While the pro-choice movement is fighting to keep abortion clinics open so that women can have access to reproductive health services, some women are taking their right to an abortion into their own hands. But they’re not just taking the abortion pill from their doctors and going home; experts believe that more women are skipping the doctor all together – both for economic reasons and personal ones.  It’s not a new idea. In Katha Pollitt’s 2014 book, Pro: Reclaiming Abortion Rights, she noted how much she wished there was some easy, non-invasive way for women to get abortions without medical professionals (and government interference):  I find myself daydreaming, there is something, some substance already in common use, that women could drink after sex or at the end of the month, that would keep them unpregnant with no one the wiser. Something you could buy at the supermarket, or maybe several things you could mix together, items so safe and so ordinary they could never be banned, that you could prepare in your own home, that would flush your uterus and leave it pink and shiny and empty without you ever needing to know if you were pregnant or about to be.  It’s an understandable wish – abortions are increasingly difficult to get in many areas of the US, they can be expensive, and getting one requires making a very private decision with people other than yourself and your family.  In an increasing number of cases, home abortions are already happening. We’ve watched as two women this year – both women of color, one sentenced to prison – were arrested for inducing abortions themselves. And home abortions may be part of the reason we’re seeing a declining abortion rate, one expert who preferred not to be identified told me: it’s not that women are actually getting fewer abortions, maybe they’re just not getting them from doctors.  Daniel Grossman, an obstetrician-gynecologist and vice president for research at Ibis Reproductive Health, published research on women who self-induce abortions and found that a “major motivating factor is barriers to accessing clinic-based care.”  This was especially true “if they were young, if the place where they could go was too far away or too expensive, or if they thought it was going to be too expensive,” Grossman told me. But Grossman also said that some of the women he interviewed self-induced because they were “the kind who like to do herbal treatments or take vitamins for their healthcare in general.” They wanted home abortions for the same reason.  Mary Mahoney, cofounder of the New York City-based Doula Project, says, “I absolutely think people should be educated on home abortion.” The Doula Project doesn’t help women obtain home abortions (doing so would raise all sorts of legal concerns) – they’re an organization that trains doulas to help and support women through their abortion experiences. But Mahoney does believe that there should be some sort of grassroots action to do so, “especially in areas where abortion is hard to get,” she said. She notes that having a doula present with medical contacts if the need arises would be ideal. But in areas with easier access, like New York, Mahoney says, “I would say a clinic is the best way to get an abortion.”  The desire to have abortions at home may also be part of the reason for the popularity of the abortion pill, the use of which, according to the Guttmacher Institute, increased from 6% of all abortions in 2001 to 23% by 2011. Medication abortion means a woman can end her pregnancy, under the guidance of a doctor, at home instead of a doctor’s office or hospital. Even the abortion procedures themselves have changed to be less invasive – the standard surgery used to be a dilation and curettage (D&C), which requires uterine scraping. Now, women are much more likely to receive an aspiration abortion (suction using a machine) or, if earlier in the pregnancy, an even less invasive manual vacuum aspiration (MVA) abortion, performed with a syringe.  When I had my abortions, I deliberately sought out a doctor who performed the MVA procedure, because it’s been described as more “midwife-like” – there’s no scraping, no anesthesia necessary and it’s over in five minutes. Mahoney says the procedure is particularly helpful for some women because the recovery time is so quick and the procedure so easy that you don’t need to bring someone to help you get home afterwards. For women who don’t want anyone in their lives to know they’re ending a pregnancy, that difference is a big one.  We’re already trying to make abortion procedures – which are incredibly safe – less invasive and medicalized. So what might the next step look like if we were to support home abortions? Perhaps doctors or trained nurses could make home visits to help people end their pregnancies. Or we could expand telemedicine so that any woman could have abortion pills mailed to them after an online medical consultation. (Groups like Women on Waves are already doing something similar for those who live in countries where abortion is illegal.)  There are so many restrictions on abortion in the United States that it’s hard to imagine a future where there is wide enough access for all women to have safe abortions at home, much less in an accessible clinic. Sadly, there’s a greater chance that more women, lacking resources, will have unsafe abortions. That’s a danger we need to address now. If we want to keep women healthy – while ensuring that the pro-choice movement is not just in a defensive crouch – we should start meeting women where they’re at. Even if it’s at home.
Whether women opt for a home procedure because they lack access to a facility or prefer to avoid medical settings, access to good care is key