacles in front of people seeking abortion, then perhaps, Whole Woman’s Health and its focus on scientific data will be the death knell of these laws too.

Analysis Politics

The 2016 Republican Platform Is Riddled With Conservative Abortion Myths

Ally Boguhn

Anti-choice activists and leaders have embraced the Republican platform, which relies on a series of falsehoods about reproductive health care.

Republicans voted to ratify their 2016 platform this week, codifying what many deem one of the most extreme platforms ever accepted by the party.

“Platforms are traditionally written by and for the party faithful and largely ignored by everyone else,” wrote the New York Times‘ editorial board Monday. “But this year, the Republicans are putting out an agenda that demands notice.”

“It is as though, rather than trying to reconcile Mr. Trump’s heretical views with conservative orthodoxy, the writers of the platform simply opted to go with the most extreme version of every position,” it continued. “Tailored to Mr. Trump’s impulsive bluster, this document lays bare just how much the G.O.P. is driven by a regressive, extremist inner core.”

Tucked away in the 66-page document accepted by Republicans as their official guide to “the Party’s principles and policies” are countless resolutions that seem to back up the Times‘ assertion that the platform is “the most extreme” ever put forth by the party, including: rolling back marriage equalitydeclaring pornography a “public health crisis”; and codifying the Hyde Amendment to permanently block federal funding for abortion.

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Anti-choice activists and leaders have embraced the platform, which the Susan B. Anthony List deemed the “Most Pro-life Platform Ever” in a press release upon the GOP’s Monday vote at the convention. “The Republican platform has always been strong when it comes to protecting unborn children, their mothers, and the conscience rights of pro-life Americans,” said the organization’s president, Marjorie Dannenfelser, in a statement. “The platform ratified today takes that stand from good to great.”  

Operation Rescue, an organization known for its radical tactics and links to violence, similarly declared the platform a “victory,” noting its inclusion of so-called personhood language, which could ban abortion and many forms of contraception. “We are celebrating today on the streets of Cleveland. We got everything we have asked for in the party platform,” said Troy Newman, president of Operation Rescue, in a statement posted to the group’s website.

But what stands out most in the Republicans’ document is the series of falsehoods and myths relied upon to push their conservative agenda. Here are just a few of the most egregious pieces of misinformation about abortion to be found within the pages of the 2016 platform:

Myth #1: Planned Parenthood Profits From Fetal Tissue Donations

Featured in multiple sections of the Republican platform is the tired and repeatedly debunked claim that Planned Parenthood profits from fetal tissue donations. In the subsection on “protecting human life,” the platform says:

We oppose the use of public funds to perform or promote abortion or to fund organizations, like Planned Parenthood, so long as they provide or refer for elective abortions or sell fetal body parts rather than provide healthcare. We urge all states and Congress to make it a crime to acquire, transfer, or sell fetal tissues from elective abortions for research, and we call on Congress to enact a ban on any sale of fetal body parts. In the meantime, we call on Congress to ban the practice of misleading women on so-called fetal harvesting consent forms, a fact revealed by a 2015 investigation. We will not fund or subsidize healthcare that includes abortion coverage.

Later in the document, under a section titled “Preserving Medicare and Medicaid,” the platform again asserts that abortion providers are selling “the body parts of aborted children”—presumably again referring to the controversy surrounding Planned Parenthood:

We respect the states’ authority and flexibility to exclude abortion providers from federal programs such as Medicaid and other healthcare and family planning programs so long as they continue to perform or refer for elective abortions or sell the body parts of aborted children.

The platform appears to reference the widely discredited videos produced by anti-choice organization Center for Medical Progress (CMP) as part of its smear campaign against Planned Parenthood. The videos were deceptively edited, as Rewire has extensively reported. CMP’s leader David Daleiden is currently under federal indictment for tampering with government documents in connection with obtaining the footage. Republicans have nonetheless steadfastly clung to the group’s claims in an effort to block access to reproductive health care.

Since CMP began releasing its videos last year, 13 state and three congressional inquiries into allegations based on the videos have turned up no evidence of wrongdoing on behalf of Planned Parenthood.

Dawn Laguens, executive vice president of Planned Parenthood Action Fund—which has endorsed Hillary Clinton—called the Republicans’ inclusion of CMP’s allegation in their platform “despicable” in a statement to the Huffington Post. “This isn’t just an attack on Planned Parenthood health centers,” said Laguens. “It’s an attack on the millions of patients who rely on Planned Parenthood each year for basic health care. It’s an attack on the brave doctors and nurses who have been facing down violent rhetoric and threats just to provide people with cancer screenings, birth control, and well-woman exams.”

Myth #2: The Supreme Court Struck Down “Commonsense” Laws About “Basic Health and Safety” in Whole Woman’s Health v. Hellerstedt

In the section focusing on the party’s opposition to abortion, the GOP’s platform also reaffirms their commitment to targeted regulation of abortion providers (TRAP) laws. According to the platform:

We salute the many states that now protect women and girls through laws requiring informed consent, parental consent, waiting periods, and clinic regulation. We condemn the Supreme Court’s activist decision in Whole Woman’s Health v. Hellerstedt striking down commonsense Texas laws providing for basic health and safety standards in abortion clinics.

The idea that TRAP laws, such as those struck down by the recent Supreme Court decision in Whole Woman’s Health, are solely for protecting women and keeping them safe is just as common among conservatives as it is false. However, as Rewire explained when Paul Ryan agreed with a nearly identical claim last week about Texas’ clinic regulations, “the provisions of the law in question were not about keeping anybody safe”:

As Justice Stephen Breyer noted in the opinion declaring them unconstitutional, “When directly asked at oral argument whether Texas knew of a single instance in which the new requirement would have helped even one woman obtain better treatment, Texas admitted that there was no evidence in the record of such a case.”

All the provisions actually did, according to Breyer on behalf of the Court majority, was put “a substantial obstacle in the path of women seeking a previability abortion,” and “constitute an undue burden on abortion access.”

Myth #3: 20-Week Abortion Bans Are Justified By “Current Medical Research” Suggesting That Is When a Fetus Can Feel Pain

The platform went on to point to Republicans’ Pain-Capable Unborn Child Protection Act, a piece of anti-choice legislation already passed in several states that, if approved in Congress, would create a federal ban on abortion after 20 weeks based on junk science claiming fetuses can feel pain at that point in pregnancy:

Over a dozen states have passed Pain-Capable Unborn Child Protection Acts prohibiting abortion after twenty weeks, the point at which current medical research shows that unborn babies can feel excruciating pain during abortions, and we call on Congress to enact the federal version.

Major medical groups and experts, however, agree that a fetus has not developed to the point where it can feel pain until the third trimester. According to a 2013 letter from the American Congress of Obstetricians and Gynecologists, “A rigorous 2005 scientific review of evidence published in the Journal of the American Medical Association (JAMA) concluded that fetal perception of pain is unlikely before the third trimester,” which begins around the 28th week of pregnancy. A 2010 review of the scientific evidence on the issue conducted by the British Royal College of Obstetricians and Gynaecologists similarly found “that the fetus cannot experience pain in any sense prior” to 24 weeks’ gestation.

Doctors who testify otherwise often have a history of anti-choice activism. For example, a letter read aloud during a debate over West Virginia’s ultimately failed 20-week abortion ban was drafted by Dr. Byron Calhoun, who was caught lying about the number of abortion-related complications he saw in Charleston.

Myth #4: Abortion “Endangers the Health and Well-being of Women”

In an apparent effort to criticize the Affordable Care Act for promoting “the notion of abortion as healthcare,” the platform baselessly claimed that abortion “endangers the health and well-being” of those who receive care:

Through Obamacare, the current Administration has promoted the notion of abortion as healthcare. We, however, affirm the dignity of women by protecting the sanctity of human life. Numerous studies have shown that abortion endangers the health and well-being of women, and we stand firmly against it.

Scientific evidence overwhelmingly supports the conclusion that abortion is safe. Research shows that a first-trimester abortion carries less than 0.05 percent risk of major complications, according to the Guttmacher Institute, and “pose[s] virtually no long-term risk of problems such as infertility, ectopic pregnancy, spontaneous abortion (miscarriage) or birth defect, and little or no risk of preterm or low-birth-weight deliveries.”

There is similarly no evidence to back up the GOP’s claim that abortion endangers the well-being of women. A 2008 study from the American Psychological Association’s Task Force on Mental Health and Abortion, an expansive analysis on current research regarding the issue, found that while those who have an abortion may experience a variety of feelings, “no evidence sufficient to support the claim that an observed association between abortion history and mental health was caused by the abortion per se, as opposed to other factors.”

As is the case for many of the anti-abortion myths perpetuated within the platform, many of the so-called experts who claim there is a link between abortion and mental illness are discredited anti-choice activists.

Myth #5: Mifepristone, a Drug Used for Medical Abortions, Is “Dangerous”

Both anti-choice activists and conservative Republicans have been vocal opponents of the Food and Drug Administration (FDA’s) March update to the regulations for mifepristone, a drug also known as Mifeprex and RU-486 that is used in medication abortions. However, in this year’s platform, the GOP goes a step further to claim that both the drug and its general approval by the FDA are “dangerous”:

We believe the FDA’s approval of Mifeprex, a dangerous abortifacient formerly known as RU-486, threatens women’s health, as does the agency’s endorsement of over-the-counter sales of powerful contraceptives without a physician’s recommendation. We support cutting federal and state funding for entities that endanger women’s health by performing abortions in a manner inconsistent with federal or state law.

Studies, however, have overwhelmingly found mifepristone to be safe. In fact, the Association of Reproductive Health Professionals says mifepristone “is safer than acetaminophen,” aspirin, and Viagra. When the FDA conducted a 2011 post-market study of those who have used the drug since it was approved by the agency, they found that more than 1.5 million women in the U.S. had used it to end a pregnancy, only 2,200 of whom had experienced an “adverse event” after.

The platform also appears to reference the FDA’s approval of making emergency contraception such as Plan B available over the counter, claiming that it too is a threat to women’s health. However, studies show that emergency contraception is safe and effective at preventing pregnancy. According to the World Health Organization, side effects are “uncommon and generally mild.”