With the massive increase in state level anti-abortion laws over the past five years, women’s access to safe and legal abortion care has become severely limited across large swaths of the country. This is especially true in Texas, where a series of restrictive anti-abortion measures have forced more than half of the state’s 41 abortion clinics to close.
As these closures have swept across the state, women’s health advocates have worried that the unprecedented decline in abortion access could lead to a dangerous rise in the number of women trying to terminate pregnancies by themselves. Those fears are confirmed and quantified in a new study released this week by the Texas Policy Evaluation Project (TxPEP), which found that at least 100,000 Texas women—and as many as 240,000—have attempted to self-induce abortions.
Based on comparisons with earlier data, the authors say these results suggest that the rate of women attempting to self-induce abortions is rising in Texas, and they point to the state’s mounting restrictions on abortion as a primary reason. A 2008 national study found that about 2 percent of women reported that they tried to terminate pregnancies on their own. In 2012, a year after Texas passed several new abortion restrictions, a study of Texas women seeking care at an abortion clinic found that about 7 percent reported attempting to end their pregnancies without medical assistance before seeking clinic care. For women living close to the border with Mexico, the prevalence rose to 12 percent. The report also cites several previous studies that have documented similar correlations between increased abortion restrictions and a corresponding increase in the prevalence of unsafe, self-induced abortions.
“[Anti-abortion] laws pretend to protect women but in reality place them, and particularly women of color and economically disadvantaged women, at significant risk.”
For this latest study, researchers surveyed a representative sample of 779 Texas women between the ages of 18 and 49 over a five month period in 2014 and 2015. Of the women surveyed, 22 percent said their best friend, someone else they knew, or they themselves had self-induced or attempted to self-induce an abortion. (Asking about participants’ close friends is a method that is widely used to get at the data for a subject women are often hesitant to talk about. Researchers say participants are more comfortable candidly discussing a decision made by a friend and are more likely to share demographic data like class or race.)
Applied to the proportion of women between the ages of 18 and 49 living in Texas, the data suggest that somewhere between 100,000 and 240,000 women have attempted to self-induce. (The lower figure counts only women who reported their own attempts; the higher one includes women who reported the actions of friends.) The report also found that self-induced abortions are more common among Latina women and those experiencing poverty, as well as women who reported barriers to accessing reproductive health services. Latinas living near the border are some of the most vulnerable women when it comes to accessing abortion. They typically have to drive hundreds of miles to access a clinic, and they face greater disparities in health care access overall.
Most of the women in the study who attempted to self-induce would have preferred to obtain an abortion at a clinic but felt it was logistically or financially out of reach, the researchers found. “[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,” the authors wrote.
“This is the latest body of evidence demonstrating the negative implications of laws, like HB2 [the sweeping anti-abortion law that the Supreme Court has recently agreed to address], 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 press release.
“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.”
Research within the U.S. and around the world confirms that restricting women’s access to abortion is directly linked to higher rates of unsafe abortion and associated complications including infertility and death. As abortion providers who practiced before Roe v. Wade have explained, laws that restrict or ban abortion don’t actually stop abortion — they just stop safe and legal abortion. This is why leading medical groups like the American Medical Association (AMA) and the American Congress of Obstetricians and Gynecologists (ACOG) oppose the type of medically-unnecessary restrictions on abortion that Republican lawmakers in Texas and other states have implemented in recent years.
According to the TxPEP researchers, the most common method for self-inducing abortion among women in the study was obtaining abortion-inducing drugs on the black market, often at “flea market pharmacies” — which are, startlingly, exactly what they sound like. While medically-induced abortion is a very safe, affordable and reliable option for terminating an early pregnancy, that’s only if you use it according to the proper directions — which unregulated flea market pharmacists don’t often provide — and only if that bottle you buy actually contains the right medication at the correct dosage, which it often doesn’t. Women in the study also reported turning to other methods of self-termination, including homeopathic remedies, getting hit or punched in the abdomen, using alcohol or illicit drugs, or taking hormonal pills. One woman who had gotten an abortion previously at her now-closed local clinic attempted to self-induce with herbs. When the herbal-concoction method did not work, she was forced to travel 150 miles to a clinic for her termination. Study participants described fear that they’d be arrested for self-inducing or that they’d unintentionally harm themselves. As one woman detailed:
It started off slow and … went from zero to sixty real quick and it was just like really painful, intense cramping. It was the worst cramping I’ve ever had and probably one of the worst pains I’ve gone through. And there was also the fact that I’m doing it at home … there’s always that slight uncertainty of like I don’t really know what I’m doing.
Thankfully, she survived, but stories like hers will become increasingly common as more clinics are shut down. If the restrictions under HB2 are upheld by the Supreme Court, 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. “As clinic-based care becomes harder to access in Texas,” Dr. Grossman warned, “we can expect more women to feel that they have no other option and take matters into their own hands.”