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Interactive Map: US Abortion Policies and Access After Roe. Credit: Guttmacher Institute. Accessed 4/15/24.
How does anyone make sense of abortion access these days? We sat down with All Options Pregnancy Resource Center in Bloomington, Indiana to talk about what’s changed since Indiana’s full abortion ban went into effect last August. Local abortion funds like All Options do a lot, but they can’t talk to clients about self-managed abortion, even though the World Health Organization says it’s safe and effective.
We learn about the ways folks are getting access to abortion pills, what to expect from a self-managed abortion and about the case in the Supreme Court now – whether the pill Mifepristone will still be legal to use for abortions, even in states where abortion care is protected.
Featuring: Episode Credits:
Music:
Transcript:
Amy Gastelum: I’m Amy Gastelum, you’re listening to Making Contact. This week we’re following up on a story about self-managed abortion that we produced last spring. A lot has changed since then, and we’re here to catch you up. That said, post Roe abortion care access is changing daily in the U. S. right now. This story is being produced for broadcast in April 2024. Things may have changed by the time you hear it.
News Caster: After the Arizona Supreme Court upheld a Civil War era abortion ban on Tuesday, Democrats in the state legislature tried to open debate on a bill that would repeal the 1864 law, but they were blocked by Republicans who cut them off and quickly adjourned for the week. It led to this chaotic scene on the statehouse floor.
House Speaker: All in favor of that motion vote aye.
Responses: Aye.
House Speaker: All opposed vote no. Ayes have it.
Amy Gastelum: Arizona recently joined several other states severely restricting abortion care, mostly in the South and Midwest. Since the Supreme Court’s Dobbs decision overturned Roe v. Wade in June 2022, access to legal abortion care has varied widely depending on the region of the country.
Some states, like California, have protected legal access to abortion care by making it part of their state constitution. Other states, like Indiana, where I live, have created bans so restrictive it’s almost impossible to qualify for a legal abortion here. But networks for helping people find abortion care are robust, and in many ways, growing.
Jessica Marchbank: Hi, this is Jess from All Options and the Hoosier Fund.
Amy Gastelum: You may remember Jessica Marchbank from the story on self-managed abortion we published last year. She’s the State Programs Director at All Options Pregnancy Resource Center in Bloomington, Indiana. In this recording from 2023, she’s in her office on the phone, following up with someone who needed funds for her abortion care.
Jessica Marchbank: Oh, good. Are you all set? You don’t need any additional financial assistance? Yes. Okay. Oh, that’s fantastic. I’m really, really happy to hear that. If anything changes, don’t hesitate to get in touch and we’ll be here. Okay?
Amy Gastelum: At the time, Jess would often refer callers like this to clinics in Indiana for care, but not anymore. Indiana’s abortion ban went into effect in August 2023. There are a few narrow exemptions, but the law is so restrictive that abortion clinics like Planned Parenthood and Whole Women’s Health aren’t providing abortion care in Indiana at all.
Amy Gastelum to Jessica Marchbank: I’m, I am curious, you know, in terms of the logistics, I mean, since August 2023, like how has that affected your work?What’s changed?
Jessica Marchbank: I mean, in some ways it’s really simple and very little has changed. And of course, in other ways, everything has changed because now the vast majority of people are not going to be able to access an abortion within the state they live in.
Amy Gastelum: It’s a huge blow, but it wasn’t a walk in the park before the ban went into effect.
Jessica Marchbank: So, leading up to the ban taking effect in Indiana, access to abortion care in state had gotten pretty bad.
Amy Gastelum: Rules like gestational age limits, mandatory counseling, and laws aimed at restricting how clinics operate already made it hard to get an abortion in Indiana. The Hoosier Abortion Access Study showed that even before the ban, about one in four Hoosiers who needed an abortion were already traveling out of state for care.
Now it’s even worse in Indiana.
Amy Gastelum to Jessica Marchbank: I’ll just say that I looked at Abortion Finder, you know, to see like, okay, if I’m six weeks pregnant, you know, where do I need to go? Like, how can I do this? And it was such a fascinating journey to be like, okay, well, the closest clinic to me is in Cincinnati, but you’ll have to go there twice.
Jessica Marchbank: You have to go there twice.
Amy Gastelum to Jessica Marchbank: I can’t be a minor. Um, but if I go to Champaign, everything changes. If I go west to Illinois, I can be a minor and I don’t have to do the counseling. And it’s up to, I think, 24 weeks gestation, whereas in Ohio it’s 22. Right. So it was like, wow. I mean, east or west makes a huge difference.
Jessica Marchbank: Oh, it definitely does. Um, a lot of our callers. So, um, right off the top of my head, if they say they’re going to Dayton, um, we always, clinic choice is always up to the individual, but we want to make sure that they have all of the information. So, um, it’s almost, depending on where they are in Indianapolis, it could be almost the same distance between, Um, sometimes they’ll say, well, you know, Champaign’s five miles farther away.
And I’ll say, but you only have to go there once. Um, and that really does make a huge difference to a lot of folks. Sometimes they’ll choose to go even further and go up to Chicago because there are numerous clinics in Chicago and sometimes it’s easier to get a fast appointment up that way. Um, even if it means they’re driving farther.
Amy Gastelum: This running around to find abortion health care is more than many people can do. In-clinic abortion care costs a lot, around $600, and often requires time off from work. Childcare and transportation are also major barriers for some. Forcing people to travel further for care means some folks just aren’t going to get it. And as Jess said, these barriers have existed long before the Dobbs decision in 2022.
Dr. Melissa Madera: Yes, Roe gave us the legal protection to get an abortion, to have an abortion, and, but, you know, so many people did not have real access to abortion, right?
Amy Gastelum: Dr. Melissa Madera is a researcher and consultant on lots of projects related to abortion access. She says people who have the hardest time getting care are those who live far from a city, are marginalized by gender identity, race, or immigration status.
Dr. Melissa Madera: And many people, many, many, many people do not have the financial ability to access abortion. Um, so we have to really think about that. Yes, Roe gave us legal access to abortion, but it didn’t actually give us all access to abortion all the time whenever we needed it.
I think what’s really important to think about is that We need multiple avenues to abortion care. Not one way is the right way for everyone, right? Um, and even in states where abortion is still accessible, um, and I hate using the word legal or, you know, talking about legalities because I don’t want to give the law any real legitimacy because it’s not legitimate.
Like, this is, this is not legitimate, right? And so We need various ways, various avenues for people to access abortion, and we should start thinking about how do we construct that for the day in which everyone in every state will be able to access abortion, or have legal access to abortion, again, using the word legal.
Amy Gastelum: The problem of legal abortion care access is old. It’s older than Dobbs. It’s older than Roe. But self-managed abortion is also old. People have been managing their own abortions for thousands of years using herbs, teas, and other methods passed down from families and cultural traditions. These days, self-managed abortion is usually done using the same medications that doctors use for abortions, Mifepristone and Misoprostol.
In 2022, the World Health Organization stated outright that it’s safe for a person to manage their own first trimester abortion without a clinician’s help. Whether you get these pills in person from a doctor or order them online, the effect is the same. Here’s how it works.
Medical Abortion Explainer Video:
There are two types of abortion available, surgical and medical. In this video, we will focus on medical abortion. Medical abortion, often referred to as the abortion pill, is a safe and effective way of ending a pregnancy. The pill is usually taken within the first 12 weeks of gestation. The whole process can take up to two weeks to complete, although most women feel normal again after just two days. Depending on the method, it can be up to 98 percent effective.
How does it work? Medical abortion can consist of two types of medication, mifepristone and misoprostol. Using a combination of both is the most effective method. Mifepristone works by blocking progesterone, a hormone necessary to maintain a pregnancy, while misoprostol works by causing the uterus to contract and contract. The combination method requires one mifepristone pill, followed by four misoprostol pills 24 to 48 hours later. If mifepristone is not available, misoprostol can be taken on its own. This method is slightly less effective. When taking misoprostol alone, 12 pills are to be taken within a 12-hour period. Four every three hours is the recommended procedure to follow.
What can you expect from a medical abortion? Misoprostol causes cramping and bleeding to empty the uterus. It can feel like a heavy period, and it’s not uncommon to pass large blood clots during the process. Side effects can include diarrhea and vomiting, tiredness, mild fever or chills, headaches, and dizziness.
To ease pain and discomfort, some of the following may help. Staying at home or in a comfortable space when taking the pills. Taking ibuprofen or painkillers before the procedure. Having a hot bath or shower. Ensuring a friend or family member present to help reassure and comfort you. Having an emergency plan in place for any potential complications.
Urgent medical advice will need to be sought if you experience excess heavy bleeding – if more than two pads are filled per hour for two hours, intense pain, continuous vomiting, a fever of higher than 38 degrees Celsius that persists for longer than 12 hours.
What happens next? This will depend on each woman’s individual experience. Most women can expect tiredness, cramping, and bleeding for a few days. Within 24 to 48 hours, most women feel fine to return to their daily routine. Although it is not essential, it is advisable to plan a follow up appointment with a health provider two weeks after the procedure. They can confirm if the process was successful and discuss your contraceptive options.
What happens to periods? Periods should return to normal four to six weeks after taking the pills. If it does not return, a pregnancy test should be taken to confirm there are no longer signs of a pregnancy.
How soon can sex be resumed? Sex can be resumed as soon as you feel ready. Pregnancy can happen soon after medical abortion, so it is advisable to talk with a health provider about the right contraception for you.
To find out more information on the options available in your nearest clinic, please visit www.ippf.org. You can also visit www.womenonweb.org for further information on medical abortion.
Amy Gastelum: While traditional in-clinic access to abortion care is increasingly difficult across the U. S., activists around the country are working to get people the care they need, especially in the form of pills. One online hub is PlanCpills. org. Here’s Dr. Melissa Madera again. She’s helped the organization with some research projects.
Dr. Melissa Madera: 2015, that’s when Plan C Pills was founded. Yeah. So it’s been, I mean, before, um, the access issues got the worst, which is right now, um, seven years ago, they were seven, eight years ago, right?
We’re in 2023 now. Um, they were thinking the, the co-founders were thinking like, how can we let people know more about how to get abortion pills online because people have been doing this and using abortion pills on their own self-managing, um, in other countries for many, many years. So the thought was, oh, this, this is something that’s happening globally. People in the U.S. should also know about it because we know, that even though we have, we, or we had, um, the right to an abortion, many people didn’t have access to abortion. So the question is how can we get more access to people? And abortion pills is one of those ways. Um, so yeah, it’s been a long time, um, that this team has been working on making sure that people know how to access, uh, abortion pills online and to manage their abortion safely. Um, And it’s the most comprehensive guide to abortion pills on the interwebs. Uh, so you can go online and search very specifically for your state. It gives you information on where to get pills, how to order them, and then resources around if you have questions about, um, the medical aspects of things while you’re self-managing, if you have questions about the legal aspects of things, also resources for those.
Amy Gastelum: Here in Indiana, if I go to PlanCpills.org, I can order pills online from Aid Access, ABUZZ, and Cambridge Reproductive Health Consultants. If I choose one of these, I would receive virtual support from a clinician if I need it and it costs around $150, no travel necessary. But there are also 25 other sites listed.
Some provide abortion pills for as little as $0. That’s right, free 99. Those sites do not offer clinician support, but PlanCpills.org also links out to the Miscarriage and Abortion Hotline, a phone and text hotline staffed by abortion care providers. Here’s Dr. Madera again.
Dr. Melissa Madera: And for some people, like, they want to use these pills, and they are like, Oh, I know it’s safe and I can do this on my own. Some people are like, Well, I don’t really want to do that. And you know what? It also has to do with your circumstances, right? Because if you are someone who can’t take, days off of work, um, or feel like, um, you know, I really have to like be home with my kids. You might want to go to a clinic, get a procedure and go back home and it’s done, right?
Um, and so one of the most important things to me is like, We need to trust people right to make the right decision that is good for them based on their own circumstances, right? So people are going to make their decisions based on like how much money I have where I live Can I take time off of work? I have kids Um, you know, it’s like there’s so many ways in which people have to like come to this decision on their own And we need to respect that and give them all the options so they can do the right thing for them.
Amy Gastelum: Self-managed abortion isn’t for everyone but planCpills.org fills a gap and proves a movement. It shows that folks are still working hard to get abortion care to people who need it. Other sites like the ReproLegalHelpline and AbortionFinder.org Also help people navigate this confusing time. But none of these sites can replace what local abortion funds do in terms of boots on the ground. Local orgs know the laws in their states.They create networks between each other to get their people’s needs met. They even advocate at the local legislative level. After the Dobbs decision, All Options was part of the group that sued the state of Indiana over an abortion ban. That action led to an injunction that lasted until August 2023.
That meant abortion care could continue for about a year. It gave networks a chance to plan how to operate after the ban would go into effect. Here’s Jess from all options in Bloomington again.
Jessica Marchbank: So if we back up two years in time, let’s go back to that. Shall we do two years ago, right? Well, it still wasn’t a walk in the park, but two years ago, um, We, as the All Options Hoosier Abortion Fund, I think we had working relationships with maybe 20 different abortion care providers, mostly in Indiana, and then a few, um, in like Illinois, Ohio, Michigan, and then like the DuPont Clinic, and a clinic in Colorado.
And we were in partnership with other regional abortion funds, but it was more allyship, but we didn’t really work closely together. So, between the Dobbs ruling and until our ban took effect, we really just doubled down on, on making sure that we were really well connected to everyone we needed to be connected to.
So we now have working relationships with over 60 abortion care providers in 9 different states.
Amy Gastelum: Wow.
Jessica Marchbank: So, um, I believe we’re working with every single clinic in Illinois, most in Michigan, most in Ohio, um, and the majority of Hoosiers really are going to Illinois at this point, but plenty still go to Ohio and Michigan.
We’re really fortunate to really build those relationships with the other abortion funds and, um, my heart just feels really full when I think about how we can lean on each other. Um, the Chicago Abortion Fund, Kentucky Health Justice Network, Abortion Fund of Ohio, um, and Midwest Access Coalition.
We have like private signal groups with all, all of the different funds. We have, um, ways to reach out directly to say, hey, we’re supporting this caller. Who needs extensive support. We can do this much. Can you do, can you do the rest?
Amy Gastelum: Meaning funding?
Jessica Marchbank: Funding and, and, um, practical support. Child care, meals, rides, hotels, things like that.
Amy Gastelum: So there are volunteers helping with these kinds of things or is it like more funding?
Jessica Marchbank: Sometimes volunteers, sometimes it’s cash assistance or a gas card, a Lyft or Uber, depends on the region and whatever fund is working with them. We are still, because we are small, we are focused on abortion funding, procedural funding.
Um, we don’t really have the capacity to do that. to do more, um, like cash assistance right now. But even so, for years and years, the Chicago Abortion Fund and Midwest Access Coalition have already been covering Indiana with that type of support and doing it well. You know, they have the infrastructure already.
Um, and I, I appreciate them so much because, um, Going into this year, we, we knew that we wouldn’t be able to sustain the level of funding that we had, um, through, like, from mid 2022 until, um, really until the ban took effect in August of 23, we were flooded with, you know, unprecedented levels of donations.
That’s what allowed us to go from funding 30 people a month to a couple of months, hundreds of people in a month. It was because we, we had more, more money. Um, those donations have dwindled. People have stopped rage giving. I think a lot of Americans think, oh, the crisis is over. Like what more really can be done? Which is like, no, the crisis is not over. And in fact, in some ways, it’s really just getting going.
Show Break: I’m Salima Hamirani. You’re listening to Making Contact, and a story about self-managed abortion in the United States. If you like today’s show and want more information, or if you’d like to leave us a comment, visit us at RadioProject.org, where you can access today’s show and all of our prior episodes. And now, back to the show with Amy Gastelum.
Chief Justice Roberts: We will hear argument this morning in Case 23 235, the Food and Drug Administration vs. Alliance for Hippocratic Medicine. and the consolidated case. General Prelogar.
Amy Gastelum: In March, the Supreme Court heard opening arguments in a case that could make it illegal for anyone to use Mifepristone for abortion care, including providers in states where abortion is legal. Remember, Mifepristone blocks the hormone progesterone, essentially ending a pregnancy. Misoprostol causes cramping that empties the uterus. It is possible to use misoprostol alone for an abortion, but it’s more effective to use both drugs.
Gen. Elizabeth Prelogar: Mr. Chief Justice, and may it please the court, FDA approved mifepristone based on the agency’s scientific judgment that the drug is safe and effective. It’s maintained that judgment across five presidential administrations, and millions of Americans have used mifepristone to safely end their pregnancies. Respondents may not agree with that choice, but that doesn’t give them Article 3 standing or a legal basis to upend the regulatory scheme.
Amy Gastelum: If the Food and Drug Administration loses this case, abortion care for everyone will change dramatically. More than half of all abortions performed in the U. S. are done using mifepristone and misoprostol. Meanwhile, local abortion funds are working this issue from all angles, leaning on one another. They’re advocating at legislative levels – All Options has sued the state, again. They’re trying to expand the exemptions for legal abortion in Indiana. They’re also coming up with creative ways to get people sexual health care. This month, All Options teamed up with the Midwest Action Coalition and Indiana Task FORCE to install an emergency contraception vending machine. It’s located at the rear of a general store called Dear Mom on Indianapolis’s Near East Side, a neighborhood where one in every four people lives in poverty.
Besides emergency contraception, the hand painted machine holds all kinds of sexual health supplies – condoms, dental dams, and pregnancy tests. The shop hosted a launch party for it. In one video posted to social media, a group of about 25 gathers in this store.
As they chat, a woman in a red t-shirt pushes a button on the vending machine while her friend records. A small green Plan B box drops. The woman reaches through the door flap, pulls out the box, and closes, smiling for her friend.
Projects like this are hyper local, and Jess says continuing to support local abortion funds is more important than ever.
Jessica Marchbank: Someone who is a strong supporter of All Options and has been for years as a donor and supporter and advocate messaged me on Facebook, I think when it was, um, announced that the ban was going to take effect. And she was basically like, hey, do you have any recommendations on where I should donate my money now, since you won’t be able to do anything? And I was like, wait, um, the only thing that has changed is that we’re not um, helping people, we’re generally not helping people access abortions in Indiana.
Amy Gastelum: You’re referring them out.
Jessica Marchbank: Yeah. Um, there’s nothing that prevents us from paying for, for a Hoosier to get an abortion in, in any of the legal states.
Amy Gastelum: What do you think that people can be doing to help folks get access to abortion or to advocate for it in a red state like Indiana or, or in a state like Mississippi?
Jessica Marchbank: There are things people can do. I do think generally if, if people are able to donate dollars, donating to grassroots organizations who are actively working in advocacy and access is really important. Like specifically within Indiana, donating to someone like All Options, it makes a real impact. Like, I get a 50 donation, um, from a, a local person and I can imagine a larger organization being like, Oh, 50. I’m like, Oh, 50! I can buy two cases of diapers, you know, like I know exactly where that money is going to go to. And I can picture the family that it’s going to go to. Or you know, to abortion funding, which is sort of this never ending stream of need. People will continue to get pregnant and not want to be so.
And so really donating to any organization that is in the fight for access and making abortion more accessible to all people is something I’ll always advocate for. Um, likewise, donating time to any of organizations like All Options, Um, Keep Our Clinics even, um, I Need An A. I think they have some, um, different volunteer opportunities and, um, those sites are vital in helping people access care.
Amy Gastelum: Um, all right. What else should people know about abortion access right now in Indiana?
Jessica Marchbank: I think the refrain that I’ve been, that I’ve been sort of broadcasting for the last 18 months is, um, first, don’t give up hope. You can get an abortion. There are, it’s not just us, it’s, there are teams of people who are here to help people get the care they need and deserve, whatever that is.
Um, so I don’t want people to feel like that sense of confusion, disinformation, and misinformation. Don’t let that keep you from exercising your rights and your choices and your agency as a human being. Um, but it’s also okay to be angry and to say this is not okay, and I want my lawmakers to know this.
Um, I want my lawmakers to know that they acted specifically against the desires of the people of Indiana when they enacted this ban. Um, and I think people need to continue to vote and to contact their legislators to express how they feel about this. Um, to say that the state of Indiana, uh, is actively repressing people’s ability to fully live lives.
And that goes for people who are having abortions, or need abortions, and for people who are parents, which, you know, there’s a big intersection there. Um, we live in a state that is making it too difficult, too costly, too emotionally costly to fully embody our lives and to raise families. And that’s not okay.
And our lawmakers need to know that. So hope, but also rage.
Amy Gastelum: Well, thank you so much for your time today, Jessica. And I’m gonna try to keep it moving.
Jessica Marchbank: Keep it moving. That’s what we gotta do. Thank you. It was really good to reconnect.
Amy Gastelum: You too. Take it easy.
Jessica Marchbank: You too. Bye.
Amy Gastelum: I’m Amy Gastelum. You’ve been listening to Making Contact. If you learned something in this episode today, I’m going to ask that you pass it on. Most of our listeners live on the coasts in states where abortion care is easier to access. If you want to share this story with your Midwest and Southern networks, go to our website radioproject. org where you can find a link to this show and share it. You can always find us on social media. We’ll see you there, and thanks.
