In the Dobbs v. Jackson Women’s Health Organization ruling, the conservative justices rejected the idea that it is a fundamental human right for women to have agency over their own bodies and ruled that state lawmakers can exert control over part of what is in fact a spectrum of reproductive health care that all people who can become pregnant will likely need to some degree. It’s a spectrum because all reproductive health experiences are connected, and the accessibility and safety of abortion care is essential to ensuring that pregnancy, childbirth, and miscarriage can be safe too. There aren’t some people who have children and others who have abortions; we’re the same people at different points in our lives.
I’ve had an abortion, a miscarriage, and a full-term pregnancy that concluded in a C-section and the birth of my son. None of these health conditions should be treated in isolation—I know because I’ve lived it. My medication abortion in some ways prepared me for my miscarriage of a planned, wanted pregnancy, because the care for both was similar. In both cases, my uterus contracted to expel the pregnancy around six weeks after conception. Some people experiencing a miscarriage undergo additional treatment, such as a D&C, to remove products of conception from the uterus. I did not require that care, but had my uterus not emptied completely in either case, I would have been at risk for infection or sepsis. Regulating or banning procedures under one condition but not the other puts all of us at risk for complications or death. That’s not hyperbole, since providers, fearing criminal charges, may not assist patients in need of life-saving care.
Decades of research, including a landmark 2018 report by the National Academies of Sciences, Engineering and Medicine, has found that abortion is overwhelmingly safe. Medication abortion is even safer than Tylenol and wisdom teeth removals. Yet, in no other similar health care setting do the justices, let alone state lawmakers, get to insert their objections. The short explanation is because patriarchy, misogyny, and good ole fashioned racism. But the longer explanation relates back to how abortion became an issue to legislate in this country—through the medical setting.
It was only in the late 1800s when state legislatures began passing criminal abortion laws, permitting abortions only if a physician agreed it was necessary, not whether the pregnant person just simply didn’t want to be pregnant or had a medical reason for terminating their pregnancy. Prior to then, it was legal to “bring back the menses” before quickening with the support of community midwives and their elders. Enter: Dr. Horatio Storer, who ushered in the century-long crusade against abortion at the American Medical Association and propelled the movement’s ideology about when “life” begins into the mainstream. Anti-abortion restrictions began popping up that allowed “therapeutic abortions” only if patients had the approval of their physicians and hospital boards.
This history makes the Jane Collective in 1970s Chicago all the more remarkable. Not only did this underground feminist health care network revolutionize the distribution of safe medical care before Roe v. Wade became the law of the land, during their operations between 1969 and 1973, but when the Janes, as they called themselves, eventually started providing abortions on their own, they were able to center the needs and desires of the women receiving care through the collective. When the Roe decision came down in 1973, the Janes were relieved but also doubtful about the treatment of women at clinics that had come to model themselves on the services the collective had created. The Roe decision, wrote Laura Kaplan in her 1995 book about the network, “written emphatically in terms of physicians’ rights, not women’s rights, revalidated the medical profession’s control of women’s reproductive health.”
“Women would still be objectified as patients, alienated from abortion as a life-determining experience. They would be acted on, not acted with,” added Kaplan. “Jane members knew that the medical profession was not going to use the opportunity to educate women. Roe v. Wade had won the war, but the battle for decent care and respectful treatment was still a long way from over.”
For some time now, abortion providers have been forced to build their practices not with the needs of their patients in mind but to meet medically unnecessary regulations. As we start this new, post-Roe chapter, it’s even more important that we recognize the crucial role self-managed abortion will play in allowing pregnant people to control when and how they receive their abortion care. A person seeking abortion can order medication for their abortion from trusted online resources such as Aid Access, which assists people in accessing medication abortion no matter their zip code.
To be sure, beyond the physical discomforts of a medication abortion, there are significant legal risks associated with SMA without the protections of Roe, particularly in the current criminalized environment and the way people of color and undocumented people are already targeted for imprisonment. But we must provide those who are seeking this care with support and accurate information about available health care services, along with the legal support services that advocates have put into place for this moment. History shows us that abortion bans do not stop abortions; they only make care more difficult and unsafe to obtain. SMA has the potential to minimize the number of preventable deaths associated with laws that criminalize abortion.
Self-managed abortion isn’t the only solution in this post-Roe environment. Clinics are essential to communities, and there are cases in which an in-clinic abortion is the only option for a patient, including for those facing incomplete miscarriages, as we saw in Malta recently. But it’s clear that not enough people are aware of the safety of medication abortion, which now accounts for more than half of all abortions in the United States, where the majority of abortions occur within the FDA-approved window for abortion-inducing drugs (up to 70 days of pregnancy). So while we donate to abortion funds and support clinics, we must also defend self-managed abortion, both the principle and the practice.
Induced abortions are an important part of what’s a spectrum of reproductive health care. As we fight to reopen abortion clinics in every state, let’s continue to push forward the Janes’ vision of health care, which is grounded not in what doctors or lawmakers or justices give us permission to do with our bodies, but in what we choose to do with our bodies, all while ensuring everyone has the resources that they need, no matter where or how their care occurs.