In an essay for the New York Times published the day after Donald Trump’s victory, Lindy West issued a call to action for women.
“We have abortion pills to stockpile.” On Twitter, women have echoed the same sentiment: gather ye abortion pills while ye may. Trump has expressed vague interest in repealing Roe v. Wade, and to avoid revisiting the days when women were self-inducing with coat hangers and catheters shoved into wombs, women are reaching, instead, for pills.
The quick answer is: you can’t. In America, in 2016, it is impossible to stockpile abortion pills without breaking the law. For this reason, I cannot, in good conscience, advocate for illegally seeking out abortion pills to keep in the medicine cabinet. But since it is a fact that pregnant women who want to be unpregnant will pursue whatever means necessary to become that way, let’s entertain the possibility, for a moment.
Daniel Grossman — a professor in the Department of Obstetrics, Gynecology, and Reproductive Services at the University of California San Francisco who studies contraception and medical abortion — told Cosmopolitan.com, the “golden standard” for medical abortion involves two drugs, taken together in a precise regimen: misoprostol and mifepristone.
Taken together, under the supervision of a doctor, those two drugs are very safe, and are “95 to 99 percent effective in inducing a complete abortion up to 10 weeks,” Grossman explained.
“But in settings where mifepristone isn’t available, the World Health Organization recommends a regimen of misoprostol used alone, which is about 85 percent effective, provided it’s used correctly,” he said.
Because misoprostol has other FDA-approved uses that aren’t abortion-related (like treating stomach ulcers), misoprostol is more easily obtained than mifepristone. Grossman said that any physician can write a misoprostol prescription, and provided your pharmacy has it in stock, you can obtain it that way.
But you still need the prescription, which means you have to actually need it in order to get it, making it impossible to stockpile.
Still, women have found other ways to procure the drug. In Texas, for example, researchers found that women who had no other way of acquiring an abortion were terminating pregnancies at home with misoprostol pills bought from pharmacies in Mexico, where the drug is sold without a prescription to anyone who wants it.
There are also organizations like Women on Waves and Women on Web — both of which deliver abortion pills to women without any access, though not to women in the United States. On its website, Women on Waves even has very clear, precise instructions for people who want to purchase misoprostol to illegally self-induce an abortion:
“To obtain one these medicines, one could, for example, say that your grandmother has rheumatoid arthritis so severely, that she is visiting, and she forgot her medicines and is in pain, and that you do not have money to pay for a doctor to get the prescriptions for the tablets or that the doctor is on a holliday,” the site instructs.
Of course you could buy misoprostol pills illegally online, from the black market or from Canadian drug stores. It’s possible that those illegal pills would be fine and safe, and if you knew exactly how far along you were in your pregnancy, and had clear instructions on how to terminate your pregnancy with those pills, you would be successful and healthy.
But it’s also possible that you won’t know the exact dosage of those pills, or how far along you were, and while misoprostol is a very safe drug when used correctly, any drug used incorrectly can have severe consequences.
“If you’re not sure exactly how far alone you are, it’s a more complicated procedure if used later in pregnancy,” Grossman said. “It may take longer, it may be less effective, it may be more painful, and essentially just more shocking for the woman to expel a second trimester pregnancy on her own. The biggest concern is that women may not know the appropriate dosage to use. In places like Mexico, where women get medication in pharmacies, they’re told crazy regimens that are not likely to be effective.”
In some states, the issue of access stripped away to the point of impossibility for some women is solved by abortion pills being sent via telemedicine. In the U.S., Grossman said this practice involves a woman visiting a clinic, having a video conference with a doctor about wanting to terminate her pregnancy, and then after an ultrasound and proper tests, she is sent abortion pills from afar.
The New York Times mentions a new model some states are trying out right now, that would have women receiving the drugs directly in their homes, with clear instructions, and then quietly terminating their pregnancies without ever having to visit an actual doctor’s office.
But 19 states currently ban the use of telemedicine to prescribe medication abortion to women remotely, so the model isn’t a perfect solution in the instance that Trump is actually able to roll back abortion access.
“My belief is that Congress, and some state legislatures, may feel emboldened under the Trump administration to pass more restrictions on abortion access, but the reality is we just got a very good ruling from the Supreme Court in Whole Woman’s Health v. Hellerstedt,” Grossman said. “I’m actually optimistic that, even though they may try to oppose more restrictions on abortion access, litigators will have a lot of tools to go after those laws.”
In the decision for Whole Woman’s v. Hellerstedt, the Supreme Court made it incredibly clear that abortion legislation without any medical backing won’t be upheld. So while yes, Trump may appoint pro-life Supreme Court justices who could try to suppress abortion rights in this country, it would be hard to do so, in Grossman’s opinion, without proving that those restrictions benefit the health and livelihood of the women they affect.
Does this mean abortion is safe under Donald Trump? Not necessarily, no, lawmakers — especially the top lawmakers — can always find new ways to restrict women’s rights. But it also doesn’t mean it’s time to break the law, and purchase black market abortion pills for ourselves and our friends, in the case that we ever need them.