Women's Abortion Options Under Anti-Abortion Laws

Abortion restrictions and anti-abortion laws have been a topic of global conversation for decades, with the conversation intensifying in recent years. The topic has been a point of contention, with some countries liberalizing their abortion laws and others restricting access. The conversation surrounding abortion laws is an important one, as it directly impacts the health and safety of women and people who can get pregnant.

Abortion pills by mail

Abortion pills, also known as medication abortion, can be used to end a pregnancy up to 10 weeks from the first day of your last period. The process involves taking two different FDA-approved medications: mifepristone and misoprostol. The first pill, mifepristone, is taken with a glass of water to block the hormone progesterone, which helps line the uterus during pregnancy. The second pill, misoprostol, is taken up to 48 hours later to increase uterine contractions. Misoprostol can be taken by holding the pills in your mouth or your vagina and allowing them to dissolve, so it is essential to follow the instructions that come with the pills.

In some states, you can do a virtual (telehealth) visit and have the pills mailed to you or pick them up at your local pharmacy. For example, Planned Parenthood Keystone offers this service to people in Pennsylvania. The cost of abortion pills through this service is about $625, but funds are available if you have trouble paying. The process from the first phone call to receiving your medications can take one to two weeks.

It is important to note that there may be legal risks to buying and using abortion pills outside of the health care system. Additionally, there may be restrictions for people who are 17 years old or younger, or waiting periods to get an abortion. It is recommended to consult your doctor or your nearest Planned Parenthood health center for more information.

Self-managed abortions

To ensure a safe self-managed abortion, individuals need accurate information, quality medications, and mutual respect and trust. It is important to have regular periods and knowledge of the first day of the last period. It is also crucial to be less than 10 weeks from the first day of the last period, not have any medical reasons that would make taking the pills unsafe, and have access to urgent care if needed.

There are various hotlines and resources that provide support and guidance for self-managed abortions, including the Miscarriage + Abortion Hotline, Aya Contigo, the Reprocare Hotline, the All Options hotline, and the Exhale text message hotline. Additionally, reliable information about the process and potential legal risks can be found on websites like Plan C (available in English and Spanish) and Repro Legal Helpline.

While self-managed abortions can be a safe and effective option, it is important to be aware of the legal risks involved. Although very few states explicitly ban this method, prosecutors have used various laws to target individuals involved in self-managed abortions. As of 2020, 61 people in the United States have been criminally investigated or arrested for allegedly self-managing their abortion or assisting someone else in doing so.

State-level abortion laws

States Where Abortion Is Protected

The "Expanded Access" category includes states that have protected abortion access through state statutes or state constitutions, as well as additional laws and policies that enhance access to abortion care. These states have taken proactive measures to ensure abortion care is accessible, such as by requiring abortion to be included in private insurance coverage and allowing a broader range of health-care practitioners to provide abortions.

States Where Abortion Is Not Protected

The "Not Protected" category includes states where abortion may still be accessible but is not protected by state law. In these states, there is uncertainty about whether the legislature will enact a ban on abortion, but concern is warranted.

States Where Abortion Is Hostile

The "Hostile" category includes states that have expressed a desire to prohibit abortion entirely and are extremely vulnerable to the enactment of new abortion bans. These states have no legal protections for abortion and often include trigger laws, which are intended to outlaw abortion when and if the Supreme Court reverses Roe v. Wade.

States Where Abortion Is Illegal

The "Illegal" category includes states that have criminalized abortion and banned it entirely, enforcing these bans through criminal penalties. In these states, abortion providers and those who assist them can face legal consequences.

Types of Abortion Restrictions

In addition to outright abortion bans, states may also impose various restrictions on abortion access, including:

• Targeted Regulation of Abortion Providers (TRAP): These laws impose burdensome legal requirements on physicians who provide abortion care, single-out abortion providers, and do not increase patient safety.
• Parental involvement: These laws require providers to notify or obtain consent from parents or legal guardians before a minor can receive an abortion.
• Consent and waiting periods: These laws require pregnant individuals to receive biased counseling or an ultrasound, often with an in-person appointment, and wait a specified amount of time before receiving abortion care. These restrictions seek to dissuade people from exercising bodily autonomy.
• Physician-only laws: These laws restrict the provision of abortion to physicians, limiting access to abortion care.
• Insurance restrictions: These laws limit when or if private health insurance plans can pay for abortion procedures, often resulting in people having to pay out of pocket for abortions.

Physician prosecution

The lack of clear guidelines on when an abortion is medically necessary leaves doctors vulnerable to legal consequences. Physicians are caught between their ethical duty to provide care and the risk of prosecution. This ambiguity has led to delays or denials of medically necessary abortions, impacting patients' access to timely and safe procedures.

The fear of prosecution has resulted in physicians seeking court orders before performing abortions, even in cases where the patient's life is at risk. This precautionary measure ensures that doctors have legal protection, but it also creates a "Catch-22" situation, as they cannot obtain a court determination before providing care but are still vulnerable to prosecution afterward.

The vague language in state laws regarding abortion exceptions further complicates the situation. Terms like "reasonable medical judgment" and "good faith" are open to interpretation, and physicians are unsure how much risk is required for an abortion to be legally justifiable. This ambiguity leaves doctors reluctant to certify pregnancies as qualifying for exceptions, as they fear being found guilty of violating the law.

The lack of clarity in anti-abortion laws has real-world consequences. Women experiencing pregnancy complications are being turned away from hospitals due to fear among medical professionals of performing illegal abortions. This situation has led to tragic outcomes, including women carrying pregnancies to term with severe and, in some cases, fatal medical conditions.

The threat of physician prosecution not only affects doctors but also limits women's access to safe and legal abortions. It creates a chilling effect, discouraging doctors from providing abortions, even in medically necessary cases, out of fear of legal repercussions. This dynamic underscores the urgent need for clear and unambiguous legislation regarding abortion exceptions to protect both physicians and patients.

Health disparities

Women of lower socioeconomic status and women of colour in the United States have higher rates of abortion than women of higher socioeconomic status and white women. This is due to a variety of factors, including:

• Differences in access to health care, higher levels of stress, exposure to racial discrimination, and poorer living and working conditions.
• Differences in the quality of and access to family planning care, with non-white patients less likely to rate their family planning visits positively.
• Differences in the perceived need for family planning, with women of colour more likely to experience pressure to limit their family size.
• Differences in contraceptive use, with women of colour less likely to use highly effective methods and more likely to discontinue methods than white women.
• Differences in the timing of sexual initiation, with Black adolescents initiating intercourse at younger ages than white adolescents.
• Differences in the rate of adolescent pregnancy, with more than 80% of pregnancies among adolescents being unintended.
• Differences in the availability of abortion services, with 87% of US counties not having an abortion provider.
• Differences in the availability of prenatal care, with documented disparities in the receipt of prenatal care and the quality of care provided.

Frequently asked questions