Based on prior research, Jason Fletcher and Joanna Venator estimate the impact of the post-Roe cessation of abortion services in Wisconsin on travel to abortion care in bordering states, the number of abortions, and the number of births by state residents.
File: Access-to-Abortion-Clinics-Post-Roe_Aug-2022.pdfCORE Fact Sheet: Seymour article in AJPH
File: Seymour_AJPH_FactSheet.pdfCORE Brief: Medical Student Education on Abortion: The Current Landscape
File: Medical-Student-Education-about-Abortion.pdf
This information reflects CORE members’ expertise in reproductive health and is not an official statement of the university.
The Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization overturns the federal right to abortion established by Roe v. Wade five decades ago. The legality of abortion access is now determined by each state. Here in Wisconsin, a pre-Roe abortion ban from 1849 is on the books. It makes performing an abortion a felony—even in the case of rape, incest, and/or health risks to the pregnant person (except to save their life). It remains unclear whether the law is enforceable, and its exact legal status could remain unknown for some time. In the meantime, Wisconsin’s abortion clinics will no longer provide abortion services. Some clinics will offer pre-abortion and post-abortion care.The Supreme Court’s decision runs counter to conclusive scientific evidence documenting that abortion is safe, common, and necessary health care, and that access to abortion is a determinant of health and wellbeing across the life course.As reproductive health researchers, clinicians, and public health professionals, we know this decision will significantly impact people in our state, particularly those individuals facing the greatest social inequities. Some Wisconsinites may be able travel to Illinois, Minnesota, or other states to access abortion care, although many will have to overcome significant financial and logistical barriers to do so. Some Wisconsinites will likely self-manage their own abortions. And some will not be able to get them at all.Research shows that denial of desired abortion care has serious negative impacts for individuals, families, and communities. Compared to abortion, risks of maternal mortality and morbidity are much higher for those who carry pregnancies to term and give birth. Other harms of abortion denial include increased likelihood of staying in abusive relationships, lower likelihood of completing postsecondary education or achieving aspirational life goals, and increased likelihood of poverty for both parents and children.Evidence also establishes that banning access to abortion will cause the greatest harms to people who are already marginalized: people living on low incomes, people of color, young people, and rural Wisconsinites. In fact, given Wisconsin’s restrictive abortion laws even before Roe v. Wade was overturned, many of these individuals and communities have already experienced significant declines in abortion access and significant increases in unwanted births in recent years. Racism, economic insecurity, and immigration status also multiply the already massive barriers to abortion care.
A person cannot be prosecuted for having an abortion under Wisconsin’s criminal law. However, the post-Roe legal climate may embolden state or local officials to investigate people who seek care following a self-managed abortion and the circumstances of that abortion. The burden of this surveillance falls most heavily on Black and Brown people, whose communities are already policed more than white communities.Policies, including reproductive health policies, should be informed by evidence. As reproductive health researchers, clinicians, and public health professionals, we look forward to a day when all people can prioritize their own health, security, and reproductive autonomy: the power to decide and control contraceptive use, pregnancy, and childbearing, without interference or coercion.Thank you for being part of CORE’s community. To learn more, visit our new After Roe page.
An updated fact sheet on how pregnancy is defined by leading medical organizations: Pregnancy begins when a fertilized egg is implanted into the walls of the uterus.
File: Contraception-Is-Not-Abortion-one-pager.pdf
Self-managing abortion is a millennia-old practice, and newer, FDA-approved medications have increased its safety and efficacy. In CORE’s latest brief on Self-Managed Abortion, we consider the methods, legality, and implications of this approach. Given the leaked Supreme Court draft decision that suggests the likely overturn of nearly 50 years of legal precedent with Roe v. Wade, people’s use of self-managed abortion is likely to grow. CORE’s brief examines what the pattern of increasingly self-managed abortions means for people in need of abortion services and the landscape of reproductive healthcare in the U.S.
People who self-manage their abortions use either medications approved by the FDA for abortion—misoprostol, also known as Cytotec, and mifepristone, also known as Mifeprex—or non-FDA-approved methods. Medical and public health organizations, including the American College of Obstetricians and Gynecologists and the World Health Organization, recommend the following regimens: mifepristone and misoprostol used together, and misoprostol used alone.
Misoprostol works by causing the cervix to soften and the uterus to contract, which expels the pregnancy tissue. While misoprostol can cause an abortion, it can be more effective in combination with mifepristone, which blocks progesterone and prevents the pregnancy from progressing.
Research finds that these methods are highly effective for most people, and the medications can be safely taken without an ultrasound or pelvic exam. Taking mifepristone and misoprostol as directed entails less risk of serious complication than taking Tylenol or having one’s wisdom teeth or tonsils removed.
Methods that are not approved by the FDA include the use of plants and herbs, ingestion of toxic substances, intrauterine and physical trauma, alcohol and drug abuse, and other drugs and substances. In a recent national study, among those people who reported having ever self-managed an abortion, 38% used herbs and 20% used physical methods, such as being hit in the abdomen. These other methods are not currently used in formal healthcare settings, and are considered less safe and less effective than pill abortion.
Medication abortion can be administered in a clinic setting or at home, but with self-managed abortion, a person who wants to end their pregnancy obtains and takes the medication outside of the formal healthcare system.
Because self-managed abortion occurs outside of the medical system, it is difficult to measure how many people self-manage abortion care. Based on a recent study of people with the capacity to get pregnant, researchers estimated that approximately 7% of people who can get pregnant in the U.S. have attempted to self-manage an abortion at some point in their lives. In recent years, Aid Access has received about 50,000 requests annually for abortion medications from people living in the United States, and this nonprofit organization is only one of several mail-order services for medication abortion. Use of self-managed abortion is expected to increase as abortion becomes criminalized or increasingly restricted in many US states.
The FDA has decided that certified providers may dispense medication abortion through the mail, but this approach is not legal in some states — including Wisconsin, where prior to Roe’s overturn, medication abortion must be given in the physical presence of a physician. However, the wording of Wisconsin’s 1849 statute also suggests that people who self-manage their abortions will not be criminalized. In the context of potential legal risks for abortion seekers and providers, it is important to consider online privacy in regard to self-managed abortion.
Just as people ended pregnancies with herbs and other interventions for centuries, today, people are taking their healthcare into their own hands by self-managing abortions. Given the hostile climate of abortion access in many US states, including Wisconsin, the use of this method will likely increase- and it is critical that people are aware that safer methods now exist in the form of medication abortion.
For more context and information on how health equity relates to self-managed abortion, read the new brief from CORE on our website.
The Collaborative for Reproductive Equity (CORE) is an initiative at the University of Wisconsin-Madison School of Medicine and Public Health. CORE supports and translates rigorous, policy-relevant research on reproductive health, equity, and autonomy in Wisconsin and beyond.
Learn more about CORE at our About page.
Rigorous reproductive health research is more critical than ever - learn more about CORE in this new info. sheet
File: CORE-one-pager-June-2022.pdfCORE BRIEF: Self-Managed Abortion
June 2022
core@obgyn.wisc.edu
core.wisc.edu
@WiscCORE
Increased abortion restrictions in Wisconsin and other parts of the U.S. will very likely result in increases in
self-managed abortion, some of which will effectively and safely help people obtain desired abortions, but
some of which put people at risk for a variety of negative outcomes.
What is Self-Managed Abortion?
Self-managed abortion refers to when a person obtains an abortion outside the formal healthcare system. Historical
record suggests that people have self-managed abortions for millennia and continue to do so to this day.
There’s a lot going on in the abortion policy landscape. Here at UW CORE, Collaborative for Reproductive Equity, we are keeping track of the current policies, and will continue to provide updates should these policies change.
In this CORE Brief, we explore Wisconsin State Laws Impacting Abortion Access. This includes data on current abortion clinics in Wisconsin, abortions by race and by age, and the overall number of abortions from 2009 to 2019.
In Wisconsin, only four health clinics currently provide abortion services. These clinics are located in three counties (Dane, Sheboygan, and two in Milwaukee), meaning that 96% of the state’s counties do not have an abortion provider. Nearly 70% of Wisconsin women of reproductive age (between 15 and 44 years) live in a county that lacks an abortion care clinic. Further, an analysis of state data from 2009-2017 showed that due to recent clinic closures, residents of some counties experienced great increases in driving distances to obtain abortion care. Increases in driving distance make obtaining an abortion more costly in terms of both time and money.
Learn more in CORE’s Brief, Wisconsin State Laws Impacting Abortion Access.
CORE has paid close attention to the leaked draft opinion in the Supreme Court’s Dobbs v Jackson Women’s Health Organization case that suggests Roe v Wade will be overturned. The opinion is not final; abortion remains legal, and clinics are still open. However, pending changes to abortion access in Wisconsin are extremely likely.
CORE has prepared a brief that reviews the potential legal scenarios and consequences of the Supreme Court’s forthcoming final decision. If Roe is officially overturned by the Court, abortion services in Wisconsin will almost certainly be unavailable. Research suggests that the denial of desired abortion services will have serious repercussions for the lives, families, and communities of Wisconsinites forced to carry unwanted pregnancies to term.
Here at CORE, we document the determinants of reproductive equity, including the impact of abortion access (or lack thereof) on Wisconsinites’ heath and wellbeing across the life course. We will continue to conduct policy-relevant research and produce evidence-based materials—both for this moment and for the long haul. We are also committed to listening to and collaborating with organizations who work to advance reproductive equity on multiple levels.
Learn more at our latest CORE brief, “What Would Happen In Wisconsin if Roe v. Wade Falls? Consequences of the Upcoming Dobbs v. Jackson Women’s Health Organization Supreme Court Decision.”