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With Roe v. Wade overturned, doctors expect to see more self-induced abortions


As abortion becomes more difficult or impossible to access in many states, some patients are relying on what's known as a self-managed abortion - people trying to end their pregnancies on their own, often using pills they get online. But when questions or complications arise, they may need to call a doctor or visit an emergency room, and health care providers are preparing to help more of those patients while protecting themselves. NPR's Sarah McCammon joins us now to talk more about this. Hi, Sarah.


FADEL: So, Sarah, explain what a self-managed abortion is and what the role of the health care system is in that.

MCCAMMON: So it's something that's been happening for a long time in various ways. You know, doctors say there are safe ways to induce an abortion under certain circumstances using medication, and, of course, there are very unsafe ways. That was certainly a reality in the years before Roe v. Wade, decades ago. But today, there are medications that will induce what is medically very similar to a miscarriage. The FDA approved a two-drug protocol more than 20 years ago, and major medical groups say the safety record for that is very strong. There are situations, though, where patients have questions or complications, and that's where the health care system can come in.

FADEL: And so what are doctors thinking about when they think about treating patients who are coming in with these complications or questions?

MCCAMMON: Well, obviously, there are medical implications. They need to know how to treat issues like cramping or bleeding and assess whether a patient might need surgery. In some states, there could also be legal implications for patients and possibly for doctors. Dr. Nisha Verma is an OB-GYN and an abortion provider, and she co-authored a new paper for the Society of Family Planning about this. She says that doctors should consult with their attorneys about what they should or shouldn't say to patients, depending on where they live.

NISHA VERMA: We need to be really intentional about what we're asking from people, making sure that we're only asking them the information that we need to take care of them.

MCCAMMON: For example, Verma says the treatment for heavy bleeding is the same whether it's caused by a miscarriage or by abortion pills, so it may not be necessary to share that kind of information.

FADEL: And so what she's talking about is concern over what is or isn't legal, depending on what state you're in. So what do we know about what is legal when it comes to self-managed abortions?

MCCAMMON: Most abortion laws in the U.S. right now do not directly punish patients for either seeking or self-inducing an abortion. That's according to attorney Farah Diaz-Tello with the legal advocacy group If/When/How. But that could change. The landscape is shifting right now. And she says some patients may fear overzealous prosecutors.

FARAH DIAZ-TELLO: Our big concern is that even if there's no legal basis for them to be criminalized, the fear of being criminalized and being entangled in the legal system is going to drive them away from health care if they need it.

MCCAMMON: And she says doctors should be careful that they aren't doing anything that could put their patients in jeopardy, such as making unnecessary reports to law enforcement.

FADEL: So you mentioned that right now, generally, patients aren't the ones that might get punished for self-induced abortion, but is it possible that that will change?

MCCAMMON: Well, first of all, there are a lot of efforts to crack down in general on the distribution of abortion pills, whether by doctors or by anyone outside of the mainstream medical system - so some of these websites. And already some states and state lawmakers are looking at ways of penalizing that. Texas and Oklahoma have enacted laws allowing individuals to sue anyone suspected of assisting with illegal abortions of all types, and a new Kentucky law calls for the extradition of people who ship abortion drugs to patients there. So this is certainly something to watch.

FADEL: NPR's Sarah McCammon covers abortion. Thank you, Sarah.

MCCAMMON: Thank you. Transcript provided by NPR, Copyright NPR.

Sarah McCammon
Sarah McCammon is a National Correspondent covering the Mid-Atlantic and Southeast for NPR. Her work focuses on political, social and cultural divides in America, including abortion and reproductive rights, and the intersections of politics and religion. She's also a frequent guest host for NPR news magazines, podcasts and special coverage.