If you are a reproductive health clinician, OB/GYN, or someone who wants to avoid pregnancy until you are ready, then it is only natural to be worried and afraid in today’s environment in which Roe v. Wade is gone — and the rights to contraceptive care also seem to be on the chopping block in some states.
Contraceptive Technology Update asked various medical, legal, and digital security experts for answers to patients’ questions. CTU also found some answers on websites and in published research.
• Can I get an abortion? If so, where?
In states with legal abortion, providers can refer patients to the nearest abortion clinic, or give them a prescription for mifepristone and misoprostol if they are interested in and eligible for medication abortion.
In states that ban abortions, providers will need to know more about their own state law before they can answer this question. For example, South Carolina lawmakers are pursuing a bill that would outlaw providing information on abortions over the internet or over the phone. As of July 28, the bill had not yet been passed and signed into law.1
Physicians are at risk by laws pertaining to free speech, medical instructions, and advice. It is unclear how the courts will respond to these types of laws and provisions.
Providers have a fiduciary responsibility to their patients to disclose medical information, the risks, and the availability of treatment, says Stacey B. Lee, JD, associate professor of practice at Johns Hopkins Carey Business School.
“You need to know if your state has a provision like that,” Lee says. “The idea that state legislatures are inserting themselves even more fully into the highly intimate relationship between provider and patient, and then muting what they can tell their patients, is terrifying to me. I can’t think of any other area where you are restricted from providing people information that may be critical to their health. That seems to turn the practice of medicine — and the First Amendment — on its head.”
Physicians in states that legislate speech about abortion should stay up to date on what the American Medical Association and other expert organizations recommend. Until they receive clear and specific legal advice or suggestions, the best answer may be to tell the patient she could learn more information about this topic from searching the internet or from Planned Parenthood or other expert resources.
“They could probably say ‘Planned Parenthood in other states may provide information, but I can’t give you that information,’” Lee says. “It’s up to the physician’s personal comfort level. There’s not one place where you can get all the information, and it seems like it’s changing as the ripple of Roe continues to go through things.”
• How safe is it to take abortion pills on my own and from an overseas source?
Research shows that self-managed abortion is a safe and effective way to end a pregnancy, including when the woman obtains the pills from Aid Access, a commonly used international source.2,3
Researchers studied outcomes data from international abortion provider Aid Access for self-managed medication abortions provided through online telemedicine outside the formal healthcare system in the United States. They found that self-managed abortions were highly effective and comparable in success rates to medication abortions performed up to 10 weeks within the formal healthcare setting. Patients did not use an ultrasound, but accurately estimated pregnancy duration by the time of their last menstrual period.2 The researchers also mention how people in the United States increasingly access online telemedicine and abortion medication through Aid Access, which operates outside of the formal U.S. healthcare setting in all 50 states.2,4
Similar services, including Women on Web and Women Help Women, are available, but have not been studied with data from U.S. women.2
A website called How to Use Abortion Pill provides detailed information about how to take mifepristone and/or misoprostol and what to expect after taking them.5
• If I experience too much bleeding or pain after my medication abortion, should I go to the hospital?
According to the Mayo Clinic, medication abortion causes vaginal bleeding and abdominal cramping, and may cause nausea, vomiting, fever, chills, diarrhea, and headache. If a person experiences heavy bleeding (soaking two or more pads an hour for two hours), severe abdominal or back pain, or a fever lasting more than 24 hours, they may need to seek medical attention.6
Also, information about normal and abnormal bleeding after a medication abortion is available on the How to Use Abortion Pill website.7
Clinicians also could note that there is no physically significant difference between a medication abortion and a spontaneously occurring miscarriage and that treatment is the same for both, according to the National Women’s Health Network.7
If a patient is concerned about hospital staff finding out about the abortion and reporting her to the authorities, her physician can reassure her of medical privacy protection and note she is not required to disclose the cause of her bleeding to ED staff.
“‘I think I’m miscarrying’ is what I would say,” Lee says. “You have the right against self-incrimination, so you are not required to tell them that [you had an abortion].”
• What if my friend is pregnant and wants me to drive with her to an out-of-state abortion clinic? Could I face legal trouble?
Some state laws target people who assist a person with an abortion, including financial assistance, driving the person to a clinic, and even showing them resources.
“Texas is particularly terrifying in that any citizen can sue someone who aids and abets,” Lee says. “Your period tracker and location and browsing can be mined, and it’s just terrifying what they can find out about you.”
If someone helps a friend, family member, or stranger obtain an abortion, they are technically guilty of aiding and abetting in states that criminalize abortion. “If I have knowledge of what she’s doing, then I’m aiding and abetting,” Lee adds. “If I have no knowledge, then you have some wiggle room.”
Taking someone across state lines to obtain an abortion can trigger legal repercussions even if a person uses a burner phone and disables all GPS, says Anton Dahbura, PhD, co-director of Johns Hopkins University Institute for Assured Autonomy and executive director of Johns Hopkins University Information Security Institute.
“Those are better than nothing,” Dahbura explains. “But there are so many ways of tracking people — a video camera if you stop for gas, or a convenience store, or if you stay overnight at a hotel.”
There also are license plate trackers in various states and localities. “It’s incredibly difficult to cover your tracks,” Dahbura says. “Authorities can collect evidence from devices, video cameras, electronic breadcrumbs on phones, and activities.”
As the post-Roe era begins, no one knows for sure how far states and local prosecutors will go to enforce laws that target people who help someone obtain an abortion. But it is possible some states will treat each suspected abortion like a murder case.
“If our government puts abortion in that criminality, you can watch things unfold in the realm of forensics — so much low-hanging fruit,” Dahbura says. “The odds are in favor of those who are prosecuting criminals if they are putting their minds to it.”
This has already happened in the United States on multiple occasions, according to evidence collected in the book Policing the Womb: Invisible Women and the Criminalization of Motherhood.8
Jailing women who had abortions or miscarriages is one way the country of El Salvador enforces one of the world’s most repressive anti-abortion laws, Dahbura says. “I think part of the strategy is to make an example of people and publicize it, and I wouldn’t want to be that person of which an example is being made,” he adds.
• Should I delete my period tracking app to protect my privacy?
It certainly helps to not use period tracking apps, Dahbura says. “Although, all the use up to that point when you delete it could have preserved data on the device or in the cloud,” he says. “It could still be subject to subpoenas and warrants and so forth.”
If a person deletes the period app before becoming pregnant, the data would not be useful to whoever searches it. But it would be useful if a person deletes it during a pregnancy.
“It’s important to make the determination to delete it up front, as opposed to stop using it by covering tracks,” Dahbura says.
• I am underage and pregnant. How can I obtain a safe abortion?
This may be the most difficult question to answer, particularly if the minor’s family is not supportive.
“What I’m concerned about is the 17-year-old kid who needs to know where to turn,” Lee says. “You don’t want that kid to turn to TikTok to figure out what their options are. That’s what concerns me the most.”
A professional organization needs to develop carefully crafted language that clinicians can give to people to help them figure out how to get the care they need, Lee adds.
REFERENCES
- Zakrzewski C. South Carolina bill outlaws websites that tell how to get an abortion. The Washington Post. July 22, 2022.
- Aiken ARA, Romanova EP, Morber JR, Gomperts R. Safety and effectiveness of self-managed medication abortion provided using online telemedicine in the United States: A population based study. Lancet Reg Health Am 2022;10:100200.
- Conti J, Cahill EP. Self-managed abortion. Curr Opin Obstet Gynecol 2019;31:435-440.
- AidAccess. https://aidaccess.org.
- HowtoUseAbortionPill.org. How to use the abortion pill.
- Mayo Clinic. Medical abortion. July 29, 2022.
- HowtoUseAbortionPill.org. Bleeding during an abortion with pills: What’s normal? Jan. 14, 2021.
- Goodwin M. Policing the Womb: Invisible Women and the Criminalization of Motherhood. 2020: Cambridge University Press.
If you are a reproductive health clinician, OB/GYN, or someone who wants to avoid pregnancy until you are ready, then it is only natural to be worried and afraid in today’s environment in which Roe v. Wade is gone — and the rights to contraceptive care also seem to be on the chopping block in some states. Contraceptive Technology Update asked various medical, legal, and digital security experts for answers to patients’ questions.
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