An international advocacy group concerned about restrictive laws in the United States plans to help women use the abortion pill at home, offering online advice and counseling about how to use medications the Food and Drug Administration says should be taken only by prescription and under medical supervision.
Women Help Women, a three-year-old organization headquartered in the Netherlands, this week launched a website to provide one-on-one counseling services for women early in pregnancy who may have illegally obtained the pill on the Internet or through other means.
Kinga Jelinska, executive director of Women Help Women, said her organization provides a version of the service in other countries but decided to launch in the United States this year because of the political climate. Republican-led states have enacted a raft of abortion restrictions in recent years, and President Trump has said he supports overturning Roe v. Wade, the Supreme Court decision that legalized the procedure nationally.
“There is a lot of fear and worry that, with the current administration and restrictions that are to the enormous disadvantage of girls and women, that access to clinical care might further diminish,” said Jelinska, an anthropologist and longtime reproductive rights advocate from Poland, where abortion is illegal except in narrow circumstances.
The launch of the site is likely to add fuel to the debate about abortion, particularly those that are done using medication. Medically induced abortions accounted for nearly a third of all non-hospital abortions in the United States in 2014 and almost half of all abortions before nine weeks’ gestation, according to the Guttmacher Institute, a reproductive rights research organization.
It also raises questions about the legal ramifications for women using the site, and whether encouraging women to take matters into their own hands this way is safe.
The abortion pill approved by the FDA is actually two drugs that may be used in combination through the 10th week of pregnancy. Taken during 24 to 48 hours, the drugs — mifepristone and misoprostol — halt the development of pregnancy and induce miscarriage. The agency recommends medical supervision followed by an in-person follow-up appointment, and it warns people not to obtain the pills over the Internet because they might be unsafe.
Abortion foes have sought further restrictions on the medications in the name of safety. A number of women have contracted infections or needed blood transfusions after a medication abortion, and some have died, although the FDA says it is unclear whether the drugs caused the deaths.
“These drugs are dangerous. They are deadly. If they are mishandled, they result in serious injury,” said Kristi Hamrick, spokeswoman for Americans United for Life, an antiabortion group that has tried to push states to require strict medical supervision for the use of abortion medications. “To just distribute them and put them in an automatic dispenser like a can of soda is absolutely medical malpractice.”
Abortion rights groups say that severe side effects from the drugs are rare; a 2015 study looking at more than 11,000 medication abortions in California found that the incidence of major complications was .31 percent.
While there is limited research about self-induced abortion in the United States, women have been performing them for generations. Today’s favored method in the United States happens to be pills, obtained via the Internet or in Mexico, where misoprostol can be purchased over the counter. Home-based abortions are safer for women than they’ve ever been, advocates say.
“There . . . are people who view this as progress, the evolution of abortion care, and an incredible opportunity to transcend the very contentious abortion debate,” said Jill E. Adams, chief strategist for the Self-Induced Abortion Legal Team at the University of California at Berkeley.
Many advocates say they support projects like the one Women Help Women has pursued, but they caution that the legal landscape for self-induced abortion in the United States is unsettled. In 2015, the 9th Circuit Court of Appeals struck down an Idaho law that made it a crime for a woman to perform her own abortion, saying it conflicted with Supreme Court rulings that guarantee a right to the procedure until the fetus is viable.
A few states still have laws that criminalize self-induced abortion, Adams said, and some women and people who helped them have been prosecuted using other criminal statutes.
A Virginia woman was arrested last month on felony charges of illegally “producing abortion or miscarriage” after the remains of a third-trimester fetus were discovered in her back yard. A Tennessee woman who tried to abort her 24-week-old fetus with a coat hanger pleaded guilty to a felony count in January after spending more than a year in jail. A Pennsylvania woman was sentenced to jail time for obtaining abortion pills online for her 16-year-old daughter in 2014.
“I would say for right now, I’m not advocating for women to be doing this on their own in the current environment,” said Daniel Grossman, a University of California at San Francisco researcher who has studied self-induced abortion in the United States. He said his concern stems from the threat of prosecution rather than the safety of the drugs.
In a paper from this week in the British Journal of Obstetrics and Gynecology, Grossman and another researcher looked at existing research and found that women tend to use the abortion pill appropriately and effectively. Though more study is needed, the drugs could one day meet FDA criteria to be offered over the counter, concluded Grossman and lead author Nathalie Kapp, chief scientist at Ipas, an international women’s health organization.
Starting Thursday, women in the United States will be able to log onto the website Abortionpillinfo.org and send a secure message to a trained counselor based overseas. Within a few hours, counselors will respond with evidence-based answers, using guidance from the World Health Organization, Jelinska said. She said she expects a range of questions, including some seeking confirmation that side effects — including cramping and bleeding — are normal.
In case of complications, the women will be told to seek immediate medical care and advised that, because U.S. laws on self-administered abortions are murky, to keep in mind that medication abortions take place in a virtually identical manner to spontaneous miscarriages. They also will be told that there is no blood or urine test that can detect the drugs in their system.
The counselors also will be able to direct women to clinics or foundations in their communities that can help them pay for abortions in a clinical setting if they prefer.
Jelinska said the service is not intended to help women get abortion-causing drugs, and a disclaimer on the website says it is not meant as a substitute for professional medical advice. Rather, she said, “we see this project as an information-delivery project.”
The service will be supported by 25 staff members, including two physicians, spread across Asia, Latin America and Europe. Some funding comes from Europe-based organizations, which Jelinska declined to identify. But the rest is from individual donors, primarily women in other countries, where Women Help Women assists clients in obtaining abortion-causing medications for a requested donation of 75 euros, Jelinska said.
Alice Crites contributed to this report.