Are there safe ways to induce a miscarriage?

Dear Reader, 

Discovering that you're pregnant at a point in your life when you don't feel ready to become a parent can bring a lot of different emotions. It's great that you and your boyfriend are both on the same page for how you want to move forward with this unexpected situation. For many people, talking with a health care provider is an ideal first step to gather more information about safe and effective options for terminating a pregnancy. However, in many regions of the United States (US), abortions are now restricted or even banned, so finding a health care provider who is legally able to provide the health service you’re seeking may be easier said than done depending on where you live. There are still some options for people across the country to safely end their pregnancies without visiting a provider physically. However, it may involve legal and technical obstacles that vary from state to state. If you live in a state where abortion is illegal, it may be wise to keep your research private, which might involve using a secure browser (such as DuckDuckGo) and a secure app for texts and calls (such as Signal). If this sounds like your situation, you may wish to go ahead and check your privacy settings before continuing with your research. Once you’re ready, read on for more abortion-related information! 

It may also be helpful to clarify that weeks of pregnancy is measured from the first day of the last menstrual cycle, rather than from your missed period. If you took a pregnancy test and measured how many weeks pregnant you are based on the date of when your period was due, this can change how many weeks pregnant you are. It’s a common mistake that a lot of people make, and it’s one that may have big consequences since medication abortions are only recommended up to eleven weeks in the US—in other words, just seven weeks after a missed period. 

There are two types of abortions, and which one is most appropriate will depend on how far along you are in your pregnancy, whether you have any other risk factors, and the restrictions in place in your home state. For folks who are earlier in their pregnancy (eleven weeks or earlier), a medication abortion may be the more appropriate option. Medication abortions generally involve taking two medications—mifepristone and misoprostol—and are typically self-administered at home or in another safe and comfortable location. These two medications work together to essentially induce a miscarriage. A medication abortion typically requires a visit to a health care provider to prescribe the medication, but some people are able to access these prescriptions via telehealth appointments. However, different states have different laws about medication abortion and online access, specifically as it relates to mifepristone, so your ability to access and use these pills might vary depending on where you live. 

The second is an in-clinic surgical abortion, which is a procedure that removes fetal tissue from the uterus. This method requires at least one in-person visit to a provider. Some states have passed laws that add extra barriers to the process (such as a required waiting period) that might result in needing multiple in-person appointments. Depending on the state you live in, there may be a limited number of clinics in your area or none at all. Some people choose to travel to a nearby state to receive the procedure, but this may also result in added costs beyond the procedure itself, such as appointment fees, travel to and from the clinic, a hotel or other temporary lodging if the trip is multiple days, in addition to lost wages if you have to take time off work. In-clinic abortions are typically used later in pregnancy. 

You mention that you're concerned about the cost of these procedures—and you're right that the "sticker price" for an abortion may be hefty, sometimes upwards of $750. Luckily, there are many strategies to keep costs down. First, the cost of either medication or in-clinic abortion will vary depending on the setting. Clinics such as Planned Parenthood tend to be less expensive, and some even have sliding scale fees to further reduce the costs for low-income patients. On the other hand, private hospitals and private practices are usually (though not always!) more expensive. Many private health insurance plans pay for some or all of the expenses, while Medicaid covers the cost of abortion in some, but not all, states. If you’re a student at a university, there may be additional funds available to support students seeking abortion-related care off-campus. It may also be worth checking if it’s covered by the student health insurance plan. Because each clinic and office independently set their own price for services, calling different providers in your area will enable you to find the cheapest option depending on your individual insurance status and resources. 

In some cases, your insurance may not cover abortion, or you may face additional costs beyond the procedure itself, leaving you responsible for the remainder of the bill. You're certainly not the only one to face these financial challenges, and there are abortion funds across the country that aim to financially support people seeking to end a pregnancy. The National Network of Abortion Funds and Women's Reproductive Rights Assistance Project both provide listings of community abortion funds throughout the United States. While it’s fantastic that these funds exist, there are a lot of people who need them and unfortunately not enough money to go around. If you choose to pursue this financial option, it’s wise to be prepared to apply to many different funds and to have some back-up savings of your own. 

Some people who are unable to shoulder the costs of abortion care or unable to access it due to state-level restrictions may choose to use self-managed abortion. If this is a method that you’re considering, you can check out the Self-Managed Abortion; Safe & Supported website for additional information. In these situations, it’s wise to know your rights. 

If you choose to have a medication abortion at home, it's strongly recommended to have a safety plan in place in case complications occur and to have a friend or trusted person with you or regularly checking on you to make sure you’re doing okay throughout the process. On rare occasions, medication abortions might cause symptoms such as severe bleeding (defined as soaking through more than two maxi-pads per hour for two or more consecutive hours), severe abdominal pain that lasts more than two days or can't be relieved with pain medication, a high or sustained fever, or abnormal green or yellow vaginal discharge. All of these symptoms can be signs of rare but severe complications, and immediate medical care is required. If you need to seek medical care and you’re worried about abortion restrictions in your state, you’re not obligated to tell your health care provider if you used abortion pills or had an abortion elsewhere. Complications from a medication abortion and from an early miscarriage look alike and require the same medical treatment. and Your provider won’t know that your complications were caused by an abortion rather than a miscarriage unless you tell them and withholding the information likely won’t impact your treatment plan. Currently, there are no available tests that can identify the presence of mifepristone or misoprostol in your blood or urine. However, research into the development of a test for this is underway which could change that additional layer of protection. If the pills are inserted vaginally, there’s a possibility that any remains of the pill may be visible. That said, if you know or feel that the health care center you are going to is not a safe space, you might consider trying to carefully remove the pill remains from your vagina before being examined. 

With the recent restrictions on abortion for people in the US, it’s an especially stressful time to be experiencing an unwanted pregnancy. To help manage any additional stress you or your partner are feeling, you may wish to reach out to a mental health professional or other health care provider if you feel comfortable doing so in your state. Providers in other states may also be available via telehealth, or students may have access to a counseling center through their college or university. While unfortunately it has become more challenging to safely terminate a pregnancy in the United States, options still exist no matter where you live or how much money you have. Hope this was helpful in providing resources to help you make the choice that’s right for you.