“Hello. I just found out that I am four weeks pregnant. I cannot carry on with this pregnancy for numerous reasons and I want to have an abortion. Though it is an option for me in the United States, in reality, it is not really an option because the $600-$700 to have it done is simply out of the question. I’m hoping you can advise me and are able to help. I am absolutely desperate.”
Martina read through her email once again and hovered her finger over the send button. The message was addressed half a world away to Women on Web, a Dutch not-for-profit group that mails abortion drugs to pregnant women who live in countries where abortion is outlawed.
Martina lives in Texas, where abortion is restricted but legal—making it one of the places where Women on Web refuses to mail the drugs. Still, Martina thought she would try her luck. She had lost her job to downsizing, and in its place she had found only part-time work. Her rent had gone up. Lately, she was borrowing money for gas.
Martina had an inkling that what she was asking for—help performing her own abortion—might not be fully legal. But she was out of answers. She hit send. Then she began to case the internet for other ways she could cause her own abortion.
If this scene feels out of place in 2016, that may be because there was a time in this country’s history when thousands of back-alley and coat-hanger abortions prompted calls for the procedure to be legal. After the U.S. Supreme Court established a right to a legal abortion, in the 1973 decision Roe v. Wade, self-induced abortions were supposed to become a thing of the past.
But almost as soon as the court legalized abortion, opponents of abortion rights began to whittle them away. Congress began prohibiting poor women from using Medicaid to cover abortions in September 1976. Obamacare, the largest healthcare expansion in decades, allowed insurers to continue to pick and choose the circumstances under which they would cover abortion and allowed states to ban the coverage altogether. The two decisions have ensured that millions of women who have sought an abortion have had to pay for it out of pocket. And a sweeping wave of anti-abortion laws has closed clinics in many states, cresting with an awesome force over the last five years.
In such a hostile climate, it is no wonder that self-induced abortions are still a significant, if largely hidden phenomenon—one that even pro-abortion-rights groups are only just beginning to grasp. One study of abortion patients found that 2.2 percent had tried to, at some point in their lives, induce their own abortions without professional medical assistance. Another estimated that potentially 4.1 percent of Texas women have tried to self-induce—or at least 100,000 women.
There is no concrete data on how many women in the U.S. have tried to self-induce. But there is some evidence—although it is inconclusive—to suggest that self-abortion attempts are on the rise. From 2008 to 2011, as the economy worsened and a wave of new restrictions choked abortion access around the country, online queries about self-induced abortion almost doubled, according to Seth Stephens-Davidowitz, an economist who analyzes Google searches.
Into this crisis of reproductive rights now walks Donald Trump. As president, Trump has promised to restrict abortion even further. He has vowed to nominate justices to the Supreme Court who might overturn Roe v. Wade. Roe, because the court is loath to reverse itself, has survived such threats before. But Trump has explicitly promised to nominate justices who might put Roe in their crosshairs.
In his first major interview after winning office, Trump described—truthfully—what might happen to some women if Roe v. Wade were overturned. “They’ll perhaps have to go, they’ll have to go to another state,” he said. “And that’s OK?” he was asked. Trump replied, “Well, we’ll see what happens.”
But we don’t have to wait and see what happens. History has already shown us what happens when women in the U.S. can’t access abortion. So has the present day.
In 2015 alone, Women on Web, the Dutch not-for-profit, received more than 600 emails from U.S. women looking for a way to end their own pregnancies. (The group does not send abortion drugs to the U.S., because the U.S. does not outright ban abortion.) Women on Web agreed to share scores of these emails with The Guardian, providing an unprecedented window into the lives of women who feel they have no other option but to end their pregnancies themselves.
Among the hundreds who wrote to Women on Web was Martina. She contacted The Guardian shortly after she found out about her unwanted pregnancy and shared every step of her journey, which eventually took her across an international border. (As corroboration, she provided photographs, including of her travel documents. Her name has been changed for her privacy.) She wasn’t sure if she faced a potential legal risk. And in fact, self-induction is in a legal gray area, and many enterprising prosecutors have charged women who carried out their own abortions with crimes. Nevertheless, Martina felt compelled to speak.
“I feel like there’s such a negative stigma to this,” she said. “It’s kind of kept under the radar, hushed, so it needs to be talked about.” People needed to know, she added, that abortion restrictions had real victims. “You’re not really helping anyone. You’re not really protecting anyone. You’re just causing women who are in these situations who feel desperate to take desperate measures.”
The letters to Women on Web form a uniform chorus of desperation. “Please” and “afford” and “help” and “fear” appear in dozens of places, signaling the nature of how these women became stranded.
“Now he is threatening me, saying I can never leave.”
“I am afraid of what he is capable of.”
“For a variety of reasons, an abortion must look like a miscarriage.”
“This has to look like a miscarriage.”
“I don’t have $600.”
“Planned Parenthood wants $650. My bf and I live in our car.”
“I can’t afford an abortion.”
“I simply cannot afford an abortion.”
A teenager in a state where minors need parental consent for an abortion said her parents were forcing her to have her baby.
A woman in Missouri wrote to say that she had gone to her state’s only abortion clinic, “but the protestors shamed me into going back. I’m not a citizen and its a little scary coz I feel very lonely.” [sic]
“I am beside myself,” read another woman’s email. One month before she wrote her email, she was raped. She received her coverage through Tricare, the insurance plan for military personnel and their families. Tricare’s policy is to cover abortion in cases of rape as long as a doctor has a “good faith belief” that the rape occurred, according to a spokesman. But this woman wrote that Tricare refused to pay for her abortion on the basis that she never reported the rape.
“To end this nightmare,” she wrote, “it would cost me one-third of my family’s monthly income.” She continued, “I have seen a doctor. I have had a sonogram. Tricare covers that. I can give birth to my rapist’s baby for free.”
“Please I am out of options,” the letters read.
“Can u please.”
“Please please please.”
“I cry and pray every night that the Lord take this child from me somehow.”
“I will keep searching online for help.”
What is striking about reading these emails one after another after another is the diversity of experiences that lead all these women down the same path. There are homeless women and middle-class women and married women and single women, women living in cities and women separated from the nearest abortion provider by an ocean: two wrote in from the big island of Hawaii, where the last clinic, a Planned Parenthood in Kailua-Kona, closed in 2014.
“When people think about low-income women seeking abortion, they have this stereotypical vision of a single woman on welfare,” said Laurie Bertram Roberts, head of the Mississippi Reproductive Freedom Fund. Her group provides financial assistance for abortions. “But it’s also people who have two jobs. Six hundred dollars is a lot of f***ing money. For a lot of the people who call us—not a majority, but many—those barriers are just too high. Even with our help.”
Women on Web wrote back to Martina a few hours after she sent her message. “We’re sorry,” the reply came, “Women on Web cannot provide the service in any country with safe abortion services.” The email listed a few not-for-profit abortion funds Martina could call for financial assistance. Then it recommended another option: “If you live close to Mexico you can also travel to Mexico to buy misoprostol,” a drug that can induce a miscarriage early in a pregnancy.
It sounded like a gamble. Martina felt a jolt of fear. “What if it’s incomplete? What if I do it wrong? What if I f*** up my organs somehow?” She pushed these thoughts aside. At least it was an option.
Martina learned that her insurance would not cover her abortion and left messages with two abortion funds. She also found a world of websites describing ways to induce abortions with herbs or vitamins. Following advice from the sources that looked the most reputable, she began taking cinnamon capsules and several thousand milligrams of vitamin C per day.
It’s not unheard of for women to turn to herbal concoctions, reproductive rights advocates said. “It’s considered an OK thing to do—this is just how they’ve handled it for years,” said Esther Priegue, the director of counseling at Choices Women’s Medical Center, an abortion clinic in Queens. Her patients occasionally use an herbal brew to try to induce a miscarriage.
The internet resounds with such recipes. “What you probably have, in reality, is hundreds of people doing it hundreds of different ways,” said Beverly Winikoff, the president of Gynuity Health Projects, a reproductive rights research group. “The way it’s always been.”
Of course, there weren’t supposed to be hundreds of different ways.
Self-induced abortion was supposed to have all but disappeared after the Supreme Court established the right to an abortion throughout the country. In the run-up to Roe v. Wade, in the late 1960s and early 1970s, abortion was restricted to a handful of major cities and the women with the means to travel there. Roughly 100,000 women crossed state lines for a legal abortion in New York state; in a single year, the number of women going to illegal providers or trying to self-induce was up to 12 times that. Some years, up to 200 women would die of complications from illegal or self-induced abortions. And compared with the number of women who survived horrific complications, that figure appears small. In 1968 alone, a single Los Angeles County hospital treated 701 women suffering from septic abortions.
But just a few years after Roe, the country seemed to vanquish the coat-hanger abortion. In 1976, the Centers for Disease Control announced that only three women had died the previous year from abortion complications—a stunning reduction in deaths. When anti-abortion activists accused the centers of undercounting, the CDC, according to the book Inside the Outbreaks, put up a $100 bounty for proof of any abortion death the centers had failed to report. “We paid out zero money,” one official recalled proudly.
But others realized that, even though women were no longer dying in scandalous numbers, illegal and self-induced abortions were still a serious problem.
The CDC announcement came out the same year Dr. Jason Doe began to do his medical residency. In the remote north-west corner of Louisiana, he rotated through an obstetrics ward that received many of the area’s most impoverished residents. The state’s only abortion clinic stood in the opposite corner of the state. “So even though abortion technically was legal” for those women, “it wasn’t available,” Doe said.
One of his first patients had unraveled a wire coat hanger and used it to break her water. Another broke her water with a red rubber catheter her friend had stolen from a hospital.
Doe’s memory of another patient is dominated by her screams. As she seized in pain, doctors removed an intact cotton boll—the husk was still attached—from her vagina. She had soaked the cotton fibers in turpentine and honey.
“In three years, I suppose I saw a dozen cases,” said Doe. (Doe agreed to speak only under a pseudonym. He works as an abortion provider in Shreveport and has kept his identity hidden from the public.) He treated women who had gone to back-alley abortion providers and a woman who had shot herself in the stomach. Turpentine became a kind of harrowing motif. One woman used a syringe to inject it into her abdomen. The tide only ceased in 1980, when two abortion clinics opened a few months apart in nearby Bossier City and Shreveport. Roe v. Wade was seven years old.
“Just making it legal is not enough,” Doe said. “If it’s not available, if a woman really does feel that she needs to terminate her pregnancy, she may be willing to try just about anything.”
His were not isolated experiences. In 1977, Rosie Jimenez became one of the first women to die from an illicit abortion after Roe v. Wade. Jimenez had previously had one legal abortion, paid for using Medicaid. But in 1976, Congress passed the Hyde Amendment, which banned the use of federal Medicaid funds to pay for abortion and which many advocates still consider the country’s biggest barrier to abortion access today. The next time Jimenez became pregnant, she sought out an unlicensed midwife in McAllen, Texas. She died of a bacterial infection.
In fact, nearly every year after Roe v. Wade brought isolated reports of a woman taking drastic steps to terminate her pregnancy. 1978: Three young women in Colorado poisoned their livers by drinking tiny amounts of aromatherapy oil to try to induce an abortion. 1984: A teenager injected herself with a local anesthetic and attempted to cut out her fetus. 1994: A Florida teenager placed a pillow over her abdomen and shot herself in the side.
Earlier this month, a woman in Tennessee was charged with aggravated assault for trying to give herself an abortion with a coat hanger. She was found out after profuse bleeding sent her to the emergency room.
It is against this backdrop of tragedies that some reproductive rights activists have argued for making the same abortion drugs used routinely in clinics available to women in their homes. “It would be phenomenal if people could receive this medication in the mail with all the instructions” and the right safety measures, said Yamani Hernandez, the executive director of the National Network of Abortion Funds. Already, she added, the internet is allowing untold numbers to find and use the drug without medical supervision. Among the 700,000 searches on self-abortion Stephens-Davidowitz identified in 2015, some 160,000 were searches for a way to obtain the abortion pill through back channels.
Is there a chance those searches could increase under a Trump presidency? “Yes,” said Hernandez. “That is something that one could reasonably predict in an environment where abortion becomes even illegal, or even more inaccessible than it has been. We will do anything in our power to get people the information and the care that they need.” Even now, her group posts instructions for self-administering misoprostol on its website—“For safety’s sake.”
Not all advocates feel good about disseminating this information. But they consider it better than the alternatives.
Recently, Roberts answered one of the “scariest calls” of her advocacy career. A young woman was on the line, saying her friend had given her a home remedy. Her friend claimed to have used this method to end four separate pregnancies, even though each time it sent her to the hospital.
“Ultimately, we helped this woman go to a clinic” before she could do something dangerous, Roberts said. “Her friend had told her to drink turpentine with sugar.”
At a crisis pregnancy center, an ultrasound confirmed that Martina’s home remedies hadn’t worked. She was still pregnant. The distress must have shown on her face, because the technician offered a flurry of reassurances. They see a lot of single moms who do it on their own. They have a store that sells baby clothes at a markdown. They help with discounts on daycare. Martina fumed. A baby is more than just buying clothes and food, she thought.
In her head, she was already reviewing her plan. She had heard back from only one abortion fund, which had turned her down for assistance because she had a job. And so, for a quarter of what a U.S. abortion clinic would charge, she had purchased a flight to Mexico City. The flight left the next day. She would stay with a friend. Abortion pills would cost about $20 at a pharmacy—if she could find a pharmacy that carried the drug and would sell it to a young woman.
Then, she would take the drugs at her friend’s house. “I’m gonna say like, ‘Oh man, I’m on my period, I’m so sorry, I hate that this is ruining the trip, I feel so sick,’” she said, sounding perfectly unrehearsed.
Martina had relied on this kind of subterfuge for the past several weeks. Friends had noticed she was distracted. Her boss had noticed she was nauseous. “This whole time that I’ve been pregnant, and that I’ve known I’ve been pregnant, that’s all I’ve thought about,” she said. “I’ve almost cried like five times today.” But you have to push that aside and act like you’re fine, she said: “Oh yeah, I’m sorry, I was zoned out for a sec.” “Oh yeah, sorry, just not feeling great.”
The more difficult challenge was hiding her pregnancy from her boyfriend. She knew he would want to start a family. At home, she was taking so much anti-nausea medication to keep from vomiting in front of him that she no longer had enough to sustain her through the work day.
“You feel alone, but you can’t do anything about it,” she said. “I just kind of have to put my feeling outside of it. You need to focus. What do you need to do in order to move forward?
“It’s kind of like when you’re drowning. If you just flap around, you’re just going to drown. But if you focus on what the goal is, on what you need to do, stay calm, that’s how you’re going to survive.”
It was the sixth pharmacy Martina went to in Mexico that sold her the misoprostol. The first five, a mix of big national chains and mom and pop shops, claimed they didn’t carry it. She felt at least one pharmacist was lying to her. Finally, she returned to the first store to ask, if not here, where could she buy it?
A little while later, she paid $26 for a blue carton about the size of her hand. Misoprostol, it said. Caja con 28 tabletas.
It wasn’t an exciting feeling, holding the box. It was scary, Martina said. “It’s just like a God-I-just-want-to-get-this-over-with” feeling. She was still too nauseous to take the pills while she was in Mexico City, so she would have to take them in the United States. It was a panicky moment, bringing pills back through customs. But there was a larger fear.
“My biggest concern is, what happens if someone finds out? What happens if something goes wrong?” Martina had said a few days earlier. “What happens if my body doesn’t completely rid itself?” In most abortion clinics, she knew, a medication abortion was induced with two drugs: one drug to terminate the pregnancy, and misoprostol to expel the pregnancy. She would only be taking the misoprostol. “So basically, you’re half-assing the job.”
She knew what symptoms would tell her something had gone wrong. But still. “There’s just so many questions. I would so much rather have a health professional help me in this and kind of guide me through it versus DIY. There’s some things aren’t meant for that, and this is definitely one of them.”
It is impossible to know what happened to all the other women who reached out to Women on Web. But a study of women who were rejected because they were past the clinic’s gestational limit found that most of them carried their pregnancies to term.
Roberts, the Mississippi activist, said that many women who struggle to pay for an abortion eventually get creative. Not long ago, she spoke to a mother who was weighing whether to raid her diaper fund to pay for her abortion. It was unlikely her parents would lend her money for an abortion, she reasoned, but they would probably help her buy more diapers.
“There are no more creative problem solvers, and I mean this, than women with no money,” she said. “And I’m saying that with the utmost respect, because there are people who will think of all this as shady. And I’m not. I’ve seen people struggling, and being brilliant, brilliant, in coming up with ways to survive.” It’s a skill she fears more women might need in the future.
Martina’s trip had cost a fraction of the money she needed to raise for an abortion in a U.S. clinic—something her mind was still trying to grasp. “The whole time I was traveling, I couldn’t believe it was happening,” she said.
We were speaking a few days after she returned from Mexico. An ultrasound had just confirmed that she was no longer pregnant, and her voice was sunny. “I am so relieved, to be honest.” She hadn’t realized, until she was no longer pregnant, how much stress she had placed on herself. Now, she felt like she could breathe, she said. Like she could step back on the path of her life and figure out where she had been when she diverged.
Martina had taken the pills on a Saturday. She took the first dose. She set a timer on her phone. Then she took the second dose.
The pills worked just like they were supposed to. She bled, but not too much. She felt the pregnancy pass. She felt exhausted.
And then it was done.