Or it could be lower, because women in states with bans may be pursuing numerous options simultaneously, said Caitlin Myers, a professor of economics at Middlebury College who studies abortion: “It’s really hard to know how much people seeking abortions are trying to get access to every possible option in a mad scramble.”
And some women are probably getting abortions in other ways that are not included in researchers’ counts, like ordering directly from Indian pharmacies online, crossing the border to Mexico to buy pills, taking herbs, or injuring themselves.
More information about what women are doing and who is most affected by bans will be available soon. For example, Lauren Ralph, an associate professor of obstetrics and gynecology at the University of California, San Francisco, is planning a large survey of women next year that asks about all types of abortions outside the medical system.
For now, data about pills from abroad “gives us information that there’s tremendous need for abortion in these places, and people willing to use these services,” said Dr. Daniel Grossman, director of Advancing New Standards in Reproductive Health at the University of California, San Francisco. “But the magnitude, we don’t know that yet. It will take time before we understand the full impact of these bans and restrictions.”
Until recently, there had been no systematic attempt to count self-managed abortions. Professor Myers and colleagues estimated the effect of abortion restrictions enacted in 2009 in Texas by measuring births years later. They found some evidence suggesting that women close to the Mexican border might have gotten abortion pills from abroad.
Previous surveys found that even when Roe was law, small shares of women took pills or herbs to try to induce an abortion on their own. And an examination of the declining abortion rate from 2014 to 2017, compared with increased use of contraception, suggested that, in recent years, the legal abortion statistics might have missed a substantial number of American women who were ending their pregnancies with pills obtained outside the country.
Even without an exact number, it’s clear that a growing number of pills from abroad are offsetting the reduction in legal abortions. A more complete picture will be known in nearly a year, when states begin to release data on the number of births since abortion bans went into effect.
Claire Cain Miller and Margot Sanger-Katz
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