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New Texas abortion law must change how we think about 'illegal' abortions

Thanks to medication abortion, people in Texas and elsewhere can have safe, self-managed abortions at home — legal or not.

On Wednesday, the Supreme Court refused to block a near-total abortion ban in Texas in a 5-4 decision. The ban, which outlaws abortions after about six weeks’ gestation — before most people even know they’re pregnant — allows citizens who “whistleblow” on anyone they believe has provided an abortion or helped someone obtain an abortion past that time period to collect a payout of $10,000.

Saying illegal abortions are “unsafe” is not only incorrect in many cases, but detrimental to pregnant Texas women who are desperately seeking abortion services.

The ruling essentially guts Roe v. Wade, the landmark 1973 Supreme Court ruling that legalized abortion throughout the country. That has understandably given rise to a narrative warning that “people won’t stop having abortions, they’ll just stop having safe abortions,” and as a consequence, “women will die.” While this was certainly true prior to Roe v. Wade — an estimated 200 people died every year from “back alley” abortions before the procedure was legal — it is unequivocally wrong now.

Thanks to medication abortion, people in Texas and elsewhere can and are able to have safe, self-managed abortions at home — legal or not. Saying illegal abortions are “unsafe” is not only incorrect in many cases, but detrimental to pregnant Texas women who are desperately seeking abortion services in the wake of these clearly unconstitutional bans. Instead of using an outdated talking point to discuss what we all stand to lose as a result of abortion bans like the one in Texas, we should be pointing people to reputable and safe networks that can help them access the care they need in the long-honored American tradition of civil disobedience.

Medication abortion has been available in the U.S. since 2000 and is approved for use to up to 10 weeks gestation. Currently, over one-third of all abortions at eight weeks’ gestation or less are medication abortions. And unlike a surgical abortion that is administered in a clinical setting, having medication that induces an abortion sent directly to a patient’s home does not require a long drive to a clinic or a flight out of state; days off work or finding child care; a walk past angry, often violent protesters; and lodging in order to acquiesce to a mandatory waiting period in which patients must wait 24 to 72 hours between their first visit to an abortion provider and their actual procedure time.

The most common medication abortion method in the United States is a two-drug regimen using mifepristone and misoprostol, according to Dr. Ghazaleh Moayedi, an OB-GYN, Texas abortion provider and Physicians for Reproductive Health board member. Mifepristone temporarily blocks the actions of progesterone in the body, preventing the pregnancy from continuing to grow. And the second medication, misoprostol, causes the cervix to soften and the uterus to cramp and push the pregnancy out.

“This process can be thought of as inducing a miscarriage,” said Moayedi, who noted that numerous studies have shown that abortion medication is extremely safe. It can be sent directly to patients via the mail and, if necessary, explained via telemedicine. When Moayedi started working in abortion care 17 years ago, she said, about 20 to 30 percent of eligible people requested medication abortion. “Today, about 50 to 60 percent of eligible patients choose mediation abortion, and even more would if there were less restrictions on obtaining it in Texas,” she said.

Emily O'Brien, 28, told me that because of targeted restrictions on abortion providers, or TRAP laws, that had passed in her state of Indiana, medication abortion was not only cheaper but more convenient. “I loved having the privacy to have my abortion alone, in the comfort of my own home and where I felt safe,” she said. “I loved having the flexibility to ‘begin’ the abortion at my personal convenience.” She added that since medication abortions are considerably cheaper than surgical abortions in Indiana, without the medication option, “I don’t know if I would have been able to have an abortion at all due to lack of funds.”

Another woman who used at-home medication for her abortion, Lindsey Bluher, said that when she found out she was pregnant at 26, she was absolutely sure she wanted to get an abortion — but unsure which method to use. “I had had a surgical abortion a few years prior and felt I knew what to expect from that method,” she recalled. But she ultimately went with medication the second time. “I didn't want to have to ask someone to pick me up, and I wanted to handle it completely on my own.”

Currently, OB-GYNs and abortion providers are allowed to dispense medication abortion to people pregnant up to 10 weeks, though a 2008 study found the use of medication abortion to be safe and effective well into the second trimester. A 2017 study published in the journal Obstetrics & Gynecologyshowed how safe medication abortion is when sent to a patient via the mail and administered outside of a clinical setting.

Now 32 states require clinicians who administer medication abortion to be physicians, and 19 states require a clinician providing a medication abortion to be physically present when the medication is administered. Along with the near-total abortion ban, Texas Republican lawmakers are pushing through additional anti-abortion legislation that would limit access to medication abortion.

While the loss of the constitutional right to access abortion care before most people know they’re pregnant is undoubtedly alarming — and calls for all of us to raise our voices in opposition — there are better ways to speak truth to power than fearmongering about the safety of the abortion choices that women now face.

“Abortion procedures and medications remain safe whether or not abortion is legal,” Moayedi noted. “Tying abortion safety to to abortion legality works to further stigmatize abortion providers and people seeking abortion care.”