Poverty, geography, and rapidly dwindling access to abortion care are driving an increasing share of Texan women seeking abortion to self-induce, according to a first-of-its-kind study of the prevalence of self-induced abortion from the Texas Policy Evaluation Project.
The study found that between 100,000 and 240,000 Texas women of reproductive age have attempted to end a pregnancy on their own without medical assistance. Based on a comparison with earlier data, the findings of this study suggest that the incidence of self-induced abortion may be proportionally higher in Texas than among women in the rest of the country.
There are two factors behind this finding. One, a large share of Latina women live along the U.S.-Mexico border and have relatively easy access to the abortion inducing drug misoprostol, which is available over the counter in Mexico and has long been widely used by women in that country and throughout Central and South America to self-induce abortion. Two, rapidly declining access to clinic-based abortion care and other forms of reproductive health care in Texas have so increased the burden of getting timely access to care that women are giving up and turning to self-induction.
The study was based on a controlled statewide representative sample of women in Texas between 18 to 49 years of age to determine the extent of women’s knowledge, opinions, and experiences related to self-induced abortion.
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Data were collected during a period in which an increasing share of U.S. women seeking to terminate a pregnancy opted for medication abortion—a method that when administered properly has been proven very safe and effective especially early in pregnancy—and in which legislatures in many states passed medically indefensible restrictions on abortion care leading to a sharp decline in access to services.
In 2013, for example, the Texas legislature passed a law known as HB 2, which includes among other provisions the requirements that doctors who provide abortions have admitting privileges at local hospitals and that all clinics providing abortion be constructed to comply with the regulations governing ambulatory surgical centers. As a result of HB 2, the number of clinics in Texas has declined from 41 to 18, and may well drop precipitously again depending on the outcome of a challenge to the law now before the Supreme Court.
The American College of Obstetricians and Gynecologists, along with numerous other medical bodies, have protested these rules in court as medically unnecessary.
The range of estimates on the number of women of reproductive age in Texas who have attempted self-induced abortion results from tools used to best elicit responses on subjects like abortion where women have been made to feel shame or stigma, and may therefore be less likely to self-report. Researchers asked women taking the survey to report on their own, and on their best friends’ attempts to self-induce. Overall, 1.7 percent of women surveyed reported they had ever tried to end a pregnancy on their own, resulting in the low estimate of 100,000 women in Texas. Asked about their best friends, 1.8 percent of women said they were certain their best friend had attempted to self-induce and 2.3 percent said they suspected a best friend of self-inducing. Taken together, the “best friends data” results in the higher estimate.
The researchers found that Latina women living in a county bordering Mexico and women confronting cost, physical, or other barriers to reproductive health care (including birth control, Pap smears, and other services) were more likely than other groups to have attempted to self-induce or know someone who attempted to self-induce.
Despite the high rates of self-induction, 13 percent of women in the survey said they had heard of misoprostol, a drug that may be used on its own or together with mifepristone in the combination drug known as RU-486. Women reported knowing people who had used herbs or homeopathic remedies, alcohol or illicit drugs, or higher doses of hormonal pills, or who had attempted to abort through getting hit or punched in the abdomen on purpose by themselves or others.
The researchers asked women about their opinions on self-induced abortion. Only 13 percent of those surveyed stated that self-induced abortion should be against the law and women should be prosecuted for it. By contrast, 34 percent of women stated that while they themselves were against abortion, they understood “why a woman would try this.” More than 25 percent stated it should not be against the law for a woman to end a pregnancy on her own.
The authors state that “criminalization of [abortion care] is not supported by Texas women of reproductive age.”
The Texas Policy Evaluation Project (TxPEP) is a consortium including researchers from the University of Texas at Austin’s Population Research Center; Advancing New Standards in Reproductive Health (ANSIRH) at the University of California, San Francisco; Ibis Reproductive Health; and the University of Alabama-Birmingham.
“This is the latest body of evidence demonstrating the negative implications of laws like HB2 that pretend to protect women but in reality place them, and particularly women of color and economically disadvantaged women, at significant risk,” Dr. Daniel Grossman, a TxPEP co-investigator and professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco, said in a statement. “As clinic-based care becomes harder to access in Texas, we can expect more women to feel that they have no other option and take matters into their own hands.”
The researchers conducted interviews with women who had attempted to self-induce an abortion in recent years in Texas. They stated:
[A] common thread among these women was that poverty layered upon one or more additional obstacles left them feeling that they had no other option. Almost all of the women interviewed contacted or considered contacting a clinic at some point during their abortion process. While there was no one reason that exclusively drove women to this outcome, four primary reasons for self-induction included: financial constraints to travel to a clinic or to pay for the procedure, local clinic closures, recommendation from a close friend or family member to self-induce, or efforts to avoid the stigma or shame of going to an abortion clinic, especially if they had had prior abortions.
The United States Supreme Court is considering Whole Woman’s Health v. Cole to decide the fate of HB 2. Should the Court decide to uphold the law, Texas will be left with ten abortion clinics in a state with 5.4 million women of reproductive age, and leave 500 miles between San Antonio and the New Mexico border without a single clinic.