With the recent massive increase in anti-abortion laws at the state level, getting a legal abortion in America has gotten a lot harder in the past five years. This is especially true in Texas, where anti-abortion laws have closed more than half of the state's abortion clinics.
Given this reality, many pro-choice advocates are concerned that more women will start to take matters into their own hands and self-induce an abortion. Maybe these women will use safe and effective methods like the medication misoprostol (which is often sold across the border in Mexico without a prescription) — or maybe they'll use less effective methods like herbal teas, or more dangerous methods like being punched in the stomach.
In order to evaluate this problem, it's important to know how many women are actually self-inducing an abortion, and why. That's what a new pair of surveys tries to set a baseline for, in order to aid further research down the line. The research comes from the Texas Policy Evaluation Project (TxPEP), an initiative that studies the impact of Texas's reproductive health laws.
The study, authors say, is the first of its kind — the first time a statistic on self-induction in the general population has been conducted. Existing research has only studied abortion patients. Previous TxPEP research found that many more women have attempted to self-induce an abortion in Texas (7 percent of abortion patients) than nationwide (about 2 percent).
The report estimates that 100,000 to 240,000 Texas women have tried to end a pregnancy on their own
To estimate how many women self-induce abortions, TxPEP took a statewide representative survey of 779 Texas women ages 18 to 49. The report found that on the low end, 1.7 percent of Texas women have tried to self-induce an abortion at some point in their lives.
That doesn't sound like a lot, but 1.7 percent of Texas women is still a huge number — 100,000 people.
Accurately calculating the number of women who self-induce abortion is fiendishly difficult for various reasons, including women's own shame about abortion and their tendency to underreport their experiences as a result, even in an anonymous survey.
To try to correct for this tendency, the researchers used two different methods to estimate the frequency of self-induced abortion: asking women themselves about their own history (that's where the 1.7 percent figure comes from), and asking women about what they think their best friends have done. Best friends are often demographically similar, the study explains, and women are less likely to lie about their best friend than about themselves.
When asked about their best friends, 1.8 percent of women said they were sure their best friend had self-induced an abortion, and an additional 2.3 percent said they suspected she had done so. Given this information, TxPEP researchers say that the high-end estimate of self-induction is 4.1 percent of Texas women, or 240,000 women.
The study also explored women's familiarity with various self-induced abortion methods. Only 13 percent of women had heard of misoprostol or its brand name Cytotec, but it was the most commonly reported method among women who said they knew someone who had self-induced.
Overall, 22 percent of women had either self-induced an abortion or said they knew someone who had.
Two groups of women ended their own pregnancies at a higher rate
Latinas living near the US-Mexico border, as well as women who reported barriers to accessing reproductive health services, were more likely to self-induce an abortion.
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.
"We hear firsthand the struggles of Latinas in Texas and nationwide who are trying to get reproductive health care," Ana Rodriguez DeFrates, the state policy and advocacy director at the National Latina Institute for Reproductive Health, told reporters on a press call announcing the study. "Now, thanks to the TxPEP research, we are connecting what we hear from Latinas on the ground with the research itself." Forty percent of Texas women are Latina, DeFrates said, and Latinas in Texas are more likely than other groups to be of reproductive age.
"This is the latest body of evidence demonstrating the negative implications of laws like HB2 that pretend to protect women but in reality place them, and particularly women of color and economically disadvantaged women, at significant risk," said lead study author Daniel Grossman.
Grossman cautioned that the study didn't specifically ask about abortions since 2013, when the omnibus anti-abortion law HB2 was passed and clinics started closing. So they don't have any specific data on whether self-inducement rates have increased since HB2 — but now they have a baseline measurement to refer to later, which may come in especially handy if abortion access gets even more restricted in Texas.
Grossman added that the study's interviews with women who had self-induced abortion provided insight into the reasons why women are doing it.
"They're doing this primarily because they're facing barriers accessing clinic-based care, and some of the barriers have been there even much before HB2 went into effect," Grossman said — such as Medicaid funding bans or the dearth of abortion clinics along the border even before HB2.
When you get down to it, most women who self-induce abortion do so because they're poor
The study also performed qualitative research, conducting in-depth interviews with 18 women who had reported self-inducing an abortion. The biggest reason they cited for doing so was lacking the money to travel to a clinic or pay for the procedure.
"I didn’t have any money to go to San Antonio or Corpus," said one 24-year-old woman from the Lower Rio Grande Valley. "I didn’t even have any money to get across town. Like, I was just dirt broke. I was poor."
Women had other reasons for self-inducing — their local clinic had closed, a friend or family member recommended that they try self-inducing, or they wanted to avoid the stigma and shame of going to a clinic. But none of these reasons alone was sufficient to make a woman self-induce, Grossman said: Adding poverty on top of other obstacles made many women feel like they had no other option.
Even if many women end up choosing safe abortion pill methods, this is a serious problem for public health and women's rights, said Amy Hagstrom Miller on the press call. Hagstrom Miller is the founder of a network of abortion clinics called Whole Woman's Health, and she is also the lead plaintiff in a major Supreme Court case against certain restrictions in HB2.
"Abortion is legal in this country, and so every woman deserves to have access to whatever method for terminating her pregnancy safely she might choose, in her local community," Hagstrom Miller said.
She added that she thinks people get into a "least common denominator" mentality about abortion access. "As though somehow, just because [a woman] was able to figure out, outside the medical system, how to get medication that she needs and didn't, you know, bleed to death — we're somehow supposed to say that that's adequate," Hagstrom Miller said. "And I think it's tremendously disrespectful to every woman who deserves the same access to safe care ... and not to be forced into a method of abortion that she may not have wanted to choose in the first place."