When Abortion Is Illegal, Women Suffer

The Atlantic (Oct. 11, 2018): When Abortion Is Illegal, Women Rarely Die. But They Still Suffer, by Olga Khazan:

On Thursday, The Atlantic published a piece surveying nations that maintain bans on abortion, in light of the belief that abortion is expected to become further restricted with Brett Kavanaugh on the Supreme Court.

Khazan writes that legal experts believe the majority-conservative court likely won’t overturn Roe v. Wade, but rather will chip away at abortion rights by narrowing the circumstances in which a woman can obtain the procedure. Still, abortion rights advocates fear that increasing restrictions will force low-income women into desperate situations and increase the rate of self-managed abortion, in which interest has spiked in recent years as access to safe and legal abortion erodes in many states.

If other countries provide guidance, Khazan writes, "abortion restrictions won’t reduce the number of abortions that take place." According to the Guttmacher Institute, abortion rates in countries where abortion is legal are similar to those in countries where it’s illegal, and in countries where abortion is illegal, botched abortions still cause about 8% to 11% of all maternal deaths, or about 30,000 deaths each year.

But, Khazan observes, doctors have gotten better at controlling bleeding in recent decades, and there has also been a major revolution in how clandestine abortions are performed thanks to medication abortion (mifepristone and misoprostol).

Mifepristone and misoprostol have made Brazil's rate of treatment for severe complications from abortion decline by 76 percent since 1992. In Latin America overall, the rate of complications from abortions declined by one-third since 2005.

Meanwhile, in El Salvador abortion is illegal, but one in three pregnancies still ends in abortion. Many women there who want to abort their pregnancies, Khazan finds, obtain misoprostol on the streets.

"Those who have internet access and reading skills can look up information about how to take it properly."

Federal prosecutors in El Salvador are known to visit hospitals and encourage doctors to report to authorities any women who are suspected of self-inducing their abortions. But because federal prosecutors are only visiting public hospitals and not private hospitals, poor women are much more likely to be reported for their illegal abortions than rich women.

In Brazil, where abortion is also illegal, about 250,000 women are hospitalized from complications from abortions, and about 200 women a year die from the complications. About 300 abortion-related criminal cases were registered against Brazilian women in 2017.

In Ireland prior to the repeal of its criminal abortion ban, women would travel to England to get the procedure—often using a fake English address so they could get the procedure for free under the United Kingdom’s National Health Service. Others, Khazan writes, "would order abortion pills from Women on Web, a Canada-based service that ships the pills to women in countries where abortion is illegal."

Whether a self-induced abortion is dangerous likely depends on where a woman gets her pills and what kind of information is available to assist her. Irish women’s outcomes were better than the Brazilian women’s possibly because they had access to regulated services like Women on Web. Brazilian customs officials, meanwhile, confiscate shipments of medication abortion into the country, forcing women to turn to the black market.

The American market for abortion drugs will boom under a Kavanaugh Supreme Court, says Michelle Oberman, a Santa Clara University law professor, but it will also become more difficult to penalize abortion providers for illegal abortions, since with medication abortion there is no doctor, only the woman. In that case, Oberman says, “everything I saw [in Ireland] will happen here”: the hospital reports, the prosecutions, the jail sentences.

Many states have already prosecuted women for doing drugs while pregnant or for otherwise allegedly harming their fetuses. Overwhelmingly, those punished tend to be poor women and women of color.