Misoprostol, Malta, and DIY abortions.

What women really think about news, politics, and culture.
Jan. 18 2011 10:26 AM

The DIY Abortion

Two new studies on how American women end their own pregnancies.

Woman looking at pregnancy test. Click image to expand.

Back in 1971, Carol Downer helped pioneer a method of early abortion known as "menstrual extraction." With abortion still illegal in most states, she and other self-helpers became underground feminist heroes by teaching women how to use a little plastic contraption to suction each other's uteruses. (And for the most part, they managed to avoid punishment—though Downer was arrested for practicing medicine without a license by treating another woman's yeast infection, a charge she beat with what was dubbed the "yogurt defense.")

After Roe v. Wade, interest in self-help abortion methods inevitably faded, and Downer became a lawyer. But lately, at age 77, she has found herself pulled back into the world of do-it-yourself reproductive care. "There is a new surge of interest," says Downer, who serves on the board of the Feminist Women's Health Centers of California and was recently visited by a carful of women driving around the country giving out hundreds of speculums.

News reports offer sadder evidence that self-induced abortions continue and may even be on the rise. There was Amber Abreu, the Massachusetts teenager arrested in 2007 for taking misoprostol, an ulcer medication which causes uterine contractions and which is used by doctors, in tandem with mifepristone (RU-486), to induce medical abortions early in pregnancy. She delivered a tiny infant who survived for four days. (Stories in Mother Jones and elsewhere have speculated that since misoprostol is now widely available online, many women may be using it as Abreu did, to induce their own abortions.) And in 2009, the Western Journal of Emergency Medicine published the case study of a 24-year-old who had actually used a coat hanger to abort (she wound up needing a hysterectomy) while a young woman in Utah made headlines when she paid a guy $150 to beat her until she miscarried.

Since we hear about do-it-yourself abortions only when they end badly, it's hard to know how common they are. But thanks to two recent studies, we now know a little more about the usually silent group of American women who try to end their own pregnancies. Both studies found that a small fraction of the women surveyed had attempted to abort without the help of traditional medical practitioners. The first one, published in the current issue of the American Journal of Obstetrics & Gynecology, surveyed 9,493 women at health care facilities that provide abortions and found that more than 2 percent had tried to induce abortions on their own. Meanwhile, a smaller study, published in the current issue of Reproductive Health Matters, surveyed 1,425 women in clinic waiting rooms and found that 4.6 percent had tried to induce their own abortions.

Both groups of researchers say it's hard to know how many people self-induce: As private as women are about abortion generally, those who try it on their own are likely to be downright secretive. It's also worth noting that both studies drew their participants from medical settings, precisely the environment that women who self-induce might be trying to avoid. But whatever their true numbers, the Reproductive Health Matters study offers a glimpse at these women's motivations via in-depth interviews with 30 women who admitted trying to induce their own abortions.

One 16-year-old said she had tried to self-abort because she didn't want her mother to know. Other women said they avoided clinics because of previous bad experiences. Still others couldn't get to a clinic. One-third of the women cited financial concerns. (The study's authors note that, as of 2005, an abortion at 10 weeks averaged more than $400.) One woman who hemorrhaged and wound up in the hospital after taking misoprostol every day for 45 days said: "If I knew all this would happen, I probably still would do it. … I didn't have the money." Another group of women simply found self-induction preferable to a clinic abortion—easier, faster, more in keeping with religious views. (Some said self-induction was, morally speaking, closer to getting one's period than to an "abortion.") Others suggested that it was "more natural."                                              

The preference for natural—or at least natural-seeming—methods seems in keeping with a broader enthusiasm for holistic health. While the researchers began their studies because they were interested in misoprostol use, the study in the American Journal of Obstetrics & Gynecology found that less than half the women who self-aborted used it. According to the smaller study, most women instead tried to end their own pregnancies with a range of other methods, including various herbs, vitamin C, birth control pills, laxatives, and a beverage cart worth of strange concoctions, including coffee with lemon, warm Coca-Cola with baking soda, various syrups, and Malta, a wheat soda.

While the studies don't address how women came up with their methods, the Internet seems, unsurprisingly, to play a key role, with two detailed guides to do-it-yourself abortions appearing online in recent years. The first, published by an amateur herbalist who goes by Sister Zeus, offers a "library of forbidden knowledge." Sister Zeus, whom I interviewed by e-mail but who declined to give her real name (presumably for legal reasons), says she has counseled more than 1,000 women about herbal "fertility control" over the past few years. In spite of her name, she is a cautious guide, encouraging readers to access mainstream abortions if they can. ("Sometimes clinics offer payment plans," she notes helpfully.) Those who aren't deterred are repeatedly encouraged to use herbs such as blue and black cohosh, pennyroyal, and dong quai with caution.

The other guide, Natural Liberty: Rediscovering Self-Induced Abortion Methods, covers methods beyond herbs, including menstrual extraction (the suction-based technique Downer taught), homeopathy, acupuncture, yoga, massage, hypothermia, and, intriguingly, psychic strategies. Published in print and online in 2008 by a feminist collective based in Las Vegas, the book reads like something out of the pre-Roe era. Fittingly, a book blurb from Carol Downer expresses concern that abortion might become illegal again: "Keep this book and your speculum in a safe place," she writes. "Whatever the political climate, you have the tools you need."

Whether those tools actually work is an open question. No one has reliable large-scale data on the effectiveness of nonmedical techniques. According to a database Sister Zeus has compiled, of the 149 women she has tracked who had confirmed their pregnancies with tests, 46 percent successfully terminated their pregnancies with herbs. The attempts tracked by the Reproductive Health Matters study were far less successful.

When self-inductions didn't work, women either had clinic abortions (sometimes after a delay that made for a more involved, more expensive ordeal) or they continued their pregnancies, in some cases risking birth defects. In Brazil, one of many countries where misoprostol self-abortions are common, there is widespread evidence of facial, nerve, and limb malformation in children born to the 5 percent to 10 percent of mothers whose efforts to abort with the drug fail.

"The point of having legal abortion is to make it safe and a decent, dignified experience," says Wendy Chavkin, a physician and professor of public health and gynecology at Columbia's Mailman School of Public Health. In countries where abortion is illegal, doing it yourself might be the best option. Here, says Chavkin, there's no need for women to face the health risks, such as hemorrhaging, on their own: "People should get legal, good care, not second rate care."

But at least some doctors think women should have more control over ending their own pregnancies soon after they're detected. "Very early abortion is not rocket science," says Beverly Winikoff, a physician and one of the co-authors of the Reproductive Health Matters study. "The earlier you're going to do this, the more the woman could do herself."Certainly, some women will try. For as with anything else, there will always be those who are inclined to take matters into their own hands.

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