Post-Roe, US women still have abortion options

For Danielle from New York, her pregnancy seemed to be going well — tests and scans had not shown any problems.

But, in week 29, Danielle learned that her baby had numerous brain malformations. If the baby lived to birth, he would be suffering. So Danielle made the difficult choice to terminate her pregnancy.

Since she was so far along, she had to fly to New Mexico to do so.

"What my husband and I experienced was just so horrible," Danielle recounted to Planned Parenthood, a reproductive rights group that assisted her. "Unless people have walked in my shoes, they don't understand."

Danielle's story of having to travel to receive abortion care is likely to become a lot more common since the landmark 1973 Roe v. Wade court decision, which enshrined the right to abortion nationwide, was overturned by the US Supreme Court last Friday.

As of writing, abortion is illegal or soon will be in 16 US states, with 13 states having "trigger laws,"meaning bans on abortion that are activated when Roe is overturned. The Guttmacher Institute, a reproductive health research and policy organization, projects that 26 states are set to ban the procedure.

"This is changing literally every hour," said Adele Costa, communication director for the National Women's Health Network, a nationwide membership-based group that promotes women's health.

Although women still have options to terminate a pregnancy in states with an abortion ban, "Lots of states are racing to make those illegal right now," she added.

Abortion basics

Modern abortion takes two forms: surgical and medical.

Surgical abortion, also known as D&C for dilation and curettage, involves a doctor using a suction procedure followed by scraping to manually remove the pregnancy from the uterus.

Medical abortion, also known as the abortion pill, involves two medications: First, mifepristone is given by mouth to stop the development of the pregnancy. Then, 24 to 48 hours later, misoprostol is taken either vaginally or by mouth, causing the body to shed the uterine lining. This procedure mimics a natural miscarriage.

Dr. Anna Whelan, an OB-GYN in Rhode Island who specializes in maternal fetal medicine and high-risk pregnancies, said medical abortion "works best up until 10 weeks, but can be used up until 12 weeks of pregnancy."

Pregnancy weeks, or gestational age, is counted from the first day of the woman's last period. In the many US states that have implemented a ban on abortion from six weeks, therefore, this means that women may not yet realize they are pregnant — since menstrual cycles typically run about four weeks — until termination of the pregnancy is no longer allowed.

Medical abortion a 'lifeline'

"Medication abortion is honestly the lifeline right now," said Costa. It can be accessed via telemedicine, while the medications can be ordered online for $40 to $600 (€38 to €570) and may be delivered by mail. "You can take the pills right in the privacy of your own home," Costa said, adding that their online availability eliminates the need to travel.

Privacy is particularly important in states like Texas, where the SB8 law deputizes the public to tell on their neighbors if someone is suspected of having gotten an abortion.

Such "self-managed abortion" is a safe and well-studied practice, Whelan explained. "The medications are safer than taking [the pain relief medicine] Tylenol and they have a really good success rate, with low need for intervention, low risk of bleeding."

If a pregnant person who self-administered these medications ends up being among the 2% who does experience complications — including symptoms of heavy bleeding, severe pain or fever — then they should go to the hospital. But they need not tell doctors about the pills.

"There's no way for us to tell, as physicians or even gynecologists, whether you had a medication abortion or are having a miscarriage," said Whelan, who is also a fellow at Physicians for Reproductive Health.

In most states, setting up medical abortion online is currently still legal — although some states with bans are trying to close that loophole. "As of now, I know of no plan to start opening people's mail," Costa said.

Yet she added that in states like Texas, even while informing yourself about abortion options, "Find ways to browse anonymously and don't give your name, because that's going to become something that they can use against you, unfortunately."

Out-of-state travel a big burden

For women who have passed that 12-week threshold, traveling to a state without a ban for a surgical abortion remains an option.

Yet such an undertaking "means time away from children, work, and the cost of travel — and as we all know, gas prices are incredibly high," Whelan pointed out.

"It's certainly an extra burden on the patients … we know that abortion restrictions are particularly harmful to patients who are of color, particularly Black and Latinx people, as well as people who are living under the poverty line."

For those in "abortion deserts" — for example along the Gulf Coast in the country's south — such travel would involve hundreds of miles.

The good news is that financial help is available for those who need it, Costa said. "Plan C and your local abortion funds — there are so many organizations ramping up right now to help cover that cost."

Some employers as well, including Amazon, Disney and Starbucks, are offering a travel benefit for US workers in states with abortion bans.

Yet such additional effort adds unnecessary stress to a procedure that is never pleasant.

Seema from New York shared her story with We Testify, an organization dedicated to destigmatizing abortion, particularly for people of color, about her choice to terminate at 28 weeks due to a high-risk pregnancy and being in abusive relationship. She had to travel to Washington, D.C., and ended up incurring $9,000 in costs (for which she was able to receive some assistance).

After the procedure, "I felt relieved. I was angry. I was stressed. I wasn't pissed off about what I went through, but that I had to leave my state to get this done."

"It was ridiculous."

Edited by: Jane Paulick