How much of the decline in the number of abortions is explained by DIY abortions?

By Randall K. O’Bannon, Ph.D, NRL Director of Education & Research

In the report released Wednesday, the Guttmacher Institute reported the welcome news that the number of abortions in 2017 was 862,320, a 7% drop from 2014. The abortion rates and abortion ratios also declined.

This has also been an era in which the number of chemical abortion [“medication abortion”] has soared. Guttmacher says that chemical abortions – 339,940 for 2017 – now constitute 39% of all abortions performed in the U.S. This is a direct consequence of the decision by the U.S. Food & Drug Administration’s (FDA) to approve mifepristone (RU-486) in September of 2000.

Activists in the U.S. and overseas (such as Women on Web and Women Help Women and Aid Access) have been vigorously promoting the use of abortion pills overseas and more recently and telling women in America how to obtain and use them at home. They have also had considerable success in persuading the FDA to water down its requirements for how chemical abortions are administered—and are looking for more changes.

The clear intention of these advocates, sometimes made explicit, is to make sure that abortion is available to women even when or where it might be illegal or at least difficult to access.

The obvious question is how much this is already happening now, and this is something that Guttmacher makes an effort to address, adding a bit of its own subtle spin.

How much have hidden self-abortions replaced clinic abortions?

In their summary “Key Points” opening the report, Guttmacher’s Rachel K. Jones, Elizabeth Witwer, and Jenna Jerman totally discount the impact of pro-life laws in accounting for the 7% drop, downplay that relevance of an overall decline in fertility, and give little consideration to the fact that fewer pregnant women are choosing to abort.

Instead they write that one of two factors that “may have contributed to the decline” included “increases in the number of individuals relying on self-managed abortions outside of a clinical setting.” (The other was their usual “go to” explanation – “improvements in contraceptive use.”)

Why would Guttmacher, the think-tank of the Abortion Industry, give such prominence to “self-managed” abortion (also called “self-induction,” or “DIY” abortions)?

As we’ll see, the evidence is meager for any substantive increase in self-managed abortions. (For example, an increase could well be the product of the way doctor’s offices and abortion clinics were asked about these “off-the-grid” abortions.)

If the evidence is so scanty, it raises the question as to why Guttmacher and the industry would so readily offer this as a possible reason for decline.

Guttmacher has decried the recent proliferation of pro-life legislation, in the form of right to know laws, clinic safety regulations, physician presence requirements (that the abortionist must be present to examine a woman before prescribing abortions pills), etc., while at the same time attempting to deny that such laws have had any impact on abortion numbers.

Part of the message of the promoters of self-abortions (whether by webcam, by drugs bought over the internet, or delivered by mail) is that they have found a way around any pro-life legislation, a way to render any legal limits on abortion moot.

Raising the possibility that some of the reduction in the number of abortions is because they have “gone underground” and therefore uncounted is not only a way to explain the decline without crediting pro-life legislation, but also to continue pushing these new self-abortion promoting groups and programs.

This also lays down a marker for future reports if and when the decline continues. Rather than admit the obvious – that pro-life legislation is working and that demand for abortion is down – they can argue that these abortions have simply shifted to the self-induced variety that are not counted by the clinics and passed along to Guttmacher.

If abortion advocates are able to get the FDA to further dilute its regulations on mifepristone so that these drugs can be legally shipped by mail and performed with little or no actual medical supervision or accounting, this could become a largely self-fulfilling prophecy.

Questions about the Question

Guttmacher asked the doctors and clinics they surveyed whether they had encountered any patients coming in for a “failed abortion” due to “self-induction.” Eighteen percent of the doctors and clinics said they had in 2017, up from 12% in 2014.

Note, however, that Guttmacher changed the question asked in the 2014 survey in its 2017 survey. In 2014, they asked whether the facility had encountered such patients and then asked how many. In 2017 Guttmacher simply asked the facility for the number of self-aborting patients it had encountered.

Because the question changed, Guttmacher says it is unclear whether this meant the clinics were unsure if they had encountered such patients or just unsure of the number. Only 10 facilities had said “don’t know” in the previous survey.

Why is this important? One thing these groups advised self-aborting women is that if they have to go to hospital because of complications, “You do not have to tell the medical staff that you tried to induce an abortion; you can tell them that you had a spontaneous miscarriage… The symptoms of a miscarriage and an abortion with pills are exactly the same and the doctor will not be able to see or test for any evidence of an abortion, as long as the pills have completely dissolved” (Aid Access website, 10/24/18).

The point is that in 2014 before such campaigns officially began in the U.S., it is unlikely that abortion clinic staff knew they needed to be on special lookout for such patients. Once these programs and studies kicked off, those in the industry were alerted to the possibility and may have begun to view patients saying they were having miscarriages with suspicion.

If they were familiar with the advice of those promoting these DIY abortions online, more facilities would be inclined to consider the possibility and suspect maybe that they had. At a minimum they might believe that they honestly would have to say “don’t know” about possible “self-managed” abortion patients.

Point? This means that the survey results may be more an indication of increased awareness (or suspicion) rather than increased self-abortions.

Study Doesn’t Suggest High Numbers

Guttmacher cites a study conducted by Daniel Grossman in 2017 which claimed to find that 1.4% of women had attempted, at some point in their life, to end a pregnancy on their own. Few (28%) of these were successful and nearly a quarter had occurred more than 17 years earlier (prior to 2000).

Even though Guttmacher believes that such abortions may be underreported, they admit that such a low percentage makes it “unlikely that even a substantial increase in self-managed abortion can account for the majority of the decline in abortion incidence nationally during the study period.”

In other words, despite identifying the possibility of the reduction in officially counted abortions as being a possible consequence of more women self-aborting, Guttmacher later calls the idea that these abortions could count for most of this decline “unlikely.”

New Programs Yet to Find High Demand

One final bit of evidence that argues against pinning very much of this decline in the number of abortions on unreported self-inductions is information Guttmacher reports from Aid Access on the number of abortion pill prescriptions they have sent by mail. Since launching its website in March of 2018 with considerable publicity, Aid Access says that it filled only 2,500 prescriptions that year.

While very unfortunate, this is hardly an indication of years of widespread hidden practice or “pent up” heavy demand. Some, not “most,” have occurred, yes.

Conclusion

Thankfully, the number of abortions has been going down, dramatically, for almost thirty years, long before these new chemical abortion methods were developed and gained prominence. They have altered the terrain some, but haven’t really reversed the overall vector.

What does not seem to occur to Guttmacher and the abortion advocates is that abortion is down because demand for abortion is down. After seeing these “choices” play out over the past few decades, many women have figured out that abortion hasn’t delivered what it promised.

Abortion hasn’t made women’s lives easier or better, it hasn’t solved their economic or relationship problems, it hasn’t given them a brighter future. It has left them empty and hollow, carrying pain that goes on for years.

It isn’t that pregnancy and birth don’t present their own challenges, but at least with life comes hope and possibilities that abortion can never deliver.

And that’s gotta count for something.