By Randall K. O’Bannon, Ph.D., NRL Director of Education & Research
For all their talk about concern for “women’s health,” abortion activists complain vociferously whenever anything is done to ensure women’s safety when visiting their local abortion clinic. Despite documented records of neglect, filth, and abuse (e.g., Kermit Gosnell), the abortion industry vociferously insisted that it is unnecessary to hold their clinics to basic safety standards.
Now comes a new “research brief” from the Texas Policy Evaluation Project. TPEP claims that between 100,000 and 240,000 women have self-aborted in Texas and strongly implies that we can expect a lot more if Texas’ new pro-life law currently before the Supreme Court, is allowed to stand. It is assumed that self-abortion in most cases will be by the use of chemical abortifacients.
Just to know their pedigree, TPEP is a group of pro-abortion researchers from the University of Texas, Ibis Reproductive Health, the University of Alabama-Birmingham, and notorious abortion academy, University of California San Francisco.
There are some fundamental questions about exactly how the researchers arrived at these numbers and even more issues with some of the tenuous connections that have been made to the Texas law which was passed in 2013.
Whatever the actual number of self-induced chemical abortions in Texas may be (and as we shall see it’s speculative), there are serious questions as to why. Are pro-life laws likely to be the culprit or is the relentless promotion of self-abortions by the abortion lobby and top researchers like those found at TPEP a more likely culprit?
Claims of the Study
The TPEP study, “Knowledge, opinion and experience related to abortion self-induction in Texas,” was published online 11/17/15. It was based on a survey results from 779 Texas women ages 18-49, conducted between December 2014 and January 2015.
The 100,000-240,00 abortions you’ve read in the headlines are an extrapolation from what these 779 women said about their own behavior and/or the actions of others.
Researchers say the survey found 1.7% of the women reporting they had at some point tried to self-abort. Asked whether their best friend had ever done so, 1.8% said they were sure they had, and another 2.3% suspected she had.
Using these figures and applying them to all Texas women 18-49 years old, TPEP calculates that between 100,000 and 240,000 women in that state have tried to self-abort at some point.
Explaining their numbers, TPEP stated that
… there are two recent changes that may be leading the incidence of self-induction to increase. The first is the advent of onerous legislation imposing restrictions on legal abortion access [the 2013 Texas law]. The second is the increasing preference for medication abortion, as well as the possibility of women accessing abortion-causing drugs on their own.
One clear implication of this is a contention by TPEP that if the Supreme Court upholds HB2, the Texas law imposing safety standards on clinics and requiring that abortionists have hospital admission privileges (as well as other provisions not before the High Court), people can expect more women to try and self-abort.
But does the data really show this? And if the number does increase in years to come, will it be a reflection of pro-life laws like H.B. 2 or the ceaseless promotion by the abortion industry?
No evidence the law the cause
TPEP’s research brief spends so much time complaining about the Texas law and implying a connection to H.B. 2 that news organizations like Reuters mistakenly stated, “The study estimated that between 100,000 and 240,000 women aged 18 to 49 in Texas have tried to self-induce abortion since the law went into effect”
Perhaps this is what TPEP wanted people to believe, but this is not what its own study says, even if you granted that its estimates are plausible.
We do not have the direct question TPEP asked, but their research brief says that numbers reflect the percentages of Texas women 18-49 who “reported they had ever tried to end a pregnancy on their own” (our emphasis).
That means that these numbers, even if accepted as accurate, reflect not the number of women who have tried to self abort since 2013 when the law was passed, but have ever tried (or considered?) to self-abort over their entire reproductive lives, which, for some, could be as many as twenty or more years!
We know that at least 63% of those were over 30 years old at the time of the survey, so that means for most respondents what happened (or was said to have happened to others) is likely to have occurred before 2013, not after.
Nothing here, at least in the numbers TPEP makes available, give us any indication of a sudden increase in chemically-induced, self-abortion after passage of the law.
A hundred thousand self-abortions represents many, many lost lives. But if that number (assuming it is accurate) is over a period of 21 years, it doesn’t gather the alarmist headlines this report has garnered.
Indeed, contrary to the scare stories, the information presented in this study, if taken at face value, would appear to indicate a decline in self-induced abortions, not an increase!
The research brief cites a 2012 TPEP study, conducted before H.B. 2 was even passed. That study concluded that 7% of Texas abortion patients reported “taking or doing something on their own to end their current pregnancy.”
However the current TPEP study places the estimate of those Texan women ever attempting to self-abort at somewhere between 1.7% and 4.1%. Is this supposed to mean the law caused attempts at self-abortion to go down?
How solid are the numbers?
TPEP researchers tell us that they asked the women about their best friends first before asking the direct question as to whether the woman herself had actually tried to self-abort. They argue this might reveal more data about the prevalence of self-abortion in a woman’s sociodemographic group than starting with the personal inquiry.
There are obvious questions about how solid evidence that is based on assumptions or suspicions of a best friend’s behavior can be statistically. But let us assume that this is some indication that such abortions occur and/or are discussed among women, regardless of whether they yield any hard numbers.
TPEP obtains the lower estimate–100,000– by extrapolating to the population of Texas women 18-49 the percentage of women admitting to attempting to self-abort (1.7%)
When they combine that with the percentages of women saying they suspected their best friend had tried to self abort (2.3%) or were sure they had (1.8%), they get the higher number–240,000.
But there is this very important question: exactly what counts as trying to self-induce? TPEP says the survey introduced the topic to the 779 women this way:
“Women make different choices about how to end an unwanted pregnancy. Some women may go to a hospital, clinic, or doctor’s office to have an abortion. Other women may do something to try to end a pregnancy without medical assistance. For example, they may get information from the internet, a friend, or family member about pills, medicine, or herbs they can take on their own, or they may do something else to try to end the pregnancy.”
Question: does looking up information on the internet count as an attempt to “self-abort?” In this day and age, many woman concerned that they might be facing an unexpected pregnancy will head for the internet right away to get information on pregnancy, morning after pills, or other options. In the process, she will encounter not only advertisements for clinics, but also ads for on-line foreign pharmacies that want to sell her abortion pills.
What if she discusses with her “best friend” rumors about herbs or chemical concoctions that induce abortions. Does this constitute an effort to “self-induce”?
If it does, nearly every woman who ever considered abortion since the dawn of the internet would have to answer “yes” to that question. TPEP will need to give more detail about its survey and its questions in order for us to have more confidence in these numbers.
The problem is real
As we’ve outlined, there a number of legitimate questions about the size of the number of women TPEP estimates are attempting to self-abort. But there is no question that there are women using chemical abortifacients and there may be many more now than there were in the past.
The question then becomes why. Who/what is driving usage?
Again, to be clear, the implication of the TPEP study is that the Texas law, passed in July 2013, played a major role in increasing self-abortions.
As we have reported before, the advent of chemical abortions has led to an underground market in abortion pills, particularly the cheap, easily available misoprostol, a prostaglandin often used in conjunction with the pricier, more controlled mifepristone (RU-486).
Women in Texas have been able to get these pills illegally at border town flea markets or from neighbors who might have picked up a few pills on a trip to Mexico.
Stories about the use of these pills or other rumored home remedies or chemical concoctions of dubious effectiveness among Latina women have been around for at least 15 years  and data from this study confirms higher use among Texas’ Hispanic population.
Stories about women in border towns using these pills have been ubiquitous since Texas passed its new abortion regulations, along with dire warnings about all the clinics closing.
But it should be noted that not only had several of those clinics closed before the law went into effect, the black market in abortion pills, along with rumors of other secret concoctions, long predated the Texas legislature’s action.
Exactly who is pushing women to self-abort?
The study and sky-is-falling stories about the study have an obvious “drop your oppressive clinic restrictions or there’ll be a rash of dangerous self-abortions throughout the land!” flavor to them. But the industry and its media allies have clearly been sending out decidedly mixed messages here which no one seems to have picked up on.
Lead TPEP researcher Daniel Grossman, senior advisor to Ibis Reproductive Health and professor in the department of obstetrics, gynecology, and reproductive sciences at UCSF, told Mother Jones (11/17/15) that “This is the latest body of evidence demonstrating the negative implications of laws like HB2 that pretend to protect women but in reality place them, and particularly women of color and economically disadvantaged women, at significant risk.”
However this same Daniel Grossman, along with other researchers, published another study “Misoprostol in women’s hands: a harm reduction strategy for unsafe abortion” in the journal Contraception in February 2013 (E-published 12/8/12). Yes, “harm reduction.”
In that commentary, Grossman and his fellow authors argued that “Women can use misoprostol on their own and with accurate information; they do not need a health care provider to use it safely and effectively.” They said that the availability of “high-quality misoprostol drugs” should be expanded.
They want to make sure that women can somehow find information on the right dosages of these pills they need to self-abort, but this is hardly supports the dire rhetoric that Grossman, TPEP, and the Texas abortion lobby are employing in their pronouncements and press interviews.
But Amy Hagstrom Miller, CEO for Whole Woman’s Health abortion chain, the lead plaintiff in the H.B.2 appeal, told Mother Jones magazine that (as paraphrased by reporter Hannah Levintova) “terminating a pregnancy with DIY [Do-It-Yourself] methods is not healthy for women” (11/17/15).
If more women do turn to self-induced chemical abortions, it will be due, probably in large part, to the heavy promotion of these stories and studies by the abortion industry and their allies in the mainstream media and the abortion blogosphere (Andrea Grimes, “Sharing Information About Self-Inducing Abortions Made Me Feel Empowered” RH Reality Check, 3/25/15).
The long-term trend, in Texas and elsewhere in the United States, has been a significant decline in the number of abortions. After passing pro-life legislation for several decades, Texas has seen its abortion numbers drop from a high of about 110,000 in 1981 to about 73,200 in 2011 (the latest figures available from the Guttmacher Institute). It is hard to imagine that this lengthy and significant reduction could be accounted for by a shift to self-abortion pills on the black market.
What seems to be the consequence of protective pro-life legislation and the closure of dilapidated, unsanitary clinics, is more women deciding to have their babies after all. And that is what really has the abortion industry worried.
 Village Voice 8/29/00, and Daniel Grossman, et al, “Self-induction of abortion among women in the United States,” Reproductive Health Matters, November 2010, pp. 136-146.