Commentary Abortion

Sharing Information About Self-Inducing Abortions Made Me Feel Empowered

Andrea Grimes

I’m not sure I really knew what "empowered" meant until I realized I had information 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 World Health Organization protocols for misoprostol use.

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

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.

Analysis Abortion

Legislators Have Introduced 445 Provisions to Restrict Abortion So Far This Year

Elizabeth Nash & Rachel Benson Gold

So far this year, legislators have introduced 1,256 provisions relating to sexual and reproductive health and rights. However, states have also enacted 22 measures this year designed to expand access to reproductive health services or protect reproductive rights.

So far this year, legislators have introduced 1,256 provisions relating to sexual and reproductive health and rights. Of these, 35 percent (445 provisions) sought to restrict access to abortion services. By midyear, 17 states had passed 46 new abortion restrictions.

Including these new restrictions, states have adopted 334 abortion restrictions since 2010, constituting 30 percent of all abortion restrictions enacted by states since the U.S. Supreme Court decision in Roe v. Wade in 1973. However, states have also enacted 22 measures this year designed to expand access to reproductive health services or protect reproductive rights.

Mid year state restrictions

 

Signs of Progress

The first half of the year ended on a high note, with the U.S. Supreme Court handing down the most significant abortion decision in a generation. The Court’s ruling in Whole Woman’s Health v. Hellerstedt struck down abortion restrictions in Texas requiring abortion facilities in the state to convert to the equivalent of ambulatory surgical centers and mandating that abortion providers have admitting privileges at a local hospital; these two restrictions had greatly diminished access to services throughout the state (see Lessons from Texas: Widespread Consequences of Assaults on Abortion Access). Five other states (Michigan, Missouri, Pennsylvania, Tennessee, and Virginia) have similar facility requirements, and the Texas decision makes it less likely that these laws would be able to withstand judicial scrutiny (see Targeted Regulation of Abortion Providers). Nineteen other states have abortion facility requirements that are less onerous than the ones in Texas; the fate of these laws in the wake of the Court’s decision remains unclear. 

Ten states in addition to Texas had adopted hospital admitting privileges requirements. The day after handing down the Texas decision, the Court declined to review lower court decisions that have kept such requirements in Mississippi and Wisconsin from going into effect, and Alabama Gov. Robert Bentley (R) announced that he would not enforce the state’s law. As a result of separate litigation, enforcement of admitting privileges requirements in Kansas, Louisiana, and Oklahoma is currently blocked. That leaves admitting privileges in effect in Missouri, North Dakota, Tennessee and Utah; as with facility requirements, the Texas decision will clearly make it harder for these laws to survive if challenged.

More broadly, the Court’s decision clarified the legal standard for evaluating abortion restrictions. In its 1992 decision in Planned Parenthood of Southeastern Pennsylvania v. Casey, the Court had said that abortion restrictions could not impose an undue burden on a woman seeking to terminate her pregnancy. In Whole Woman’s Health, the Court stressed the importance of using evidence to evaluate the extent to which an abortion restriction imposes a burden on women, and made clear that a restriction’s burdens cannot outweigh its benefits, an analysis that will give the Texas decision a reach well beyond the specific restrictions at issue in the case.

As important as the Whole Woman’s Health decision is and will be going forward, it is far from the only good news so far this year. Legislators in 19 states introduced a bevy of measures aimed at expanding insurance coverage for contraceptive services. In 13 of these states, the proposed measures seek to bolster the existing federal contraceptive coverage requirement by, for example, requiring coverage of all U.S. Food and Drug Administration approved methods and banning the use of techniques such as medical management and prior authorization, through which insurers may limit coverage. But some proposals go further and plow new ground by mandating coverage of sterilization (generally for both men and women), allowing a woman to obtain an extended supply of her contraceptive method (generally up to 12 months), and/or requiring that insurance cover over-the-counter contraceptive methods. By July 1, both Maryland and Vermont had enacted comprehensive measures, and similar legislation was pending before Illinois Gov. Bruce Rauner (R). And, in early July, Hawaii Gov. David Ige (D) signed a measure into law allowing women to obtain a year’s supply of their contraceptive method.

071midyearstatecoveragetable

But the Assault Continues

Even as these positive developments unfolded, the long-standing assault on sexual and reproductive health and rights continued apace. Much of this attention focused on the release a year ago of a string of deceptively edited videos designed to discredit Planned Parenthood. The campaign these videos spawned initially focused on defunding Planned Parenthood and has grown into an effort to defund family planning providers more broadly, especially those who have any connection to abortion services. Since last July, 24 states have moved to restrict eligibility for funding in several ways:

  • Seventeen states have moved to limit family planning providers’ eligibility for reimbursement under Medicaid, the program that accounts for about three-fourths of all public dollars spent on family planning. In some cases, states have tried to exclude Planned Parenthood entirely from such funding. These attacks have come via both administrative and legislative means. For instance, the Florida legislature included a defunding provision in an omnibus abortion bill passed in March. As the controversy grew, the Centers for Medicare and Medicaid Services, the federal agency that administers Medicaid, sent a letter to state officials reiterating that federal law prohibits them from discriminating against family planning providers because they either offer abortion services or are affiliated with an abortion provider (see CMS Provides New Clarity For Family Planning Under Medicaid). Most of these state attempts have been blocked through legal challenges. However, a funding ban went into effect in Mississippi on July 1, and similar measures are awaiting implementation in three other states.
  • Fourteen states have moved to restrict family planning funds controlled by the state, with laws enacted in four states. The law in Kansas limits funding to publicly run programs, while the law in Louisiana bars funding to providers who are associated with abortion services. A law enacted in Wisconsin directs the state to apply for federal Title X funding and specifies that if this funding is obtained, it may not be distributed to family planning providers affiliated with abortion services. (In 2015, New Hampshire moved to deny Title X funds to Planned Parenthood affiliates; the state reversed the decision in 2016.) Finally, the budget adopted in Michigan reenacts a provision that bars the allocation of family planning funds to organizations associated with abortion. Notably, however, Virginia Gov. Terry McAuliffe (D) vetoed a similar measure.
  • Ten states have attempted to bar family planning providers’ eligibility for related funding, including monies for sexually transmitted infection testing and treatment, prevention of interpersonal violence, and prevention of breast and cervical cancer. In three of these states, the bans are the result of legislative action; in Utah, the ban resulted from action by the governor. Such a ban is in effect in North Carolina; the Louisiana measure is set to go into effect in August. Implementation of bans in Ohio and Utah has been blocked as a result of legal action.

071midyearstateeligibilitytable

The first half of 2016 was also noteworthy for a raft of attempts to ban some or all abortions. These measures fell into four distinct categories:

  • By the end of June, four states enacted legislation to ban the most common method used to perform abortions during the second trimester. The Mississippi and West Virginia laws are in effect; the other two have been challenged in court. (Similar provisions enacted last year in Kansas and Oklahoma are also blocked pending legal action.)
  • South Carolina and North Dakota both enacted measures banning abortion at or beyond 20 weeks post-fertilization, which is equivalent to 22 weeks after the woman’s last menstrual period. This brings to 16 the number of states with these laws in effect (see State Policies on Later Abortions).
  • Indiana and Louisiana adopted provisions banning abortions under specific circumstances. The Louisiana law banned abortions at or after 20 weeks post-fertilization in cases of diagnosed genetic anomaly; the law is slated to go into effect on August 1. Indiana adopted a groundbreaking measure to ban abortion for purposes of race or sex selection, in cases of a genetic anomaly, or because of the fetus’ “color, national origin, or ancestry”; enforcement of the measure is blocked pending the outcome of a legal challenge.
  • Oklahoma Gov. Mary Fallin (R) vetoed a sweeping measure that would have banned all abortions except those necessary to protect the woman’s life.

071midyearstateabortionstable

In addition, 14 states (Alaska, Arizona, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Maryland, South Carolina, South Dakota, Tennessee and Utah) enacted other types of abortion restrictions during the first half of the year, including measures to impose or extend waiting periods, restrict access to medication abortion, and establish regulations on abortion clinics.

Zohra Ansari-Thomas, Olivia Cappello, and Lizamarie Mohammed all contributed to this analysis.

News Law and Policy

Texas Could Be Next to Give Police Hate Crime Protections

Teddy Wilson

Police officers have shot and killed 165 people in Texas since the start of 2015. Of those, 35 were Black men, 12 of whom were unarmed. There were 2 officers killed by firearms in Texas in 2015.

Texas Gov. Greg Abbott (R) announced Monday that he would ask the state legislature to pass a law classifying acts of violence committed against law enforcement officers as hate crimes, mimicking a similar measure passed by Louisiana lawmaker.

Abbott said in a statement that the proposal is intended to send a message.

“At a time when law enforcement officers increasingly come under assault simply because of the job they hold, Texas must send a resolute message that the State will stand by the men and women who serve and protect our communities,” Abbott said.

Abbott will ask the GOP-held Texas legislature to pass the Police Protection Act during the upcoming 2017 legislative session, which convenes in January. The proposal would extend hate crime protections to law enforcement officers.

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Abbott’s proposal would increase criminal penalties for any crime against a law enforcement officer, regardless of whether or not the crime qualifies as a hate crime. The proposal would create a campaign to “educate young Texans on the value law enforcement officers bring to their communities.”

Abbott’s proposal comes in the wake of a shooting in Dallas that left five police officers dead, and six others injured. Micah Xavier Johnson targeted police officers during a peaceful Black Lives Matter protest, before he was killed by law enforcement.  

Police officers killed at least 1,146 people in the United States in 2015, according to the Guardian’s database The Counted. Police officers have shot and killed 165 people in Texas since the start of 2015. Of those, 35 were Black men, 12 of whom were unarmed, according to the Guardian’s database. There were two officers killed by gunfire in Texas in 2015, according to the National Law Enforcement Officers Memorial Fund (NLEOMF).

Police in Texas have shot and killed 53 people so far in 2016, per the Guardian‘s database.

The Dallas shooting increased the urgency of calls to increase the penalties for violence against law enforcement.

U.S. Sen. John Cornyn (R-TX) introduced similar legislation in Congress, designed to make killing a police officer a federal crime. Cornyn said in a statement that police officers protect communities and deserve “unparalleled support.”

Louisiana Gov. John Bel Edwards (D) in May signed into law the so-called Blue Lives Matter bill, which amended the state’s hate crime law to include acts of violence against any “law enforcement officer, firefighter, or emergency medical services personnel.”

Proponents of laws creating more penalties for crimes against law enforcement claim these measures are needed because of a growing threat of targeted violence against law enforcement. Data shows that violence against law enforcement has declined to historically low levels, while killings of civilians by police officers have risen dramatically.

Violent attacks on law enforcement officers are lower under President Obama than they have been under the previous four presidential administrations, according to the Washington Post’s analysis of data from the Officers Down Memorial Page.

During the Reagan presidency, there was an average of 101 law enforcement officers intentionally killed per year; during the George H.W. Bush administration, there was an average of 90 police killed per year; during the Clinton years, there was an average of 81 police killings annually; and during George W. Bush’s presidency, there was an average of 72 police killings via stabbings, gunfire, bombings, and vehicular assault per year.

There have been an average of 62 law enforcement officers killed annually during Obama’s seven and a half years in the White House.

The number of Texans who died during the course of an arrest almost doubled from 2005 to 2015, according to an analysis of state data by the Dallas Morning News. The increase in deaths coincided with a 20 percent reduction in the number of arrests statewide.

Matt Simpson, a policy strategist at the ACLU of Texas, told the Dallas Morning News that the number of deaths during arrests in Texas add to the evidence of systemic racism within the justice system.

“We have pretty strong evidence in a variety of ways that the criminal justice system is disproportionate,” Simpson said. “These numbers are unfortunately stark reminders.”