You decide: Is banning abortion medications truly about women's safety?

“Abortion has been with us as long as has pregnancy. The question for society has always been the price women will be forced to pay for their abortions in terms of dollars, disease, degradation, and death… Those who wish to restrict or eliminate access to legal abortion must be willing to accept responsibility for these costs, both financial and human.”¹

Contents

• Introduction

• Is banning abortion medications really about women’s health and safety?

• Commonly-used unsafe self-abortion methods

• Abortion medications reduce morbidity and mortality where abortion is banned

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Introduction

Back in 2013, “more than 300 provisions were introduced across the country to prevent access to abortion” under the guise of protecting women's health and safety.² In August of that year, J. Pepper Bryars, the former press secretary and speechwriter for Alabama Gov. Bob Riley, authored an op-ed in which he proudly admitted that “abortion opponents' true goal [was] not to make abortion clinics safer [for women], but to close all abortion clinics.”³ "Our goal should remain… to make all abortion illegal and inaccessible… And our strategy and arguments should always support that long-term goal,” he added.⁴

Woman-protective anti-abortion arguments (WPAA) emerged as a strategy in the 1990s, “fueled by anti-abortion market research. According to John Willke, head of the National Right to Life Committee and pioneer of the 1970s' fetal-focused arguments, he embraced WPAA early in the 1990s when research showed that the movement's fetal-focused arguments were falling on deaf ears.”⁵ The prevailing public sentiment, Wilke discovered, was that “pro-life people were not compassionate to women and that we were only ‘fetus lovers’ who abandoned the mother after the birth. They felt that we were violent, that we burned down clinics and shot abortionists. We had to convince the public that we were compassionate to women.”⁶ In response to this research, Wilke created the now familiar slogan “Love Them Both,” and the anti-abortion movement began to argue that abortion harms women.⁷

“For audiences concerned about protecting women’s rights, woman-focused antiabortion argument was potentially conflict resolving: it could reassure those who hesitated to prohibit abortion because of concerns about women’s welfare that legal restrictions on abortion might instead be in women’s interest.”⁸ But WPAA fused “talk about women’s health and women’s rights with some very old forms of talk about women’s roles: Abortion must harm women because women are by nature mothers. Choosing against motherhood and subverting the physiology of pregnancy will make women ill—and in all events cannot represent what women really want, because any real woman wants what is best for her child. Women who seek abortions must have been confused, misled, or coerced into the decision to abort a pregnancy—because the choice to abort a pregnancy cannot reflect a normal woman’s true desires or interests. Using law to restrict abortion protects women from such pressures and confusions—and frees women to be true women.”⁹

WPAA is aimed at protecting fetuses by restricting women’s choices, which is said to be “good” for women. Advocating for restricting women’s rights because doing so is “good for women is advocating on the basis of a sex-role-based belief that, as Dorinda Bordlee [and other anti-abortion activists] emphasized,... ‘What’s good for the child is good for the mother. So now we’re advocating legislation that is good for the woman.’ On this sex-role-based view, there is no conflict of interests between women and the unborn life they bear because, as Bordlee explained, what is good for the child is good for the mother. A state can restrict abortion to protect the unborn and it is good for women’s health because what is good for children is good for women’s health. The descriptive claim is also a normative claim about sex roles that are ‘good’ for women.”¹⁰

Hence, activists spoke “about women’s health in a special, coded, sex-role-based way concerned with the wrongs of a woman ending a pregnancy—and not otherwise concerned with women’s physical wellbeing.”¹¹

In the 21st century, the use of woman-protective anti-abortion arguments soared. Today, while downplaying the movement's gender-based assumptions about women, groups that oppose reproductive rights and autonomy publish “studies” to back up their beliefs, knowing that “most people (clinicians included) do not have the biostatistics training necessary to discern the methodological flaws and biases in much of the [anti-abortion] research.”¹² Purported to “prove” that abortion harms women, these “studies” are designed to lend a veneer of scientific authority and credibility to WPAA.

Despite the contemporary anti-abortion movement's emphasis on “science,” WPAA remains grounded in gender-paternalism. “Women’s decisions about abortion are shaped by circumstances that women face before conception and can foresee after birth.”¹³ “In fact, global studies show that highly restrictive abortion laws make abortion unsafe for women but do little to lower abortion rates.”¹⁴ “WPAA offers abortion-restrictions as a one-size-fits-all cure for the many social circumstances that lead women to end a pregnancy. The claim is that by restricting all women, government can free women to be the mothers they naturally are. Woman-protective antiabortion argument is gender-paternalist in just the sense that the old sex-based protective labor legislation was. It restricts women’s choices to free them to perform their natural role as mothers.”¹⁵

Is banning abortion medications really about women’s health and safety?

Since the Dobbs decision, groups that oppose reproductive rights and autonomy are laser focused on prohibiting access to safe and effective medications that induce abortion, particularly targeting mifepristone and misoprostol. Proponents have consistently framed their efforts to cut off access to these medications as a benign effort to “safeguard[] the health and safety of women.”¹⁶

Given the anti-abortion movement's history of cloaking its goals in woman-protective anti-abortion arguments (WPAA), it is prudential to ask, “Is the anti-abortion movement’s goal of cutting off all access to mifepristone and misoprostol truly a benign effort to protect women’s health and safety?”

To answer this question, we must envision a world in which women continue to attempt to induce their own abortions, but without the use of safe medications like mifepristone and misoprostol. This is not difficult to imagine. Such was the case before Roe v. Wade.

“Faced with decades of fertility… millions of desperate women terminated unplanned pregnancies to preserve the health and well-being of their families. Thousands of women suffered and died in the process.”¹⁷ In the 1940s, for example, “more than 1000 women were known to have died each year from complications of [unsafe] abortion. The true number was considerably higher. Every large municipal or county hospital had a ‘septic abortion ward,’ and infected induced abortion was the most common reason for admission to gynecology services nationwide during those years. Reports from large public hospitals chronicled the suffering.”¹⁸

“In Chicago, the results of the restriction of abortion could easily be seen in Cook County Hospital's wards. In 1939, Cook County Hospital treated over one thousand women for abortion-related complications; twenty years later that number had more than tripled. By 1962, the county hospital reported caring annually for nearly five thousand women with abortion-related complications… [M]ost had either induced their own abortions or gone to an [unqualified] abortionist… This hospital's experience was duplicated around the country… In the mid-1950s, Los Angeles County Hospital saw over two thousand abortion cases annually. D.C. General's septic abortion ward always had fifteen or twenty extremely ill women in it.”¹⁹

“[I]nvasive methods, such as insertion of tubes or liquids into the uterus, were more successful [at ending pregnancies] than other approaches. Coat hangers, knitting needles, and slippery elm bark were common insertion methods; the bark would expand when moistened, causing the cervix to open. An old method was to place a flexible rubber catheter (a hollow tube) into the uterus to stimulate labor.”²⁰ But “sepsis from the use of nonsterile instruments in the vagina and uterine cavity, often complicated by lung abscesses, septic emboli, and septic pelvic thrombophlebitis” were a common result.²¹ “Although many of the infections may have been treatable, some women avoided or delayed seeking care, [] fearing that their crime would be discovered. For the same reason, though some women’s bodies were sent to the medical examiner’s office by hospitals, others were simply dumped on the streets.”²²

“Though inserting instruments into the uterus posed substantial risks, other approaches proved equally hazardous.”²³ For example, one woman “had heard that cold on the abdomen would cause a miscarriage; she went out into the snow naked, became hypothermic and died, presumably from ventricular tachycardia.”²⁴ Another woman “took sleeping pills because she thought they would cause miscarriage; she lost her own life instead.”²⁵

“Another frequently lethal complication was air embolism, caused either by soapy-water vaginal enemas (used in an attempt to prevent infection) or by air blown into the cervix, an intervention rumored to cause abortion. If enough air is trapped between the membranes surrounding the pregnancy and the uterine wall and enters large, low-pressure maternal venous channels, it can either travel into the right ventricle and obstruct cardiac output or enter the arterial circulation and cause catastrophic embolic phenomena. (And because a special type of autopsy is required to diagnose air embolism, its frequency was most likely underestimated.)”²⁶

“Surveys suggested that miscellaneous methods and oral medications, such as laundry bleach, turpentine, and massive doses of quinine (a drug used to treat malaria), were the most commonly used approaches. Injecting toxic solutions into the uterus using douche bags… or turkey basters was common. Absorption of soap solutions, turpentine, antiseptics, and other toxins into the woman's blood stream could poison the kidneys, lead to kidney failure, and ultimately kill the woman. Potassium permanganate tablets placed in the vagina were popular as well; these did not induce abortion but could cause severe chemical burns to the vagina, sometimes eroding through to the bowel.”²⁷

“The demand for abortion attracted entrepreneurs, and the illegality of abortion meant that the safety and efficacy of various drugs and methods went unregulated. In the early 1950s, sales of a vaginal pill used to induce abortion boomed, and growing numbers of women entered the hospital suffering from vaginal burns. The vaginal pill was the method of destitute women who could not afford to contact a doctor for an abortion but could buy pills. One patient at Cook County Hospital was a twenty-nine-year-old black woman who was described as ‘extremely pale, cold, and covered with beads of perspiration. . . . [Her] vagina was filled with clots of blood.’ She told the physicians that she had placed a "grey tablet" in her vagina in order to induce an abortion. When she bled twelve hours later, she believed she had aborted. The hospital treated her, gave her blood transfusions, and, after four days, sent her to the prenatal clinic. The tablet had both injured her and failed to cause an abortion.”²⁸

“In the 1960s, physicians and clergy led the quest for safe abortion. They argued that the suffering from unsafe abortion could no longer be tacitly sanctioned. By the late 1960s, most Americans were eager to abandon the bad old days of abortion as well. The public health consequences of illegal - or legal but inaccessible - abortion were clear and well-documented. Women clearly deserved better.”²⁹

Unfortunately, Roe v. Wade didn't magically mean that safe abortion was available to everyone who needed it. TRAP laws, or Targeted Regulation of Abortion Providers laws, enacted under the guise of protecting women's health and safety created tremendous hurdles for low income and minority women. Some who were unable to access abortion turned to unsafe methods. For example, in September of 2015, in a desperate attempt to end her pregnancy, a young woman in Tennessee named Anna “sat in a water-filled bathtub and forced a coat hanger into her [uterus].”³⁰ “The whole time she was concerned for her health, her safety and never gave any attention to the health and safety to the unborn child,” Murfreesboro Police Department Sergeant Kyle Evans later chastised.³¹

When she began to bleed uncontrollably, Anna asked her significant other to drive her to the hospital. The hospital called the police and Anna was charged with attempted first-degree murder for her failed attempt to end her own pregnancy.³²

At the time, low income women like Anna were “the hardest hit by [an] increasing spike in abortion restrictions in states like Tennessee, where anti-abortion activists had[] fought hard to make the procedure so time consuming and expensive that few people with limited means could realistically manage to get one. With every plea for help, these women in crisis [often] faced[] doctors, police, and prosecutors who [were] set on punishing them for choices often made out of desperation.”³³

[Meanwhile, Murfreesboro Police Department Sergeant Kyle Evans went on to complete law school and, in 2021, “was appointed to serve as the Rutherford County Sheriff’s Office’s staff attorney.”³⁴ He was promoted to the rank of Major a year later.³⁵ (If Rutherford County sounds familiar, it's likely because the county made national news for arresting and jailing Black children as young as 8 years old for a “crime” that does not exist.)]

“Third-world abortion methods today are similar to those in the U.S. before the 1970s. These can be divided into broad classes: oral medications and injectable medicines, vaginal preparations, intrauterine foreign bodies, and trauma to the abdomen. In addition to the detergents, solvents, and bleach used in the U.S., women in the Third World still rely on teas and brews made from local plant or animal products, including dung.”³⁶ “Foreign bodies inserted into the uterus to disrupt the pregnancy often damage the uterus and internal organs, including the bowel. Hemorrhage and infection related to these crude methods may require hysterectomy as a life-saving measure, leaving the women sterile - and often castrated - early in life. When pelvic infection is severe after unsafe abortion, hysterectomy plus removal of the ovaries (thus, castration) and fallopian tubes may be needed to save the woman's life. In settings as diverse as the South Pacific and equatorial Africa, abortion by abdominal massage is still used by untrained practitioners. The vigorous pummeling of the woman's lower abdomen is designed to disrupt the pregnancy sometimes bursts the uterus and kills the pregnant woman instead.”³⁷

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Commonly-used unsafe self-abortion methods

■ Treatments taken by mouth

• Toxic solutions

• Turpentine

• Laundry bleach

• Detergent solutions

• Acid

• Laundry bluing

• Cottonseed oil

• Arak (a strong liquor)

• Tea made of livestock manure

• Boiled and ground avocado or basil leaves

• Wine boiled with raisins and cinnamon

• Black beer boiled with soap, oregano, and parsley

• Boiled apio (celery plant) water with aspirin

• Tea with apio, avocado bark, ginger, etc.

• "Bitter concoction"

• Assorted herbal medications

• Quinine

• Chloroquine

■ Drugs, substances, and foreign bodies inserted into the uterus through the cervix

• Stick, sometimes dipped in oil

• Lump of sugar

• Hard green bean

• Root or leaf of plant

• Wire

• Knitting needle

• Rubber catheter

• Bougie (large rubber catheter)

• Coat hanger

• Ball-point pen

• Chicken bone

• Bicycle spoke

• Enemas

• Soap

• Shih tea (wormwood)

• Potassium permanganate tablets

• Herbal preparations

• Soap solutions

• Turpentine

• Antiseptics

• Other toxic substances

■ Trauma

• Jumping from top of stairs or roof

• Child Jumping on abdomen

• Blows to the abdomen

• Other forms of trauma

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Abortion medications reduce morbidity and mortality where abortion is banned

“Global studies show that highly restrictive abortion laws make abortion unsafe for women but do little to lower abortion rates.”³⁸ However, since the advent and availability of mifepristone and especially misoprostol, maternal mortality and morbidity caused by self-induced abortions has been dropping worldwide in countries that prohibit abortion. In Latin American and Caribbean countries, for example, “the decline in abortion-related maternal mortality is observed due to access to safer abortion by using misoprostol as a [medication] abortion despite the most-restrictive abortion laws. Despite highly restrictive abortion laws, access to the [medication] abortion increases access to safer abortion.”³⁹

“Substantial declines in abortion-related morbidity and mortality and lower costs of treating complications are observed… with [medication abortion] than with other self-induction methods.”⁴⁰

This returns us to our question: “Is the anti-abortion movement's goal of cutting off all access to mifepristone and misoprostol truly a benign effort to protect women’s health and safety?”

Or is it just another case of cynically using woman-protective anti-abortion arguments to enact policy at women’s expense?

Share your thoughts in the comments.

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2. Gay, A. (2013, August 8). The anti-abortion agenda explained (here’s a hint: It’s not about women’s safety): ACLU. American Civil Liberties Union. https://www.aclu.org/news/reproductive-freedom/anti-abortion-agenda-explained-heres-hint-its-not-about-womens

3. Gay, A. (2013, August 8). The anti-abortion agenda explained (here’s a hint: It’s not about women’s safety): ACLU. American Civil Liberties Union. https://www.aclu.org/news/reproductive-freedom/anti-abortion-agenda-explained-heres-hint-its-not-about-womens

4. Bryars, J. P. (2013, August 7). Of course we want to close all abortion clinics (opinion from J. Pepper Bryars). al.com. https://www.al.com/opinion/2013/08/of_course_we_want_to_close_all.html

5. Jordan B, Wells ES. A 21st-century Trojan horse: the "abortion harms women" anti-choice argument disguises a harmful movement. Contraception. 2009 Mar;79(3):161-4. doi: 10.1016/j.contraception.2008.11.008. PMID: 19185666.

6. Jordan B, Wells ES. A 21st-century Trojan horse: the "abortion harms women" anti-choice argument disguises a harmful movement. Contraception. 2009 Mar;79(3):161-4. doi: 10.1016/j.contraception.2008.11.008. PMID: 19185666.

7. Siegel, Reva B. (2020) "Why Restrict Abortion? Expanding the Frame on June Medical," Supreme Court Review: Vol. 2020, Article 8.

Available at: https://chicagounbound.uchicago.edu/supremecourtrev/vol2020/iss1/8

8. Reva B. Siegel, The Right’s Reasons: Constitutional Conflict and the Spread of Woman-Protective Anti-Abortion Argument, 57 Duke Law Journal 1641-1692 (2008) Available at: http://scholarship.law.duke.edu/dlj/vol57/iss6/2

9. Reva B. Siegel, The Right’s Reasons: Constitutional Conflict and the Spread of Woman-Protective Anti-Abortion Argument, 57 Duke Law Journal 1641-1692 (2008) Available at: http://scholarship.law.duke.edu/dlj/vol57/iss6/2

10. Siegel, Reva B. (2020) "Why Restrict Abortion? Expanding the Frame on June Medical," Supreme Court Review: Vol. 2020, Article 8.

Available at: https://chicagounbound.uchicago.edu/supremecourtrev/vol2020/iss1/

11. Siegel, Reva B. (2020) "Why Restrict Abortion? Expanding the Frame on June Medical," Supreme Court Review: Vol. 2020, Article 8.

Available at: https://chicagounbound.uchicago.edu/supremecourtrev/vol2020/iss1/8

12. Jordan B, Wells ES. A 21st-century Trojan horse: the "abortion harms women" anti-choice argument disguises a harmful movement. Contraception. 2009 Mar;79(3):161-4. doi: 10.1016/j.contraception.2008.11.008. PMID: 19185666.

13. Siegel, Reva (2018) "ProChoiceLife: Asking Who Protects Life and How -- and Why it Matters in Law and Politics," Indiana Law Journal: Vol. 93: Iss. 1, Article 12.

Available at: https://www.repository.law.indiana.edu/ilj/vol93/iss1/12

14. Siegel, Reva (2018) "ProChoiceLife: Asking Who Protects Life and How -- and Why it Matters in Law and Politics," Indiana Law Journal: Vol. 93: Iss. 1, Article 12.

Available at: https://www.repository.law.indiana.edu/ilj/vol93/iss1/12

15. Reva B. Siegel, The Right’s Reasons: Constitutional Conflict and the Spread of Woman-Protective Anti-Abortion Argument, 57 Duke Law Journal 1641-1692 (2008) Available at: http://scholarship.law.duke.edu/dlj/vol57/iss6/2

16. See Americans United for Life paper accessible at:

Carolyn McDonnell, J. D. (2024, August 27). Report: Understanding the mail-order abortion rules within the federal “comstock act.” Americans United for Life. https://aul.org/2024/08/27/report-understanding-the-mail-order-abortion-rules-within-the-federal-comstock-act/

17. Grimes , D. A., & Brandon , L. G. (2014). The Bad Old Days . In Every Third Woman in America: How Legal Abortion Transformed Our Nation (ebook, p. 5). essay, David A. Grimes, MD & Linda G. Brandon.

18. Grimes , D. A., & Brandon , L. G. (2014). The Bad Old Days . In Every Third Woman in America: How Legal Abortion Transformed Our Nation (ebook, p. 5). essay, David A. Grimes, MD & Linda G. Brandon.

19. Reagan , L. J. (2022). Repercussions . In When Abortion Was a Crime: Women, Medicine, and Law in the United States, 1867-1973 (Ebook, p. 254). essay, University of California Press.

20. Grimes , D. A., & Brandon , L. G. (2014). The Bad Old Days . In Every Third Woman in America: How Legal Abortion Transformed Our Nation (ebook, p. 7). essay, David A. Grimes, MD & Linda G. Brandon.

21. Rosenbaum, L. (2019, September 4). Perilous politics — morbidity and mortality in the pre-roe era | nejm. The New England Journal of Medicine . https://www.nejm.org/doi/full/10.1056/NEJMp1910010

22. Rosenbaum, L. (2019, September 4). Perilous politics — morbidity and mortality in the pre-roe era | nejm. The New England Journal of Medicine . https://www.nejm.org/doi/full/10.1056/NEJMp1910010

23. Rosenbaum, L. (2019, September 4). Perilous politics — morbidity and mortality in the pre-roe era | nejm. The New England Journal of Medicine . https://www.nejm.org/doi/full/10.1056/NEJMp1910010

24. Rosenbaum, L. (2019, September 4). Perilous politics — morbidity and mortality in the pre-roe era | nejm. The New England Journal of Medicine . https://www.nejm.org/doi/full/10.1056/NEJMp1910010

25. Rosenbaum, L. (2019, September 4). Perilous politics — morbidity and mortality in the pre-roe era | nejm. The New England Journal of Medicine . https://www.nejm.org/doi/full/10.1056/NEJMp1910010

26. Rosenbaum, L. (2019, September 4). Perilous politics — morbidity and mortality in the pre-roe era | nejm. The New England Journal of Medicine . https://www.nejm.org/doi/full/10.1056/NEJMp1910010

27. Grimes , D. A., & Brandon , L. G. (2014). The Bad Old Days . In Every Third Woman in America: How Legal Abortion Transformed Our Nation (ebook, p. 10). essay, David A. Grimes, MD & Linda G. Brandon.

28. Reagan , L. J. (2022). Repercussions . In When Abortion Was a Crime: Women, Medicine, and Law in the United States, 1867-1973 (Ebook, p. 253). essay, University of California Press.

29. Grimes , D. A., & Brandon , L. G. (2014). The Bad Old Days . In Every Third Woman in America: How Legal Abortion Transformed Our Nation (ebook, p. 12). essay, David A. Grimes, MD & Linda G. Brandon.

30. Grant, R. (2024, August 9). Woman faces three felony charges for attempted coat hanger abortion. VICE. https://www.vice.com/en/article/woman-faces-three-felony-charges-for-attempted-coat-hanger-abortion/

31. Staff author. (2015, December 12). Woman charged, tried to abort fetus. News Channel 5 Nashville (WTVF). https://www.newschannel5.com/news/local-news/woman-charged-with-attempted-murder-tried-to-abort-fetus

32. CBS/AP. (2015, December 13). Woman charged with attempted murder in failed abortion. CBS News. https://www.cbsnews.com/news/tennessee-woman-charged-with-attempted-murder-in-failed-abortion/

33. Barker, T. (2024, July 28). The new reality: Women charged for murder after self-inducing abortions. VICE. https://www.vice.com/en/article/the-new-reality-women-charged-for-murder-after-self-inducing-abortions/

34. WGNS. (2021, December 15). Former Murfreesboro police officer hired as new sheriff’s office attorney. WGNS Radio. https://www.wgnsradio.com/article/72179/former-murfreesboro-police-officer-hired-as-new-sheriffs-office-attorney

35. WGNS NEWS. (2022, December 14). RCSO Capt. Kyle Evans promoted to major. WGNS Radio. https://www.wgnsradio.com/article/78409/rcso-capt-kyle-evans-promoted-to-major

36. Grimes , D. A., & Brandon , L. G. (2014). The Bad Old Days . In Every Third Woman in America: How Legal Abortion Transformed Our Nation (ebook, p. 12). essay, David A. Grimes, MD & Linda G. Brandon.

37. Grimes , D. A., & Brandon , L. G. (2014). The Bad Old Days . In Every Third Woman in America: How Legal Abortion Transformed Our Nation (ebook, p. 12). essay, David A. Grimes, MD & Linda G. Brandon.

38. Siegel, Reva (2018) "ProChoiceLife: Asking Who Protects Life and How -- and Why it Matters in Law and Politics," Indiana Law Journal: Vol. 93: Iss. 1, Article 12.

Available at: https://www.repository.law.indiana.edu/ilj/vol93/iss1/12

39. Latt, S. M., Milner, A., & Kavanagh, A. (2019, January 5). Abortion laws reform may reduce maternal mortality: An ecological study in 162 countries - BMC Women’s health. BioMed Central. https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-018-0705-y

40. Dzuba, I. G., Winikoff, B., & Peña, M. (2013). Medical abortion: A path to safe, high-quality abortion care in Latin America and the Caribbean. The European Journal of Contraception & Reproductive Health Care, 18(6), 441–450. https://doi.org/10.3109/13625187.2013.824564