Demystifying Self-Managed Abortion

When many people hear the term ‘self-managed abortion,’ they may think unsafe abortion or pre-Roe v. Wade methods of terminating a pregnancy. Nowadays, self-managed medication abortion is extremely safe, effective, and can be done in the comfort and privacy of one’s own home.  Erin Matson, Executive Director of Reproaction, sits down to talk with us about the myths, barriers to care, and the actions folks can take around self-managed abortion.

Self-managed abortion refers to when somebody ends their pregnancy outside of a medical setting. “The World Health Organization (WHO) has put misoprostol on the list of essential medicines and created a protocol for how women may manage their abortion with misoprostol without direct provider supervision.” Many choose to end their pregnancies outside of clinic settings due to immigration status, fear of being misgendered or patronized by clinic staff, or fear of protestors.

Despite the fact that medication abortion has been approved by the FDA for over 20 years, providers who wish to dispense medication abortion have to jump through extra logistical hoops to do so. Patients themselves face an in-person dispensing requirement, meaning they have to be physically handed the medications by their doctor rather than picking them up at a pharmacy (during the pandemic, the Biden administration has repealed that rule so that folks can access medication abortion through telemedicine and not expose themselves unnecessarily to COVID-19). The FDA has also announced that it will be conducting a formal review of the restrictions set in place for medication abortion.

Abortion pill “reversal” is an unsubstantiated claim that a medication abortion can be reversed with progesterone. The American College of Obstetricians and Gynecologists says there’s no evidence that this procedure is effective. It’s misinformation like this, though, that permeates the public understanding of abortion and erects more barriers to care.

Links from this episode

Reproaction on Twitter
Reproaction on Facebook
Reproaction information on self-managed abortion
What do Bridges, Roads, and Abortions Have in Common? – article by Erin Matson
How to Spot a Fake Clinic

Transcript

Jennie: Welcome to rePROs Fight Back, a podcast where we explore all things reproductive health, rights and justice. I'm your host, Jennie Wetter, and I'll be helping you stay informed around issues like birth control, abortion, sex education and LGBTQ issues and much, much more-- giving you the tools you need to take action and fight back. Okay, let's dive in.

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Jennie: Welcome to this week's episode of rePROs Fight Back. I'm your host, Jennie Wetter, and my pronouns are she/her. So I thought we'd take a minute in the intro here to talk about a big reproductive justice issue that was in the news last week, Britney Spears had a hearing to review the conservatorship that she has been under for the last 13 years. I'm sure a lot of you have seen information on that with, you know, the #FreeBritney hashtag and a lot of other issues, but in the hearing, she revealed that she would like to get married and have another child. And she revealed that her conservators would not allow her to have her IUD removed. This is an unacceptable form of reproductive coercion. It is a violation of someone's basic human rights to force them to be on birth control against their will, right? We need to remember that reproductive rights are a fundamental human right, and the right to decide if when and how to parent are basic human rights and forcing someone to be on birth control when they don't want to be, is a real violation of their human rights. And also want to raise a really important conversation that we need to be having around disability justice and reproductive justice and how they intersect. This is something I've been wanting to talk about on the podcast for a while, and, you know, I've dropped the ball and we haven't had that conversation yet. Something we definitely need to do, because it is a really important issue to talk about how the disability rights movement and the reproductive rights movement intersect. It's a really important conversation. And, you know, the problem is so much bigger than, than Britney Spears, right? She's the story we're hearing because she's a star, right? She has a platform for people to talk about her and talk about her issues, but there are, I'm sure there are so many other people who are going through the exact same thing who don't have that power. So it really, she has the resources to fight this. And so many others do not and are just not in a position to draw attention to what's happening to them or the resources to fight back. So we need to make sure as a country, we are having this conversation around disability justice and reproductive justice. And I hope that this conservatorship hearing and Britney revealing about her IUD helps spark that larger conversation. It's already happening with so many people, but I think it's not reaching a much larger audience and it is a really important one to have. So it's something we will look to have on the podcast, um, to make sure that as many people as possible are hearing about these issues. And with that, I will turn to this week's episode. I'm really excited to talk about self-managed abortion. And I couldn't think of a better person to talk to than Erin Matson at Reproaction. She is so wonderful. And I'm so grateful to have, take some time with her today and talk all about self-managed abortion. So with that, we'll turn to this week's interview.

Jennie: Hi Erin, thank you so much for being here today.

Erin: Thanks so much for having me, Jennie.

Jennie: I'm really excited to talk to you, but before we get started, do you want to take a second and introduce yourself and include your pronouns? Erin: Absolutely. So I'm Erin Matson. I use she/her pronouns and I am Executive Director of Reproaction, which I co-founded with Pamela Meritt.

Jennie: Awesome. Well, I'm really excited to talk to you today. We've talked about self-managed abortion before, but it was someone from Guttmacher, so it was much more research focused and I am really excited to have a much more kind of practical conversation about self-managed abortion.

Erin: Yeah. Self-managed abortion is the bomb. So I'm really excited to be talking about it with you today.

Jennie: So I guess we should really start at the beginning then. Like what, what are we talking about when we talk about self-managed abortion?

Erin: Yeah. So self-managed abortion is when somebody ends their pregnancy outside of a medical setting. At Reproaction, we've been working for years on getting the word out about self-managed abortion with pills. These pills are awesome, they are safe and effective. And um, so it's getting the word out about that, but just so people are clear self-managed abortion means you didn't go to a doctor, you didn't go to a clinic, you didn't go to a nurse, you self-sourced that abortion.

Jennie: Great. And I think, you know, one of the things that when people think of self-managed abortion, then you're maybe thinking of, you know, unsafe abortions or like abortion outside of the healthcare system, like pre-Roe days. So maybe we should talk about some misconceptions and myths around self-managed abortion.

Erin: Yeah. Thank you for that. And I think that's, I'm actually going to start with the pre-Roe days, especially because we have this horrible new-

Jennie: Yeah!

Erin: …case coming toward the Supreme Court that's a direct challenge to Roe v. Wade and people have very serious reason to believe that Roe will either be gutted or overturned. So, I want to share directly that the days prior to Roe v. Wade were a disaster and people were really getting hurt by not having access to abortion. And those were the true days of back-alley abortions and butchers who were taking advantage of people who didn't have anywhere else to turn and back alleys. When we talk about the modern day, the present tense, it is not the same situation. What we have is abortion pills, which have been approved by the Food and Drug Administration. They have more than a 20-year solid track record of safety and efficacy in the United States. And we also have reams of data from overseas that show that women have been able to successfully end their pregnancies in countries where abortion is outright banned or severely restricted, safely and effectively using these pills. I want to just pause for a moment and be deliberate and share that people of all genders experience, pregnancy and people of all genders end pregnancies. When I do use the word “women” I do so with regards to research that I've seen so as not to change the wording of the research, but I it's very important to be inclusive. So to go back to your original question, like, what are some of the myths and misconceptions about self-managed abortion? And I'm talking about self-managed abortion with pills specifically because that's the work we do at Reproaction, that if Roe is overturned, then we're just going to go back to the pre-Roe days and that self-managed abortion is unsafe. And the fact of the matter is that is completely not true for self-managed abortion with pills-- that abortion pills are extremely safe. They're safer than Tylenol, which is not, you know, restricted at all. People have access to that on a shelf at the drug store, and it's less controlled than things like whiteout is in schools, for example. So they're extremely safe. Another myth is that there's something unseemly about it or something wrong about it that in fact, abortion pills are safe and effective, and they work. And there's nothing like black market or shady about using pills to end a pregnancy or to control your own body. So I would say those are some of the primary misconceptions that people have. One additional piece that I'd like to add is that it's like a last resort. And that only self-managed abortion is only for people who don't have access to abortion because of hateful lawmakers or judges who are overlooking constitutional precedent in this country. And that's not the case. There's a variety of reasons why someone might choose self-managed abortion beyond being pushed out of access because all the clinics have been forced to close near them, or because they can't afford an abortion procedure, which remains a huge barrier today. Some people just like the safety and the convenience of being able to have an abortion at home. Abortion is a very individual experience for people. I have heard some abortion storytellers who share their stories about how much they enjoyed being able to have an abortion at home and take their medication abortion at home, to be in a supportive environment, with supportive people that they may choose to be. And then of course, there's other reasons that some people just don't want to go to a clinic for a variety of reasons, including it could be that folks are being mis-gendered or being hassled for their gender, immigration status is another thing that can be a source of concern for interacting with the medical system-- people don't want to be deported. So there's a whole range of reasons that someone might want to self-manage an abortion at home.

Jennie: So this made me have two separate thoughts. Like another reason is like, there are often a lot of protestors at a number of clinics and it can be an unpleasant experience. So again, that would be another reason that people would just not want to have to deal with that extra hassle to get access health care.

Erin: Right. I mean, when you take self-managed abortion pills, it's… a person can choose what they want their abortion to be like. So, for example, like I am obsessed with the television show, Lost, loved to watch, and I could totally see being like, you know what, I want to have this abortion with a Lost episode and just like, sit down and like, watch it for the third time that I'm watching this series. [Laughs] It's not going to take a whole series of Lost. Nothing takes that long. But like, I want to do that versus, you know, walk the gauntlet through people who are going to tell me I'm going hell or, you know, another piece is, is, as we know, like protestors at clinics, a lot of times like, well, they sometimes go in and have the care of themselves, but folks may have people in their families who are anti-abortion and it's easier from a management of their own family to self-manage. And this just falls into the like, broader, like, you should be able to access the care you want in the way that works best for you. Right? So you should find the best birth control that you want to take. That is the method you want the same should be true for your abortion.

Jennie: Absolutely. Okay. So, what are some of the barriers to self-managed abortion now? So we have like myths, but there are also some logistical barriers that exist at the moment.

Erin: Right. So, I'm going to answer this question because we work on self-managed abortion with pills. I'm going to answer this question for abortion pills, period, and not just, it's a whole spectrum of issues, regardless of whether someone wants to self-manage. So that would be like getting it outside of the medical system, to telemedicine, which is interfacing with the medical system, but you may get the pills by mail and meet with a doctor on Zoom to getting pills in a clinic or in a pharmacy or not because abortion pills can't be dispensed at a pharmacy. Wait, that's real. I'm not sure all of our listeners….so let me tell you a little bit about the FDA's dereliction of duty as far as it goes to abortion pills. So, as I mentioned earlier in the show, medication abortion has been, has more than a 20-year track record of safety and efficacy with FDA, but there are these restrictions that are placed upon it that do a variety of things. They make it extremely onerous for, for medical practices to provide it. So they have to get in a special registry, which isn't the case for other medications. There's a requirement in person dispensing requirement. And so instead of calling in a prescription to a pharmacy like we do with any other pill, folks have to have it physically handed to them by a doctor. And we've seen some expansion on telemedicine and, and some really great stuff with the Biden administration recently. So a couple things have happened in the spring of 2021. First is the Biden administration put forward as an emergency order as part of COVID that suspending in-person dispensing requirements so that folks can get the pill through telemedicine the way we're doing everything else with the doctor over Zoom, which by the way, is just fabulous. I recently, you know, had like a rash on my leg and I was able to just like, like facetime with my doctor and get medication, like an hour later, it would have been such a drama, um, to go into the doctor and get it, so everyone's seeing the benefits of telemedicine. This was just the Biden administration extending that to abortion pills, which makes great sense. So that is going to continue through mid-July and then they've made it clear that they intend to keep that going through the public health emergency, which will likely go through at least the end of the year at a minimum separately. There was also an announcement that the Biden administration, or excuse me, that the Food and Drug Administration is formally going to review the restrictions that are placed on medication abortion that make it so hard to get. And because we know that the science is very clear that there's no reason to put restrictions on medication abortion, and because the Biden administration has indicated at all steps that they intend to follow the science on all matters of medicine and public health. That there's a real opportunity that we can get real with medication abortion and start dispensing pills as if they were pills and not something that hateful anti-abortion forces would rather control instead.

Jennie: Yeah. I mean, that would make a huge difference. Like there's no reason to have to go in person and we should be making it easier to access, especially as, you know, anti-choice people are trying to make it harder and harder to access care throughout abortion services, but particularly later, yeah.

Erin: And just a little bit about the anti-abortion movement. So I really look at them really closely at Reproaction. I will say, I think nothing scares the living daylights out of them more than abortion pills, because they're safe, they're effective and they can't be stopped. For decades, they have been lying to people and saying that they can end abortion by overturning Roe v Wade. And guess what, Jennie, they can't. No, you can't put pills back in the bottle and they know it. They know it, they can never stop it. And so, you know, and going back to you brought up harassment and the violence and harassment that they perpetrate, like literally, what are they going to do? Are they going to start like standing outside everyone's doors and yelling, wondering what might be in their medicine cabinet, they simply cannot control this and they know they can't control this. So, it's a big threat to the empty promises that they've been making for a long time. I want to, if you will indulge me for a second, you did also ask about barriers to self-managed abortion. And I'd also like to raise just independent of the medication abortion, it's just education, period. We've got to get the word out about the World Health Organization protocol of how the pills work so that people understand how to use them.

Jennie: Yes, for sure. I think that people are getting more and more familiar with it. And I think, you know, even like the pandemic, like people have been hearing more about it being an option, which I think is a great thing. Cause I think it's also the demystification of abortion. Like people have a very different idea of what it is versus what it actually is. And so getting that understanding of like, especially early abortion is just medication abortion is really important, right?

Erin: Right. And to be clear about what it is and, and the fact that abortion is a relief. That's what most people report after they have an abortion, that their primary takeaway and feeling is relief. And with regards to medication abortion, just as you said, demystifying it and making it clear, so people know what to expect that it does involve cramping, that it's not unusual that people become sick to their stomach in a variety of ways. So, you know, to be prepared that it may be like a sick day, but it's worth it.

Jennie: Yeah. So the FDA barrier, that's one of the biggest things that needs to change. Is there anything else that we need to adjust to make sure that it can be as widely accessible as possible or policy recommendations?

Erin: That's a great question. So I think to dive a little more into the FDA restrictions, one of the important ones, so the in-person dispensing requirement is just ludicrous and needs to go away. Additionally, a big piece of that, that is also really horrible about the restrictions is the special registration requirements. And so normalizing the pill and making it accessible in a variety of places. I think, you know, separately, this isn't quite the question that you asked, but I think it's really important that we think about abortion as part of the critical infrastructure in this country that we need to be rebuilding and access to reproductive healthcare. And specifically, I would like to see things like incentives for opening new reproductive healthcare providers, particularly in states that are less hostile to abortion access with emphasis also on border areas with states that are more hostile. So things that are close by, I think that is something from a policy perspective, we could and should be providing financial incentives to abortion providers, to open new spaces. And then additionally, to provide financial incentives to healthcare providers of all stripes to start providing these abortion pills. Again, they're safe and they're effective. And so, so you should easily be able to get them at your family care doctor at the minute clinic, wherever you go. So providing incentives for folks to expand their care offerings.

Jennie: So one, this is making me think of one other thing that gets into talking about medication abortion, and sorry to surprise you with it, but I know you can handle it, is the push we've seen in the last couple of years about quote unquote abortion reversal around medication abortion. Do you maybe want to touch on that bonkers mess?

Erin: Yeah, no, I'm so glad you brought that up because I am ready to go there. And I had thought about bringing it up. So abortion pill reversal is this so-called oh, what should we call it? Procedure thing created out of nothing. And it's a theory that abortion opponents have created to harass people who are seeking abortion care. And it's heavily tied in with anti-abortion fake clinics of which, there are so many, 27,000 plus in the United States. We track those on our fake clinic database at Reproaction. So you can always go look those up and see if it's a real clinic or a fake clinic. So abortion pill reversal, like these abortion opponents had, like, I literally picture them like a cartoon, you know, how you get like a thought bubble above your head. And like, so there's like a thought bubble and it's like a light bulb except the light bulb is like broken and janky. And so what they're thinking is, okay, typically when folks are provided medication abortion in a medical setting, first they're given mifepristone, and then they're given misoprostol. And their idea was like, okay, if we provide, if we give progesterone, which is a hormone involved in pregnancy, to folks in between the pills—so they've taken one pill, but they haven't taken the second medication -- we can supposedly reverse the abortion. Now there hasn't been any actual scientific peer reviewed studies. So I want to adhere to the science and not make blanket statements as I cast shade, but there's no evidence to suggest that what they're doing is in any way different than if someone had just simply started with mifepristone and then stopped taking misoprostol. And ultimately what they're doing is an unethical experiment on people. They are experimenting on people. There's a long history in this country of people experimenting, particularly on people of color, without consent. And I do think it's really important to bring up that this is racist in its application because so many of the fake clinics deliberately prey upon people of color and target people of color explicitly, and also use any number of racist messages, anti-abortion messages, targeting people of color. So that's a piece of it that it's just, you know, they're testing on people, but people don't even realize they're being experimented on. There's no data to suggest it works. One of the things that I worry about is, is it safe? Like literally they, they make all these wild claims, like they're saying that abortion isn't safe, which is not true. Abortion is overwhelmingly safe, but are they going to kill someone in this process? They don't know what they're doing. They're just giving people injections.

Jennie: Yeah. And I feel like I remember there being a study that they had to stop because people were at risk and you know, that again, this goes to something we really see and the anti-choice movement and has spread much further than that. But anti-science like, there are so many things that are just not based in science that are pushed through anti-abortion folks.

Erin: Yeah, no, absolutely. And listen, it's 2021 and it's a movement moment in public health in this country. And we've got to seize it and make sure that non-scientific rhetoric and things that flat out lie about medicine. You know, there's a big conversation going on right now about anti-vax material on the internet and what needs to be taken down for misinforming people. And I think it's really incumbent on supporters who are listening now to make sure that reproductive health rights and justice is included in those conversations. Because the fact of the matter is the tide is turning. People are sick of this garbage misinformation and disinformation out there. And that's what this is.

Jennie: Yeah. And I really hope that we see the repro get included, that so often it gets treated as separate from health and then public health, but it's clearly a strong part of it. Right?

Erin: Right. And so, and let's go down to the roots of why that has not been happening. And I think it's more than just health. It's also, you see the marginalization of abortion in the progressive movement. And ultimately, you know, it's, again, I keep saying it's 2021, it's 2021. We all know what happened on January 6th of this year, hate is intersectional. And we need to be very clear that the anti-abortion movement is fundamentally a white supremacy movement and that this is all interconnected. And, you know, the analysis needs to go much deeper than the fact that we know that that abortion opponents were there at the Capitol. Of course they were. But the reality is that we've got to make sure that abortion is included in all of the sectors where it belongs-- it's healthcare. It's not abortion, some other thing over there-- it's healthcare. It's also an indivisible part of the progressive movement. You know, progressive's believe in science and public health and economic justice and gender equality and racial justice, and abortion access is all of those things. So we've got to make sure to include that. And, you know, I think one of the exciting things is that self-managed abortions is something that people come to on their own terms and that's really empowering. And so I think this could also be the beginning of more collective empowerment.

Jennie: So there's a big Supreme Court case coming up and it's going to be the striking right at the heart of Roe. So what are some of the risks that we'll be facing if Roe ia overturned or not even overturned, but like really gutted?

Erin: Yeah. So one of the things that people think about Roe being overturned is that abortion will become illegal and then people are going to… going to suffer medical consequences. And I want to be very clear that now that we have abortion pills, which didn't exist in the pre-Roe days and they're so safe and so effective, the primary risk is not medical, it's legal. And specifically, there are already cases that have taken place around the country where people have been prosecuted for ending their own pregnancies, which is a gross violation of their human rights, by the way. And also people have been prosecuted for miscarriage and stillbirth. And so I think that's something that we would see a lot more of the people most impacted by that are people of color and young people and especially poor people as well, or people of low income status. So that's something that we watch with great alarm, you know, just recently, and this isn't something… I want to be clear… It's not something that's just relegated to conservative states in the past few years. Virginia, which has a governor who is pro-choice and an Attorney General who is pro-choice, it has still been the case that multiple people had charges pending against them. One felony charges against [someone] for self-managed abortion. And another woman was actually convicted for having a stillbirth at home. If you can believe this, a prosecutor thought it was a good idea to go after her. And she was convicted before she was ultimately pardoned by the governor, but that took a lot of work. And so that's something that people should be really tuned in to. And I want to lift up the really excellent work of colleagues at If, When, How: Lawyering for Reproductive Justice, as well as National Advocates for Pregnant Women in fighting against that.

Jennie: So we always like to wrap up by focusing on actions the audience can take, is there anything the audience can do around this doing in general?

Erin: Yeah! So on access to medication abortion, one thing I've mentioned, the Biden administration and the Food and Drug Administration and work that's being done to review expanding access to telemedicine abortion. So the reality is that a ton of states bar telemedicine abortion. So one of the most important things that people can do is to be active at their state capitol because that's really where the action is in terms of self-managed abortion. The number one thing I'd want folks to do is just educate themselves about how misoprostol works and how abortion pills work at reproaction.org/sma, or just, you can go to our website reproaction.org. We've got the World Health Organization protocol up there. We've also got petitions that folks can sign to increase access to medication abortion. We call our campaign Abortion Pills are Magic because it's kind of awesome. And yeah, that's what I would say. Folks, do get engaged at the state level, educate yourself and demand change.

Jennie: That is wonderful as always Erin. It is so great to talk to you. I'm glad you got to talk about your amazing op-ed. We'll make sure to include links to the, your op-ed on abortion as infrastructure in our show notes so people can read it and hear more about that amazing idea, but thank you for being here.

Erin: Thank you so much.

Jennie: Okay. Everyone. I hope you enjoyed my conversation with Erin. I had so much fun talking to her about all things self-managed abortion.

Jennie: Thanks for listening everyone. And we'll see you on our next episode of RePROS Fight Back. For more information, including show notes from this episode and previous episodes, please visit our website at reprosfightback.com. You can also find us on Facebook and Twitter at RePROS Fight Back, or on Instagram at reprosfb. If you like our show, please help others find it by sharing it with your friends and subscribing, rating and reviewing us on iTunes. Thanks for listening.

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