How women are navigating the post-Dobbs decision

Kaniya was right in the middle of her college finals last year when she discovered she was pregnant.

“I didn’t have the resources to support a child,” said Kaniya, who asked to use only her first name to protect her privacy. “I wasn’t making enough money financially. I was working multiple jobs. I didn’t have the capacity to take care of a child.”

The young woman, now 21, made the difficult decision to have an abortion. Her first choice was to do this close to her family to have their support and care. But they lived in Kentucky, a state that implemented a near-total abortion ban after the Dobbs ruling two years ago.

Kaniya tried to make an appointment near her home in Maryland. But every clinic she called was full for weeks, she said. The wait time was likely the result of an influx of women from states with strict bans, according to the Guttmacher Institutea research group that supports access to abortion.

“You had to wait at least a month,” she told NBC News. “I even thought about traveling for an hour and haven’t been able to make an appointment yet.”

After connecting with advocacy groups for help, she made the decision to have an abortion without consulting a doctor or clinic, a process known as a self-managed abortion. Most commonly, women use the abortion pills mifepristone and misoprostol.

“Someone got the pills for me from one of the organizations I connected with,” she said. “I didn’t have to pay anything. Even if I was working multiple jobs, it could mean a lot of money.”

As more states implement abortion restrictions, the number of women undergoing self-managed abortions is increasing, according to a study new study from the Advancing New Standards in Reproductive Health research group at the University of California, San Francisco.

Researchers interviewed 7,000 women ages 15 to 49 and found that in the year before the Dobbs decision, 2.4% reported self-managed abortions. In the year following Dobbs, this percentage increased to 3.4%, according to a report recently published in JAMA Network Open.

This increase comes as new search finds that the average number of abortions per month is also increasing. According to #WeCount, a research project by the Family Planning Society, a group that supports abortion rights, the number of abortions nationwide reached 100,000 in January for the first time since the group began tracking two years ago. years. For the report, released Wednesday, researchers collected data from abortion clinics and providers across the country between April 2022 and March 2024.

“If we make access to abortion more difficult, that doesn’t mean people will need an abortion less often,” said epidemiologist Lauren Ralph, associate professor of gynecology and obstetrics and reproductive sciences at UCSF and one of the study’s authors. study on self-managed abortions. “We see the opposite. The onus is really on the healthcare system and policymakers to ensure we connect people to safe and effective methods rather than restricting access.”

Ralph’s study, based on surveys conducted with different groups of women across the country in 2021 and 2023, found that the most common methods women reported using for self-managed abortions these were herbs, emergency contraceptives, alcohol and drugs, and even self-harm, including hitting oneself in the stomach.

Slightly fewer women used the abortion pills misoprostol and mifepristone.

Nearly 1 in 5 required medical or nurse treatment, but few required emergency care from a hospital, according to the study. The most common complications were bleeding and pain.

“In terms of serious side effects, we haven’t seen many,” she said. “Maybe they didn’t get the result they wanted. It just wasn’t effective.”

Dr. Nisha Verma from Georgia OB-GYN and complex family planning specialiststated that some women self-manage because they prefer privacy and confidentiality or have had negative experiences with the healthcare system.

But many of the people she sees in her Atlanta office are forced to manage their own abortions because they live in a state with a six-week ban and don’t have the means to travel out of state.

“Every day I see the complete relief in my patients when I can provide them with the abortion care they need, and I also see the desolation in the eyes of those for whom I cannot provide care,” said Verma, who is a fellow of the American College of Obstetricians and Gynecologists. “For these, their options for abortion care are self-management of the abortion. This can be done using safe and reliable access to mifepristone and/or misoprostol, although some patients may not be aware of or be able to access this method.”

Awareness is Susan Yanow’s focus.

For almost a decade, she has worked with organizations such as SASS – Self-Managed Abortion; Safe & Supported, a global nonprofit organization that provides information and access to medication abortions. While much of her time has focused on international defense, that changed when Donald Trump was elected in 2016, raising concerns that Roe v. She was right.

“This came on the heels of research at the time that showed that almost half of people of reproductive age did not know that abortion pills existed,” she said. “Then we started a two-hour training that explains how the pills are used. It is information and not advice. Therefore, it can be shared in any state.”

Nearly two-thirds of abortions in the U.S. are now medication abortions, according to the Guttmacher Institute. The process involves taking mifepristone followed by misoprostol, which can be taken up to two days later.

Despite legal challenges, doctors say both misoprostol and mifepristone are safe medications. Complications are rare but can include blood clots in the uterus, infection, and pregnancy tissue left in the uterus.

“There is abundant evidence demonstrating that early medical abortion with mifepristone and misoprostol – or misoprostol alone when mifepristone is not available – is safe and effective when people have access to quality medicines, use them according to evidence-based guidelines, and are aware of how to recognize and seek care for unusual complications,” said Dr. Monica Dragoman, an obstetrician-gynecologist at Mount Sinai Health System in New York.

In 2022, the World Health Organization updated its guidance, recommending that self-management with these medications is an option for women up to 12 weeks of gestation.

“So considering how safe they are, people can use them on their own if they know how to use them,” Yanow said.

She is now working to “demedicalize” and destigmatize pill use.

“We have people driving 1,000 miles to get these pills and coming back and taking them home because they think they need a doctor involved,” she said. “The reality is that the pills are taken at home. Cramps and bleeding happen at home. Doctors are not present during a miscarriage, which happens at home. So the myth that has been perpetuated because of regulations and fear and stigma and anti-abortion policies is that a doctor has to be involved, and they don’t.”

Kaniya said that during her experience she never felt like she needed a doctor. The worst side effects included nausea, vomiting, fatigue and cramps, which lasted about five hours. She had some close friends to support her and felt relieved that she didn’t have to go to a clinic where she might encounter protesters or someone she knew.

“I don’t have to deal with a lot of people,” she said. “I can allow as many people as I want in this space. I can let people in on my own terms.”