Several countries and regions continue to encounter challenges in abortion rights advocacy. The implementation of pro-abortion laws remains challenged, and its delay has lead to unsafe abortions conducted in illegal clinics, putting pregnant individuals in life-threatening situations. Common challenges to an individual’s right to abortion include politico-legal opposition, cultural indoctrination, and administrative failures of implementation.
Global Overview of Abortion Access
In Texas, abortions are now illegal as a consequence of the state’s Senate Bill 8. Popularly called “the heartbeat bill,” the bill prohibits abortion procedures conducted after six weeks of pregnancy. This is particularly restricting since about 85-90% of abortions take place after the sixth week of pregnancy. When abortion providers filed an emergency request to the Supreme Court to protest the Republican legislation of people’s bodies, the Court declined to take action. The bill is, actually, quite difficult to challenge since it allows private citizens, instead of state officials, to sue anyone involved in the facilitation of abortion.
In Latin American and Caribbean regions, abortion laws are particularly restrictive. Very few countries legally permit unrestricted first trimester abortion. In Mexico, for instance, states can liberalise or restrict abortion as long as they do not violate the Mexican Constitution.
The Mexican government amended its constitution in 1974 to allow citizens to “decide in a free, responsible and informed manner on the number and spacing of their children.” The 2007 reform pertaining to the legalisation of abortion within the first trimester in Mexico City eventually abolished criminal penalties against people who had undergone abortion. In September 2021, the Supreme Court unanimously decriminalised abortion, thereby preventing the legal prosecution of people who either seek abortion or suffer miscarriage. Although the Mexican government has decriminalised abortion, individual states can still modify legalisation.
Also read: How Does Stigma Affect Access To Self-Managed Abortions?
Argentina resembles Mexico in terms of the backlash that its legislation has encountered. When the Voluntary Termination of Pregnancy Bill was introduced in the legislative agenda in 2018 under the conservative Mauricio Macri’s administration, it was approved by the Chamber of Deputies but voted down by the Senate. In 2020, a modified version of the bill was sent to Congress again. Abortion was, then, legalised. New challenges related to implementation have emerged since the decriminalisation of abortion. The most obvious threat is the legal battle against pro-choice legislation. Additionally, since Argentina is a federal state, its jurisdictional authorities can freely determine their own policies.
In Europe, Poland has very restrictive laws on abortion. A 1993 law in the country sanctioned abortion only when pregnancy constituted a threat to human life, the foetus was endangered, or the pregnancy was a result of rape or incest. In 2020, Poland deemed abortion, in case of severe foetal abnormalities, unconstitutional. The major challenge that pro-choice activists confront in Poland is the state-sanctioned endorsement of the far right.
India offers relatively liberal policies concerning abortion. The Medical Termination of Pregnancy Act enacted in 1971 permits Indians to legally seek abortion, yet legalisation of has not proven to be sufficient for offering accessible and safe abortions. A recent report published by the Guttmacher Institute demonstrates the extent to which abortion procedures remain stigmatised. Using 2015 data from across six of the most populous states in India, which represent 45% of the female population, the report concludes that a vast majority of abortions are accessed in informal healthcare networks.
Introduction to Self Managed Abortions
A pregnancy can be terminated by either a miscarriage or an induced abortion. In spite of the stigma surrounding pregnancy termination, the practice of abortion is not particularly uncommon: one in four pregnancies end in induced abortion. However, accessing safe abortion can be challenging for a wide range of legal, social, administrative, and financial reasons.
Consequently, of the 56 million abortions that occur worldwide, 25 million are unsafe. 97% of these unsafe abortions occur primarily in developing countries. This is precisely why reliable information concerning self managed abortions (SMA) needs to be prioritised in mainstream discourse.
WHO recommends medical abortion and manual vacuum aspiration as medically reliable methods appropriate for safe termination of pregnancy. Medical abortion, or abortion with pills, is a self-managed abortion procedure that does not require the intervention of surgically trained health professionals. It is a non-invasive process where the pregnant individual takes pills to contract the uterus and push out the pregnancy.
SMA is highly effective: the risk of life-threatening complications is very low. The completion of the procedure can be safely arranged in homes. Pills required to facilitate abortion are also quite affordable.
One measure to access information of the SMA procedure and support for post-abortion care is to consult trained professionals or local pharmacists. They can establish if the pregnant individual is eligible to take drugs by a simple screening process, following which the doses and timings can be detailed.
Medical Abortion Methods
The first method of medical abortion involves the use of one 200mg tablet of mifepristone and four 200mcg tablets of misoprostol. The method’s effectiveness is comparable to that of manual vacuum aspiration. Risk of the pregnancy continuing after the dose is less than 1%.
The 200mg tablet of mifepristone needs to be swallowed with water. About 40% of women experience nausea after the administration of mifepristone. Less than 10% of women experience bleeding or cramping.
If women and other abortion-seeking individuals vomit within an hour, the dose would have to be repeated. If they vomit after an hour, the use of another dose won’t be necessary since enough drug would have been absorbed to initiate abortion. Misoprostol will be used after twenty-four hours but before forty-eight hours. After the mouth has been made moist by drinking water, the pregnant individual needs to put the four 200mcg tablets of misoprostol between the gums or directly under the tongue. Next, they need to hold for thirty-minutes, and subsequently rinse their mouth with water, drinking everything left of the pills. Mouth can taste chalky during this step.
The alternate method of medical abortion involves the use of repeated doses of twelve 200mcg tablets of misoprostol. The success rate of this procedure ranges between 75% and 90%. The risk of the pregnancy continuing following the dose consumption is 5-7%. It is less expensive than the first method.
Once the mouth is moist, four pills have to be placed between the gums or under the tongue. Secretions of the pills can be swallowed. After thirty minutes, the mouth can be rinsed. It is advisable to wait for three to four hours before repeating the first step. The pregnant individual needs to wait for three to four hours again after the completion of the second step. The final step is essentially a repetition of the first step with four 200mcg tablets of misoprostol.
Common symptoms that accompany the process of medical abortion include cramping and bleeding. These are central to the facilitation and completion of medical abortion. The expulsion of the products of pregnancy is expected during bleeding. Some undesirable side effects can also be experienced on account of the medications. Most side effects are, however, minor and go away within four to six hours of taking misoprostol.
Also read: What Are Self-Managed Abortions?
Supportive Care after Dose Consumption
Effective management of expected symptoms and undesirable side effects characterises supportive care. Less than 10% people bleed after the mifepristone dose. Since bleeding generally begins after the administration of misoprostol, pregnant individuals can coordinate accordingly to access a safe and comfortable environment during bleeding.
Some non-medical methods to ease pain during bleeding include listening to music, keeping a hot thermos on stomach, and avoiding stressful labour. Non-steroidal anti-inflammatory drugs such as Ibuprofen and Diclofenac sodium, when taken in appropriate doses, can also ease physical pain. Ibuprofen also aids in resisting fever and chills. Paracetamol tends to be ineffective in alleviating pain caused by cramps.
Lying down and eating dry food items can overcome nausea and dizziness. Additional medications such as Domperidone, Onadansetron, and Metaclopromide can be prescribed, depending on the pregnant individual’s health and medical history. Loperamide can be recommended in case of diarrhoea.
While the pregnancy is expelled after the last dose of misoprostol, the abortion process may continue over the following days, lasting for up to seven days. Heaviest bleeding occurs during the actual abortion. Cramping and bleeding gradually decrease after the expulsion of the products of conception. Some bleeding, resembling that during menstruation, continues for up to two weeks, with its intensity decreasing with time. Whether or not the individual requires consultation with health care providers depends on their health and the method of medical abortion taken.
Failure of bleeding after dose consumption, continuation of pregnancy signs, or continued heavy bleeding after seven days are uncommon but possible outcomes. In such scenarios, intervention by a trusted health care provider is recommended.
Sometimes, a urine pregnancy test taken shortly after the completion of medical abortion is observed to be positive. This happens because it takes up to three weeks for the pregnancy hormone (HCG) to disappear. It is advisable to take the urine test, if required, after three weeks following the medical abortion procedure.
The primary component of post-abortion care typically includes follow-ups with pharmacists. In case the procedure is unsuccessful, the treatment of the incomplete abortion must be prioritised.
SMA procedures are accessible and affordable measures to mediate the termination of an unwanted pregnancy. They enable individuals to exercise their reproductive choice, particularly in regions where abortion services are either illegal or ineffective. Mainstream discourses on abortion access need to accommodate self-managed abortions in popular vocabulary to spread awareness about the procedure.
This piece is written in partnership with HowToUse Abortion Pill, who works to share facts and resources about abortion pills – what to consider beforehand, where to acquire quality abortion pills, how to use them safely, what to expect, and when to seek medical help if necessary. They equip women with the information they need to safely navigate abortion on their own terms. Ally, the safe abortion assistant from HowToUse, is available 24/7 to support you through abortions with pills. You can speak to Ally in Hindi or English, and support is available through a free WhatsApp number +1 (833) 221-2559 OR directly on http://www.howtouseabortionpill.org/.
Featured image source: Plan C