Will new Texas abortion law result in unsafe abortions? Here’s what the research says
When Texas enacted the nation’s most restrictive abortion law Sept. 1, some abortion rights advocates worried the restrictions could end in a dire situation: With most abortions in Texas now illegal, would women try to perform their own abortions, and end up injuring or killing themselves?
Abortion experts said the answer isn’t definite. But the availability of medication abortions mean unsafe, physical attempts at abortion will be less common if the law remains in place.
“I think it’s fair to say that we don’t expect to return to the dark days pre-Roe,” said Dr. Abigail Aiken, an expert on self-managed abortions.
Since the Food and Drug Administration approved the first abortion drug in 2000, it has become a more common method of abortion even as the nationwide abortion rate has declined, according to the Kaiser Family Foundation. More than a third of abortions done at eight weeks gestation or earlier are done via medication, according to the most recent data.
The new Texas law, known as Senate Bill 8, outlaws all abortions after cardiac activity can be detected in a fetus via a vaginal ultrasound, which usually happens when a person is about six weeks pregnant. All types of abortions, including medical abortions, are banned by the new law. And the mailing of abortion pills will be explicitly criminalized by a new Texas law going into effect Dec. 1.
Because the drugs used in medical abortions can be accessed and mailed outside of the formal medical system, medical abortions will continue to be an option for people seeking to end their pregnancies despite the law.
But the information and internet access needed to access a medication abortion aren’t tools all people have, Aiken said.
“It’s not out of the question that ... somebody out there isn’t going to resort to something unsafe,” Aiken said.
Liza Fuentes, a senior research scientist at the Guttmacher Institute, has studied how past abortion restrictions have affected pregnant people’s decisions in Texas. In the last 20 years, relatively few Texans have resorted to physical or mechanical attempts to end their pregnancies, according to Fuentes’ research.
“Do we think that we will see people ending up in ERs as a result of [this law]? In the past, we have not seen that,” Fuentes said.
But given that the Texas law bans between 80% and 90% of abortions in the state, is it likely that some people will turn to unsafe measures?
“I can’t answer that question,” Fuentes said. “Because I don’t know.”
The abortion pill
Before Roe v. Wade established a constitutional right to an abortion in 1973, it is estimated that at least 200 women died annually from unsafe, at-home abortions, although the number could be higher.
Before the Supreme Court decision codified the right to an abortion, doctors throughout the U.S. reported stories of women dying after physically harming themselves, using tools like wire coat hangers or drinking poison. After Roe, deaths from both legal and illegal abortions dropped dramatically in the U.S., both because of the decreasing frequency of illegal, unsafe abortions and improvements in medicine.
The approval of medical abortions in 2000 and the expansion of a medical abortion nonprofit in the U.S. in 2018 have both dramatically changed the abortion landscape, and made abortion pills an increasingly common method to terminate a pregnancy, said Aiken, who is the principal investigator of Project SANA, a group that studies self-managed abortions in the U.S.
In 2018, the abortion nonprofit Aid Access began operating in the U.S. because of increasing demand for the service, according to its founder. Aid Access is a unique abortion provider with no parallels in the U.S. People seeking an abortion can fill out a request form online, which is then reviewed by a doctor. If the pregnant person is not more than 10 weeks pregnant, and has no serious complications, Aid Access will mail them the pills needed to induce an abortion at home.
Women can also access abortion pills via online pharmacies or, if they live close to the border, from Mexico, Aiken said.
Together, medication abortions have been a “game changer” for people trying to end a pregnancy on their own, outside of the formal health care system, Aiken said.
Fuentes agreed, and said the availability of medication abortions has drastically changed the landscape of self-managed abortions. The circumstances before Roe v. Wade - when more women were injured or died trying to end their pregnancies via unsafe abortions - are unlikely to repeat themselves.
“It’s unlikely that we will ever revisit that time,” Fuentes said.
When Texas halted all abortions in the state in March 2020 after deeming abortions a “non-essential” service, Aid Access saw its requests for medical abortions double within one month, according to Aiken’s research.
Once Senate Bill 8 has been in effect long enough, Aiken will return to the nonprofit’s data to see whether more people are using the service to self-manage their abortions using pills.
There is no state or federal law that explicitly criminalizes self-managing an abortion, Aiken said, although laws have been passed to make it more difficult to access abortion medications. On Dec. 1, a new law will go into effect in Texas making it illegal to mail abortion-inducing pills in Texas. The law was co-authored by Texas Rep. Stephanie Klick, a Republican who represents part of Fort Worth.
Because Aid Access is an international nonprofit, it’s unlikely the group could be successfully prosecuted under the new law when it goes into effect, Aiken said, meaning the group will likely be able to continue providing medication abortions even after it is in place.
‘This current law is not Texas’ first rodeo’
The introduction of medical abortions has dramatically changed self-managed abortions, which is defined as any abortion that happens outside of the formal health care system, Aiken said.
But there are other options that pregnant people will turn to if they don’t know how to or aren’t able to access medical abortions. Texas has previously restricted access to abortion in the last 20 years, allowing researchers to study the decisions pregnant people in those situations make, Fuentes said.
“This current law is not Texas’s first rodeo,” Fuentes said. “Texas has effectively banned some form of abortion three times since 2004.”
Some pregnant people will turn to herbal or botanical supplements to try and induce an abortion. Because very little research has been done on these abortion methods, Aiken said there’s limited evidence as to how they work. But most of them are neither particularly dangerous nor particularly effective.
“The thing with most of those options is that they’re not so much unsafe, but probably not going to be effective,” Aiken said.
When Texas previously restricted abortion access in 2012, Fuentes said the people who didn’t attempt to self-manage their abortions would either travel out of state, if they had the time and money, or else continue with their pregnancy.
Those three options, Fuentes said, are the major outcomes she and other researchers have observed in the past decade in Texas.
What’s next
The U.S. Justice Department has sued Texas over the law, and a judge has set an Oct. 1 hearing date to consider a temporarily blocking the law. At the same time, two people have sued a San Antonio doctor who wrote publicly about violating the law. Those lawsuits could ultimately force a ruling on whether the law is legal and can remain in place.
Until then, it’s unclear exactly how many pregnant people will leave the state for abortions, will continue their pregnancies, or else will self-manage their abortions at home.
“It’s really hard to say what proportions of people will end up doing what,” Aiken said.
This story was originally published September 27, 2021 at 5:45 AM.
