I bought the good boxed wine last fall when I invited my friends over to my place to learn the World Health Organization’s protocols for inducing safe abortion with misoprostol. Hell, I even broke out my special glasses from Pier One. Somebody brought fancy cheese. As we curled up on my living room’s puffy white sectional and started discussing our bodies, we could have passed for one of those yogurt commercials where people are always talking in stilted euphemisms about bowel irregularity. Instead, we were chatting about self-induced abortions.
Abortions in theory, you understand. I don’t tell people that they should induce safe abortions on their own outside of a legal abortion facility, or instruct them in how they, personally, can do so. That is illegal.
What I do tell people is that the World Health Organization has publicly made available information that explains how a pregnant person might induce an abortion using misoprostol, a drug with a variety of other medical uses, including treating ulcers in humans and arthritis in dogs. I share those WHO protocols—again, totally, publicly available information—with people who want to learn them.
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In addition to the wine and cheese, I also set out a little bowl of mini-M&M’s so my friends could better understand how the WHO protocols would work. A person would put four misoprostol pills—about the size of those M&M’s, but hexagonal—in the little pocket between their tongue and the bottom of their mouth, and they would wait half an hour for those pills to dissolve. Three hours later, they would do the same with another four pills, and one more time, three hours later, the same again.
The woman who taught me the WHO guidelines for inducing abortion with “miso,” right down to the M&Ms, has traveled around the world sharing them with people living in countries where abortion is illegal: Indonesia, Tanzania, Thailand, Turkey. Now, Laura—not her real name—has turned her attention to Texas.
Laura told me that what makes her especially “nutty” is that America has gone so far backward on abortion rights in her lifetime. “I really, really, really never thought it would get this bad,” she said.
But it is bad, and it’s getting worse. In Texas, abortion access is already mostly limited to people who live in or can travel to major metropolitan areas and who can afford to make two separate trips to a legal provider, because the state requires people seeking abortion care to get an ultrasound 24 hours before their procedure.
Just one legal abortion provider remains in Texas’ Rio Grande Valley—hanging on by a very thin shoestring. People who live in West Texas and the panhandle are now often closer to the few clinics in New Mexico and Oklahoma than to the ones in the state. As for East Texas, my fingers are crossed, probably in vain, in the hopes that Louisiana’s viciously anti-choice lawmakers don’t shutter the few remaining clinics in that state—frequently easier than the ones in Houston or Dallas for rural East Texans to access.
This most recent series of attacks on Texans’ bodily autonomy began back in 2011. That’s when lawmakers first proposed mandatory ultrasounds and a $70 million cut to family planning funds. I was sure, at the time, that they’d never really go through with it. But they did. According to university researchers, those cuts to family planning providers shuttered a quarter of the state’s reproductive health-care clinics that served low-income populations.
By 2013, when Texas anti-choice lawmakers promised not to pass any new abortion legislation, I had learned to be far more skeptical. Turns out, I was right to be. That’s the year we got HB 2, despite the fact that thousands of orange-clad Texans turned up at the state capitol to protest a bill that our own then Lt. Gov. David Dewhurst hailed as a way to shutter all but a few legal Texas abortion facilities. Before the law passed that year, Texas had more than 40 abortion providers. Today, we have 16. If HB 2 goes into full effect, that number will be cut in half, leaving just eight facilities to serve a state with a population of 26 million.
What I’m saying is that I’ve felt helpless for a long time now, and I think a lot of Texans who care about reproductive health have too. Helpless to stem the tide of anti-choice legislation that continues here today, even after so much damage has already been done. Helpless to talk sense into anti-choice lawmakers who believe abortion causes breast cancer, or that HPV vaccines will make teenagers promiscuous, or that trans people should be put in jail for using a public bathroom. Just weeks into this year’s legislative session, lawmakers have already proposed more anti-choice bills than there are remaining legal abortion facilities in Texas.
And Texans themselves have been rendered helpless by policies that harm them by the millions, because anti-choice lawmakers are singularly focused on catering to a small base of highly conservative primary voters.
According to the University of Texas’ Texas Policy Evaluation Project (TxPEP), more than 1.9 million Texans will live more than 50 miles from an abortion facility if HB 2 goes into full effect. That’s scary enough, but consider this: State lawmakers’ cuts to family planning funds ushered in a 54 percent reduction in clients served between 2011 and 2013. By the numbers, that means “pro-life” lawmakers effectively took contraception out of the hands of about 178,000 people.
Remarkably, opposition from our state’s most powerful leaders hasn’t stopped us from fighting for what we believe in. To the contrary, I think more Texans than ever are involved in the battle not only for abortion access, but for issues that span the reproductive justice spectrum: Medicaid expansion, better prenatal care, and birthing rights. We know we’re starting a long journey, but it’s a really tough one. I won’t sugarcoat that.
Even though I’ve spent years protesting anti-choice laws, writing about Texans who can’t access the medical care they need, and raising money for abortion funds, the day that I learned the WHO protocols for inducing safe abortion with misoprostol marked the first day I hadn’t felt totally frustrated in a long, long time. Finally, I didn’t feel like there was a towering pink granite building standing in the way of progress, of bodily autonomy, of…freedom.
I don’t care if that sounds dramatic or hyperbolic. It was fucking incredible. When I walked out of that first training seminar on miso, I was literally shaking. I talked a mile a minute to my husband, words tumbling out of my mouth with confused excitement, trying to parse this new, unfamiliar feeling: empowerment.
Feminists use that word a lot. We talk about empowering ourselves to make our own decisions about when and whether to have a family. We talk about empowering ourselves in the workplace. We talk about empowering ourselves to speak out against harassment and rape culture. But I’m not sure I really knew what that word meant until I realized I had knowledge that no ALEC-fueled lawmaker could take away from me—or from the dozens of other Texans who are now spreading the word about the WHO protocols for miso.
It’s happening in living rooms across the state, but particularly in the Rio Grande Valley, where Latinas have modified a “training” model into a “knowledge-sharing” model, passing along the WHO’s information to their family and friends. Now, they’re inspiring others—including me—to do the same.
I won’t pretend like the idea of learning WHO protocols for self-inducing a pregnancy termination didn’t sound a little scary at first. So much of how even pro-choice folks talk about self-induction echoes well-founded, decades-old fears about coat hangers, knitting needles, and bleach douches. But miso, according to the WHO protocols, is different. In clinical medication abortion care, doctors prescribe a combination of miso and a drug called mifepristone to induce abortion. Miso can work on its own, though, and it’s only slightly less effective than the combination.
Just hearing about miso as a possibility felt revolutionary to me. As soon as I could, I rounded up my closest friends for a knowledge-sharing session at home in Austin. I made modifications of my own to the training documents: I edited the gendered language in the instructions as much as possible, to better accommodate trans and genderqueer folks who don’t identify as women but who might need abortions.
After we grasped the basics of the protocols, we practiced repeating them and role-playing how to share them with others using non-instructive language—a task that seemed kind of embarrassing at first, but I nagged my friends through it. Before long, we had our scripts down pat.
I need to be clear: The absolute first thing I want, and what I work for every day as a journalist who writes about reproductive justice issues, is for legal abortion to be accessible and affordable on demand for everyone who needs it. I believe in a single-payer health system that funds the contraception, prenatal care, maternity care, post-natal care, and abortion care of a pregnant person’s choosing.
But I also live in Texas, where state lawmakers are actively trying to overturn Roe v. Wade. Because of this, I let people know that the WHO information exists and that it is a medically sound, evidence-based protocol. I am always careful not to advise people directly to use miso; I don’t want to break the law, and neither do others who share the WHO protocols. In Texas, assisting someone in obtaining an illegal abortion is a felony—though we can be thankful that the law prevents pregnant people themselves from being prosecuted for attempting to induce an abortion on their own.
Texans deserve this information, though. Texas’ broken social safety net makes it almost impossible for low-income people to support the pregnancies, and children, they do want to have. But no matter why any Texan needs abortion care—and I, unlike our anti-choice lawmakers, trust Texans to be able to make family planning decisions for themselves—many can’t make it to a legal abortion facility for medical services. And anyone who is willing to accept reality knows that ending legal abortion care will not end abortion itself.
That much is clear from the work that Laura has done around the world: People who don’t want to be pregnant will try to find a way. They may not be successful, and they may hurt or even kill themselves in the process, but they will try.
Knowing that, I consider it a moral imperative to share the WHO protocols with whoever wants to learn. It’s not about actually using misoprostol; it’s about knowing it’s possible.
My friend Rachel, who came over last fall for that miso session, said she left the knowledge-sharing meetup at my house with a “fulfilling, empowering kind of feeling.”
“I was having wine and hanging out with my friends, it was normal,” she told me.
And that feeling of normalcy—of destigmatizing talk about abortion—even spread into other areas of our lives. After we talked about the WHO protocols and topped off our wine glasses, another friend half-jokingly raised her hand and ventured: “I have a stupid question. What happens if you have an IUD and you need an abortion?”
Of course, it’s not a stupid question, and if you can’t take a dive into the world of Dr. Google over wine and cheese with your friends, when can you? Here we were, a room full of feminists who, either in our volunteer time or professional capacities, do all kinds of work on reproductive health care. And we finally felt able to ask the questions we’d been afraid to ask elsewhere.
Soon, we were commiserating over our wide range of experiences trying to get contraception in Texas. We were telling ridiculous stories about bad sex and good sex and love and doctors who did, and didn’t, understand our needs. We talked about our abortions and our miscarriages, our ambivalence—or not—about having kids.
I thought I knew those four friends pretty well before we learned about misoprostol together, but after that night, I felt closer than ever to all of them. I’m accustomed to spaces of resistance and defensiveness bringing folks together: It’s easy, and even fun, to bond over being angry at lawmakers who don’t trust Texans with their own bodies.
But nothing compares to the feeling of solidarity that came from learning together, from being proactive, from feeling like we were finally able to do something other than fight against. I felt like we were finally fighting for.