Private Bleeding: Self-Induced Abortion in

the Twenty-First Century United States

Tiana Bakić Hayden

Gender Issues

ISSN 1098-092X
Volume 28
Number 4

Gend. Issues (2011) 28:209-225

DOI 10.1007/s12147-011-9105-4

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Gend. Issues (2011) 28:209–225
DOI 10.1007/s12147-011-9105-4

ORIGINAL ARTICLE

Private Bleeding: Self-Induced Abortion

in the Twenty-First Century United States

Tiana Bakić Hayden

Published online: 26 October 2011

 Springer Science+Business Media, LLC 2011

Abstract Although not common, self-induced abortion continues to exist in the

contemporary United States, where women are being criminalized for the practice.
This paper analyzes the reasons that women have for inducing their own abortions
given the existence of legal alternatives. It argues that changes in medical tech-
nologies and information technologies have made self-abortions safer and more
accessible, while structural and cultural barriers have limited access to legal abor-
tions. While some feminists and reproductive rights advocates have problematized
the practice of self-aborting itself as dangerous and indicative of the deterioration of
the rights guaranteed under Roe v Wade, this paper suggests that feminists must turn
their attentions to changing the terms under which abortion is treated under the law.

Keywords Abortion law
Medical abortion
Roe v Wade
Misoprostol

Self-abortion

As she wrote her police statement in early October, 2004, Gabriela Flores’
handwriting was shaky, devoid of punctuation or capital letters, and full of errors
which revealed how brief her schooling in her native Mexico had been: ‘‘I took the
pills 3 oral and 2 vajinal and after six ours I aborted my dauter of 4 month after it
was 6:00 o’clok in the morning and I called the lady so she can help me clean up
[15].’’ 1 Flores, an undocumented agricultural worker, was 22 years old and already
had three children, two of whom resided with her family in Mexico, and a third with

1
(Original Spanish: Cuando me tome la pastillas 3 tomada y 2 bagina y despues de 6 oras aborte a mi ija
de 4 meses leugo eran la 6 de la manana y le able ala senora para que fuera ayudarme).

T. B. Hayden (&)
New York University, New York, NY, USA
e-mail: tbh222@nyu.edu

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her in South Carolina. Unable to speak any English, earning the minimal wages of a
migrant laborer, and pregnant again, Flores found herself without financial and
emotional support, and abandoned by the man who had impregnated her. She
decided to terminate the pregnancy herself, and alone one night after work, she took
five capsules of an ulcer medication with known abortofacient properties, delivered
the lifeless fetus, and buried it in her back yard. Two days later, police appeared at
Flores’ door and arrested her, taking her away from her young child to the county
jail, where she would spend the better part of the next 6 months. Appealing to the
authorities in her statement, Flores wrote, ‘‘I alone could not maintain 4 children
and nobody was going to help me…please understand me I did it because I could
not maintain 4 babies…please forgive me.’’
The story of Gabriela Flores offers a sobering illustration of something that
remains a reality in the United States today: women being prosecuted for
performing abortions on themselves. Flores was asking forgiveness in her statement
for ‘‘performing or soliciting an unlawful abortion,’’ a crime with which seven
women in South Carolina, primarily from rural areas, had already been charged
between 1999 and 2004 [5, pp. A1]. South Carolina’s laws regarding abortion are
not unique. Indeed, in the last several years, women in Pennsylvania, New York,
Texas, Georgia, and Massachusetts have been charged with soliciting illegal
abortions. Flores’ case and the others like it may come as a surprise to the
generation of Americans who have come of age in the years since the Supreme
Court’s landmark ruling in Roe v Wade legalized abortion throughout the country in
1973. While not common, the resurgence and criminalization of self-induced
abortion speaks to the precarious state of reproductive rights in the United States
today.
Prior to the Roe decision, abortion was not entirely or universally illegal in the
United States. Most states had laws that permitted physicians to perform abortions
under specific circumstances, ranging from imminent threat to the mother’s life to
psychological duress. Nevertheless, what constituted an ‘‘illegal’’ abortion prior to
1973 was far broader than it is today, encompassing some doctor-approved and first-
trimester procedures. The effects of abortion’s illegality prior to 1973 have been
well documented.2 Maternal mortality and morbidity resulting from botched
abortions, often performed in unsanitary and terrifyingly solitary conditions
abounded. Wings of hospitals, known as ‘‘infected OB’’ or ‘‘septic wards’’ were
devoted to caring for sick and dying women suffering from infected uteruses, sepsis,
shock, jaundice, and massive blood loss—the aftermath of unsafe and illegal
abortions. Well-intentioned and reputable physicians, as well as women’s health
advocates, midwives, and quacks, were arrested and prosecuted for performing or
enabling abortions. Poor women, often women of color, suffered the most in these
times, unable to travel to other states where legal abortions were available.
The Roe v Wade ruling was a decisive victory for advocates of women’s health
and equality under the law. Since abortion was legalized in the United States,
maternal mortality and morbidity rates have plummeted, as women are no longer

2
For a thorough discussion of the era of abortion illegality in the United States, see Reagan [25].

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forced to seek out illicit and dangerous methods of terminating their pregnancies.
Today, over one-third of all American women will undergo an elective abortion at
some point in their lives, making it one of the most commonly performed surgical
procedures in the United States. It is also one of the safest, with major complication
rates of less that 1%, far lower than those associated with carrying a pregnancy to
term [14].
Yet in the last decade, there have been a number of instances of women inducing
their own abortions, and, at times, being criminally prosecuted with charges ranging
from ‘‘soliciting an illegal abortion’’ to ‘‘voluntary manslaughter.’’ Gabriela Flores
is but one of the better-documented cases of women who have self-induced
abortions in the post-Roe era, but it is safe to assume that there are more instances
than we can know about. Illegal activities, particularly stigmatized, reproductive
behaviors which traditionally belong to the private sphere, such as abortion, are
notoriously difficult to obtain reliable information about, even if given access to
medical records and police reports, both of which are often unavailable for
contemporary cases. Further, even if the number of women engaging in self-induced
abortion is statistically insignificant, the reemergence of the practice is itself
significant because it flies in the face of conventional wisdom that views such
behavior as either belonging to a bygone era or as simply anomalous. The fact that
some women in the United States today self-induce their abortions begs the question
of why this is the case, given the existence of legal alternatives.
There is almost no scholarship on the topic of self-induced abortion in the United
States since 1973, and this dearth speaks of the extent to which illegal, clandestine
abortions are seen as a thing of the past. There have, however, been some attempts
in media sources or in studies by Planned Parenthood and other reproductive health
organizations, to explore the pervasiveness and reasons behind self-induced
abortion in the United States. All of these, however, have been limited either by
focusing on a specific population, such as young teenagers or Latinas, or on a
specific abortive method, such as the drug misoprostol. This paper addresses the
question of why some women choose to seek abortions outside of the legally
protected, medical framework enshrined in Roe v Wade. It looks at the cases of
several women from across the racial, geographical, and class spectrum, whose
methods of abortion and results vary considerably, and argues that self-induced
abortions are the result of a confluence of religious, rhetorical, technological, and
legislative changes in the United States. Not simply the practice of ignorant women
or the poor, self-induced abortion can be viewed as relatively expected given the
state of health care, immigration, and changing reproductive and information
technologies.
Previous studies and media reports have largely espoused the opinion that women
who choose to self-induce abortions are victims simply by virtue of their failure to
engage in medically administered and approved abortions. In exploring the reasons
that women have for seeking to self-induce abortions, this paper also problematizes
such assumptions as reifying the authority of medical knowledge and practitioners
over women’s bodies, and upholding the distinction between acceptable and
unacceptable abortions enshrined in the law. This paper suggests that rather than
stigmatizing certain reproductive practices as signifiers of deviance or ignorance,

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a feminist agenda must not only work towards ensuring women equal access to safe
medical care, but must also insist on the right of women to engage in abortive
practices within or outside of the context of the medical system. Moreover, as
treating women who self-induce abortions primarily as victims of institutionally
constrained circumstances that lead them to not seek medically sanctioned
procedures, feminists and journalists covering the issue neglect the more profound
victimization of women at the hands of the police and courts.

Technological Change

Self-induced abortion can take many forms. Journalist Cynthia Gorney compiled a
list of various methods and tools used in the 1960s, before legalization: Lysol
douche, Hexol douche, gauze packing, artist’s paintbrush, curtain rod, slippery elm
stick, garden hose, polyethylene tube, ear syringe, copper wire, wire coat hanger,
pencil, knitting needle, woven silk catheter, chopsticks, bicycle pump and tube,
plastic tube with soap solution, gramophone needle, castor oil by mouth, ergot by
mouth, turpentine by mouth…the list goes on [13]. The crudeness of such tools is
evidenced by the death, infection, and illness that they caused, and today the fear of
many women’s reproductive rights activists is that any attempt to reverse Roe would
most likely result in a return to these methods. Historian Linda Gordon sums up this
sentiment succinctly in her book on abortion history, warning that, ‘‘Making
abortion hard to obtain…will return us to the time of crowded septic abortion wards,
avoidable deaths, and the routinization of punitive treatment of women by state
authorities and their surrogates’’ [12].
The fear of a return to a dark past makes it clear why health care providers and
feminists meet the emergence of self-induced abortion in the United States with
such trepidation. Self-induced abortions are seen as a signifier of women’s lack of
access to legal, safe options, and as a harbinger of the further demise of
reproductive rights, in large part because of their historic association with death
and danger. But while banning or radically restricting abortion is certain to have
negative repercussions of various sorts, changes in medical and information
technologies have altered the terrain of self-induced abortions, making them safer
and more accessible, and possibly contributing to women’s willingness to opt for
the non-legal procedures. The drug most responsible for this change is called
misoprostol.
Misoprostol is a synthetic prostaglandin drug which was originally developed
for use in treating gastric ulcers, but which has abortofacient and labor-inducing
qualities. Like other prostaglandins, misoprostol is a synthetic, polyunsaturated
fatty acid, which mimics the body’s hormonal regulatory system, controlling
muscular contractions, blood pressure, and body temperature [4]. In pregnant
women, misoprostol causes contractions of the uterus, which can lead to expulsion
of uterine contents. Although not approved by any regulatory body for such
purposes, doctors in the United States and other countries commonly administer
misoprostol to women to speed up or induce labor and assist in more rapid
delivery [11]. Among women in earlier stages of pregnancy, the expulsion of

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uterine contents amounts to an induced abortion, and many of the documented

cases of self-induced abortion in the United States involve the off-label use of
misoprostol.
Amber Abreu was one such case. An 18-year old immigrant from the Dominican
Republic, Abreu was a precocious young woman who obtained a high school
general equivalency diploma, found a job in a Macy’s department store, and
enrolled in English as a Second Language classes, all within 16 months of arriving
to the United States. When she found herself pregnant for the first time, Abreu
obtained misoprostol pills and took them in a bid to induce a miscarriage in her 24th
week of pregnancy. Unlike Gabriela Flores, who also took misoprostol, Abreu went
to a hospital where she miscarried the child, who survived outside of the womb for
4 days before dying. Officials there tested the baby’s urine, and upon uncovering
traces of misoprostol, contacted the police, who arrested Abreu and charged her
with one count of ‘‘procuring a miscarriage,’’ a felony in Massachusetts which
carries a punishment of up to 7 years in prison [3].
Amber Abreu and Gabriela Flores are the two most prominent cases of
misoprostol use in self-inducing abortions because both women were arrested and
charged with criminal intent in highly publicized cases. But the phenomenon of
misoprostol use, especially among Latinas, has garnered sufficient attention in
medical and public health circles to suggest that there are more cases than these. A
2000 study published in the Journal of the American Medical Women’s Association
interviewed Latina women in an undisclosed city about their awareness of and use
of misoprostol for abortions, and found that over 35% of the interviewees were
familiar with the drug, or knew of someone who had taken it [27]. In a study
published by Planned Parenthood on the sexual and reproductive health of
Dominican women in 2008, Cytotec (the brand name under which misoprostol is
often sold) was listed as an abortofacient known to or used by some of the women
[7]. Gynuity, another reproductive health organization, has also conducted a
separate study on the use of misoprostol, and several articles have been written
about the trend in publications such as ABC News, The New York Times, USA Today
and Mother Jones [cf. 8, 10, 19].
Various studies and reproductive health advocates have emphasized that
misoprostol use is far from common and not as widespread as media attention
would indicate. Yet the question remains as to why some women self-induce
abortions at all. One reason may be that, unlike the cruder methods available in the
1960s, self-induced medical abortions, using misoprostol, are far safer and more
effective than anything available prior to 1973, as indicated by clinical trials
conducted on the safety, efficacy, and acceptability of misoprostol use in pregnancy
termination. A 2000 study published in the journal Human Reproduction found
misoprostol alone to have a success rate of 85% [16], while another study from 2002
suggested that it was nearly 88% effective in terminating early pregnancies,
compared to a 92–94% success rate for legal, pill-based abortions, and 98% for
surgical procedures [21]. Indeed, in countries where abortion is illegal and women
are forced to self-induce, the introduction of misoprostol into common (if
clandestine) use has significantly lowered maternal mortality and morbidity rates

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associated with illegality.3 While none of the studies have suggested that
clandestine, unsupervised misoprostol is a preferable alternative to legal abortions,
they do provide quantitative evidence of the relative safety and efficacy of the drug
to terminate pregnancies when compared with other, illegal methods.
The weakened correlation between self-induced abortion and danger may explain
why some women are willing to take their abortions into their own hands and self-
diagnose rather than go to great ends to obtain legal abortions at high prices. In
addition, when misoprostol abortions do fail, they often appear indistinguishable
from ‘‘natural’’ miscarriages, something that women’s health organizations
emphasize to women who seek abortions in countries where they are illegal.
Women with incomplete misoprostol abortions can go to hospitals and complain of
miscarriage, therefore averting the legal and cultural proscriptions against aborting
[20]. The ability of medical abortions, whether illegal misoprostol, or legal RU-486,
to appear as ‘‘natural’’ is also a significant selling point for women who might be
reluctant to seek surgical abortions. It is worth noting, however, that women who do
go to hospitals to finish a miscarriage—self-induced or spontaneous—are subject to
scrutiny and questioning by doctors and police, a move reminiscent of the
interrogation and intimidation tactics used in the years prior to the Roe ruling.
Medical abortions are those which are induced by oral ingestion of pharmaco-
logical agents with abortofacient properties. This includes RU-486, mifeprix,
mifepristone, misoprostol, and the array of other approved oral abortion methods
used throughout the world. The studies that have been done on these illustrate both
the appeal of such methods to women, as well as the risks inherent in them, which
make some medical authorities and activists wary. RU-486, pioneered in France in
the 1980s, was approved for use in inducing abortions in the United States in 2000.
It is a legal abortion method through the 9th week of pregnancy, and one that has
been growing in popularity over the last decade. In studies of surgical versus
medical abortions in the United States, women have consistently reported a higher
degree of satisfaction with the latter, and a greater inclination to recommend the
method to a friend [9, 17]. In a large, multi-state trial conducted in the mid-1990s
and published in the journal of the American Medical Association, half of the 2,121
women taking the RU-486 pill as part of the trial had already experienced a surgical
abortion in the past. When asked to compare their experiences with the surgical
versus medical procedures, 76.9% reported being happier with RU-486, citing the
noninvasive nature of the abortion and ‘‘its ‘‘natural’’ (like menses or miscarriage)
appearance’’ [33, pp. 363–5].
But there have been significant concerns with RU-486. In 2006, after multiple
deaths associated with RU-486 use came to light in the United States, Congressional
hearings were held to determine whether or not to pull the drug from circulation
[28]. Because of the polarized nature of abortion politics in the United States, the

3
Misoprostol has in fact been endorsed by feminist organizations such as ‘‘Women on Waves,’’
dedicated to providing women in countries with repressive abortion laws with access to safe abortions and
information. ‘‘Women on Waves’’ posts instructions and information about misoprostol on its website
www.womenonwaves.org. Doctors in the United States have also emphasized the safety of misoprostol
compared with other ‘‘folk’’ abortion methods. See the Gynuity study published on www.ibis.com. Also,
see Arilha [1].

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Congressional hearings quickly devolved into partisan acrimony, with most

Republicans pushing for an end to RU-486 using blanket anti-abortion rhetoric,
and making spurious claims about the negative effects of abortion and abortion
providers on women’s health. Alarmed at the potential of such vitriol to damage
abortion rights, and armed with endorsements of safety by the American Medical
Association and multiple scientific studies, feminists and reproductive health
advocates succeeded in stemming the tide of criticisms and ensuring that RU-486
remains on shelves, albeit with stricter guidelines as to its use.4
Criticisms of medical abortion came not only from pro-life forces, however.
Janice Raymond, a professor of Women’s Studies and a medical researcher, argued
that far from being an example of ‘‘medical progress revolutionizing our lives’’
RU-486 was simply another example of unwarranted and risky medicalization of
women’s reproductive health [18, pp. 19]. Compared to surgical abortions,
Raymond pointed out, RU-486 was more time consuming, less effective, and
entailed far greater chemical input and more long-term health risks [24]. Other
doctors have reached similar conclusions, and several abortion clinics do not
provide medical abortion services citing concerns over safety and standards.
Nevertheless, there is a large degree of reluctance among reproductive rights
advocates to shun an option which a number of women evidently express preference
for.
While RU-486 is controversial, therefore, its relative safety, ease of use, and
popularity among many women make it a legal and legitimate option in the United
States for terminating pregnancies. Similarly, although misoprostol alone has not
been approved for use as an abortofacient, and despite its lower efficacy rates,
women who ingest misoprostol are engaging in a behavior that is radically safer
than were the options for self-inducing abortions in the past. This improvement in
safety, coupled with the growing awareness and acceptance of medical abortive
technologies, may in part explain why some women, especially those from parts of
the world where misoprostol use is common knowledge, opt for self-induced
abortions. Although technology certainly does not exist in a vacuum, and the
context of its development and use speak to the constraints and conditions of its
time, changing technologies do affect people’s perceptions and decision-making
processes. The advent of safer, medical abortive technologies, accordingly, may
offer some insight into why women are willing to self-induce abortions given legal
alternatives.
It would be incorrect to assert, like some enthusiasts, that medical abortions are
necessarily an improvement over surgical procedures, or that they can help
emancipate women in some way. But it is also erroneous to accept the distinction
between physician-administered RU-486 and self-administered misoprostol that
renders one legal and acceptable and the other a felonious crime that harkens back
to days of coat-hanger abortions and septic wards. More alarming from a women’s
4
The deaths associated with RU-486 were in fact caused by the practice at certain Planned Parenthood
locations of instructing women to insert some of the pills vaginally rather than taking them all orally over
a more extended period of time. This was done to expedite the process for women, but resulted in uterine
infections from the bacteria Clostridium. Planned Parenthood stopped this practice after the deaths came
to light.

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rights perspective than the decision to self-induce an abortion—a practice, after all,
which is as old as sex itself—is the criminalization of women for making
reproductive decisions outside of the increasingly narrow framework permitted by
the law. The erosion of legal options and decline in accessibility of legal abortions is
the second reason that may explain the decision to self-induce abortions in the
United States today.

Inaccessibility

Abortion today is more difficult to obtain in many states than at any other time
since legalization. In the 1990s alone there was an 11% reduction in abortion
providers around the country that left nearly 90% of all counties without any
providers at all. Over one-third of all American women now find themselves
living in counties without abortion services, with women in the Southern states
and rural areas particularly hard hit [26, pp. 89–93]. That the highest documented
number of prosecutions for self-induced abortions come from South Carolina, a
state with a large rural population and relatively few providers, is therefore
unsurprising.
In Texas, a state in which only 7% of counties have clinics, local newspapers
have reported on the clandestine use of misoprostol to terminate pregnancies,
especially among low-income women or those in remote areas [32]. Texas, like tens
of other states, forces women to undergo a mandatory 24-h waiting period and
counseling session before they are allowed to abort, prolonging the procedure into a
multi-day affair. Additionally, the lack of Medicaid funding for abortions, the result
of the 1977 Hyde Amendment passed by Congress, makes them prohibitively
expensive for many women. The average abortion in the United States costs
between $300 and $600, depending on the provider, the type and amount of
anesthetic used, and how far along the woman is in her pregnancy. This sum
represents more than half a month’s salary for many women, and combined with
travel costs, hotels, and taking days off of work, the price of a safe, legal abortion
becomes very high indeed.
The reduction of abortion’s accessibility is probably the number one reason for
an increase in self-induced procedures. Women may not be able to take time off of
work to travel and be away for the requisite 2 days that abortion now takes in many
states. They may not be able to obtain permission from their parents, if notification
is required in their state for teenagers. They may not be able to afford the costs of
getting an abortion. Indeed, while abortion may be technically legal as a result of
Roe v Wade, subsequent Supreme Court decisions and legislative decisions have
taken much of the promise of reproductive self-determination out of the ruling.
Historian Leslie J. Reagan warns in the epilogue to her book about the era of
abortion’s illegality ‘‘Feminists should look carefully and not be fooled into
thinking that abortion is still legal if it isn’t. If legal abortion is so restricted that it is
available only to rich women or to women whose lives are endangered by pregnancy
or to women pregnant as a result of rape, then abortion should be declared, in truth,
illegal’’ [25, pp. 251].

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Self-induced abortions may be seen as an indicator of abortion’s growing

illegality, both because women are again searching for extra-medical options for
terminating their pregnancies, and because they are being criminalized in the
process. Not all of these women are Latina, however, nor is misoprostol alone the
new face of self-induced abortions. Katrina L. Pierce, a 24 year old mother of three
from a small town in New York state was arrested in April of 2007 and charged with
the crime of ‘‘Self-abortion in the second degree’’. Pierce, already a familiar figure
in the local sheriff’s office as a domestic abuse victim, was found by police in her
rural home in a distraught state. An anonymous 911 caller had told police she was
‘‘worried’’ about Pierce, who confessed to taking more than 30 Tylenol and five
800-mg Motrins in a bid to abort her 13-week-old fetus. With no abortion clinics
nearby, young children to take care of, in an abusive relationship, and having little
money, Pierce attempted to terminate her own pregnancy [23].
Gabriela Flores’ case, as well, is one largely caused by the inaccessibility of legal
abortions. Living in a rural area, with no English skills or knowledge of the US
medical system, working full-time and with a young child to take care of, legal
abortion was not an easy reality for Flores, even if she did know it was an option.
And it appears that she did not, for in her police statement Flores wrote that she
thought, ‘‘if I went to the hospital [for an abortion] maybe they would put me in jail
and I was very scared for my children that they would be left alone’’ [15]. The lack
of awareness of abortion’s legality, or fear of seeking one in a hospital is not
uncommon according to Dr. Daniel Grossman, an obstetrician interviewed about
self-induced abortions in a recent ABC News article. Dr. Grossman explained that
many women, especially undocumented immigrants, are either unaware that they
can get abortions, or uncertain how to go about it [8]. Even if they do know,
however, self-induced abortions are often a far cheaper option. A dose of
misoprostol necessary to induce miscarriage could cost between $2 and $5,
compared to a RU-486 pill which could cost 100 times as much [10].
But a lack of abortion providers, and a higher cost of services does not by itself
explain the existence of self-induced abortions, for even poor and rural women have
historically gone to great lengths to secure abortive services for themselves,
overcoming geographic, legal, and financial barriers in the process. One factor, as
discussed above, is the availability of relatively safe, effective illegal options which
make self-induction a more reasonable choice for many women. Another factor,
however, is the changing rhetoric surrounding abortion, whereby clinics and
medical spaces themselves become so heavily stigmatized and symbolically laden
that women may choose to avoid them in order to conduct their own abortions.

Stigmatized Spaces

Since the 1980s, abortion clinics have been targeted physically and rhetorically by
anti-abortion forces as purveyors of evil in American society. From protests and
vigils held outside of clinic doors, to intimidation and harassment of women and
employees entering buildings, to vandalism and violent physical attacks—and in
some cases murder—against medical staff, the clinic is at the frontlines of the

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abortion wars. Protesters overwhelm abortion clinics, harassing women and staff
who entered, taking their pictures and posting them in public places, and blocking
entry into the buildings. Although the 1994 FACE (Freedom of Access to Clinics)
Act led to a significant decline in violent confrontations in front of clinics, violence
and vandalism continue to this day [26, pp. 95–99]. All over the country, abortion
clinics struggle against the vigils, prank calls, lawsuits, client harassment, and other
direct action strategies that are launched against them daily by pro-life forces.
But the physical attacks on abortion clinics are only one part of the mass
stigmatization of these spaces. The rhetoric equating abortion clinics and doctors
with evil, and the spaces with pollution has amplified in the last 20 years. Reva
Seigel, analyzing South Dakota’s attempt to ban abortion outright in 2006, points to
an insidious new argument gaining credence in pro-life communities that it is the
clinics rather than the mothers that are at fault. The South Carolina report argues
that ‘‘clinics lead unwitting women into acting contrary to their ‘‘very nature as a
mother’’: ‘‘It is so far outside the normal conduct of a mother to implicate herself in
the killing of her own child. Either the abortion provider must deceive the mother
into thinking the unborn child does not yet exist, and thereby induce her consent
without being informed, or the abortion provider must encourage her to defy her
very nature as a mother to protect her child’’ [29]. Rather than simply targeting
women who abort as ‘‘bad mothers,’’ clinics and those who work in them are cast as
culpable, coercing and convincing women to act against their own nature and
interest (and, it goes without saying, that of their unborn child).
Not limited to discursive attacks, clinics and doctors have been physically
targeted, attacked, and even murdered. Most recently, Dr. George Tiller, one of the
few doctors to perform late-term abortions in the entire county, was killed in his
church in Kansas on May 31, 2009. After his murder, some writers speculated to
what extent the character attacks on Tiller in both extreme anti-abortion and
mainstream conservative media venues contributed to the killing [cf. 29]. ‘‘The
O’Reilly Factor,’’ one of Fox News’ most popular broadcasts, for example, shows
literally tens of references to ‘‘Tiller the Baby Killer’’ in its archives, and Bill
O’Reilly himself was extremely condemnatory of Tiller’s practice and politics and
regularly attacked him on air. Conservative pundits and organizations for his
abortion practice often had targeted Tiller, and even ‘‘moderate’’ anti-abortion
organizations referred to him as a murderer or worse, some even refusing to
condemn his killing.
The demonization of abortionists, however, is nothing new. The New York Times
in 1871 called abortion ‘‘The Evil of the Age,’’ and newspapers in the late
nineteenth and early twentieth century were replete with sensationalistic stories
about the morally bereft doctors, madams, and quacks who performed abortions [12,
pp. 5]. Yet such coverage largely waned as the medical profession threw its weight
solidly in favor of abortion’s legalization in the 1960s. No longer were rogue
doctors, quacks, and unlicensed midwives the archetypal evil abortionists, but some
of the most respected doctors, lawyers, and scientists in the country were coming
out and openly supporting legalization.5 Now, however, the strategy of pro-life

5
For a more complete discussion, see: (Gordon [12], Chap. 13); (Reagan [25], Chap. 7–8).

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campaign is to increasingly focus on women’s (and unborn children’s) victimization

at the hands of clinics.
The effect of these attacks on abortion clinics and their widespread demonization
has resulted in these spaces becoming places of evil for many Americans. Although
women may know where to get an abortion, and not have financial barriers to
overcome, the stigma associated with clinical spaces and what they culturally
represent may be so strong as to deter women from seeking legal abortions. This
appears to be the case with a young woman named Teri Rhodes. Rhodes grew up in
a middle-class, white community in Michigan, completed her primary and
secondary education in Catholic schools, and had received a scholarship to
Mercyhurst College in Erie, Pennsylvania. A good student with a record of
community service work, athleticism, and a strong family connection, Rhodes
shocked the country when she got pregnant, hid her pregnancy from everyone she
knew, secretly delivered her child, and smothered it in a plastic bag upon birth.6
What is interesting about the Rhodes case is that although she continually stated
that she was ‘‘against abortion’’ and ‘‘thinks abortion is wrong,’’ a police search of
her dorm room computer revealed research on the internet about ‘‘what can kill a
fetus,’’ ‘‘alternative methods of ending pregnancy,’’ ‘‘herbal abortion techniques,’’
‘‘pregnancy termination’’ and ‘‘terminating pregnancy’’ [30]. Indeed, it appears that
Rhodes willfully induced labor, or attempted to induce abortion, before giving birth
to a living child at 9 months gestation. Why would a college-educated student with
financial resources, living within the vicinity of an abortion clinic, far away from
parents, choose to self-induce an abortion rather than seek clinical help? Why search
for ‘‘alternative’’ ways to end a pregnancy rather than use the most common and
safest method available?
A likely reason seems to be that abortion clinics carry with them an aura of
shame and associations of wrongdoing that are simply untenable for some women,
particularly young women raised in extremely Catholic, conservative homes, like
Rhodes. Indeed, a study of misoprostol use among women in an American city
found that they were likely to cite such self-induced abortions as being ‘‘more
acceptable…since abortion is against their religion.’’’ Furthermore, a New York
Times article about self-induced abortions reported women as using terminology
such as ‘‘bringing down the menses’’ to refer to their abortions [19]. In Brazil, where
abortion is highly stigmatized and illegal, studies have found frequent use of such
euphemistic language to refer to self-induced abortions [20]—language which was
common in the United States through the nineteenth century. Yet the study in Brazil
suggested that such language stems not from denial or lack of awareness of
pregnancy or abortion, but rather constitutes a ‘‘hidden transcript,’’ a way for
women to negotiate away from the criminalized, stigmatized discursive terrain
which abortion inhabits in Brazil and abort on their own terms. While abortion may
be technically legal in the United States, it seems that ‘‘hidden transcripts’’ may
exist here as well, as some women attempt to terminate their pregnancies without
entering the politicized physical and discursive spaces of clinics and legal abortions.

6
There are hundreds of articles about the Rhodes case. See, for example: ‘‘College Athlete Accused of
Killing Her Own Newborn,’’ from ‘‘The Nancy Grace Show [31].

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Additionally, legal abortions are regulated in such a way that may pose
ideological deterrents to women wishing to end their pregnancies. A key example of
this is the imaging and ‘‘informed consent’’ requirements that many states have for
abortion practitioners. Political scientist Melody Rose has suggested that persua-
sion—that is, persuading the pregnant woman not to have an abortion through
‘‘informed consent’’ and ‘‘consciousness raising’’ strategies, is a key component to
the contemporary anti-abortion struggle. An example of one such strategy is the
2005 proposed Unborn Child Pain Awareness Act which would require abortion
providers to tell women at 20 weeks or more of pregnancy that ‘‘You are
considering having an abortion of an unborn child…who has the physical structures
necessary to experience pain…the process of being killed in an abortion will cause
the unborn child pain, even though you receive a pain reducing drug or drugs’’ [26,
pp. 139–40]. While not passed, multiple states do have informed consent
requirements which essentially entail telling the woman that she is about to kill a
complete, separate life, using terminology which is value-laden, and has been found
by various state courts to impose an undue burden on the abortion-seeking woman.7
Imaging technologies may also be powerful deterrents to women who want to
abort, as Rosalind Petchesky argues in her article about the power of fetal imagery
in America today. Petchesky suggests that fetal imagery is not an objective
representation of ‘‘life,’’ but rather a symbolically saturated cultural product,
containing within it significations of pure life and innocence, all the while occluding
the pregnant woman’s desires and imposing on her the duty to motherhood. What
makes the personification of the fetus possible, Petchesky has argued, invoking
Michel Foucault, is a ‘‘panoptics of the womb’’—visualizing technologies which
allow for a narrative of pure but hidden life, to be uncovered [22]. Ultrasound and
other imaging technologies are now routinely used to dissuade women from
aborting, especially in the clinical setting. Women in various states may be forced to
look at images of developing fetuses or of ultrasounds, images which gain the
meaning of ‘‘child,’’ endowed with human sociality and quite separate from
the mother, before signing informed consent statements which further endow the
unborn with personhood.
In a context in which abortion clinics are stigmatized, and a campaign to equate
abortion with murder is well under way, the imaging and consent laws many clinics
are forced to implement act as yet another deterrent to women seeking to terminate
their pregnancies. Far from being objective or factual, the information that women
are receiving in these contexts, acts to reinforce anti-abortion discourse about
fetuses as babies, aborting women as bad mothers, and abortion as murder. Many
women may, indeed, find informed consent requirements to be as much of an
obstacle to seeking a legal, medical abortion as financial or geographical constraints.
Both Teri Rhodes and Amber Abreu seem to indicate that this may be the case.
Young women who seem not to have lacked in accessible clinics, awareness, or
7
For example, Thornburgh v American College of Obstetricians and Gynecologists, Pennsylvania
(1986) found that the informed consent provisions interfered with the physician’s discretion and was
meant to dissuade women from aborting. On the other hand, Planned Parenthood v Casey (1992)
overturned much of the previous decision and did not find state-mandated information about fetal
development to be unconstitutional. For more, see (Rose [26]).

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financial resources, but rather were opposed to abortion itself, or at least the
practices and discursive spaces which the legal, regulated form of it entails.

Abortion and Medicine

Self-diagnosing a medical condition, obtaining drugs through alternative or illegal

means, and treating oneself are an inherent part of the American medical landscape
[6]. In a context where nearly 50 million people are uninsured, and where even the
insured often do not have access to affordable abortions, the decision to self-induce
abortions is hardly irrational. It is perfectly in line with what Americans have been
doing for centuries and what they continue to do for ailments and physical
conditions, including pregnancy. Indeed, for most of history abortion was a private,
formally unregulated practice, and its current medicalized status is a relatively
recent development.
Yet the medicalization and legalization of abortion went hand in hand, mutually
reinforcing one another. Although the American Medical Association played a large
role in the movement to outlaw abortion and forms of contraception in the
nineteenth century, in the 1960s and 1970s, physicians constituted a critical voice in
the movement for (re)legalization which led to Roe v Wade, and their interests and
authority were clearly reflected in the ensuing ruling. Roe reiterated the right of
physicians and government to intervene in reproductive matters, based on the
ultimate authority of doctors. The ultimate arbiters of viability, health, and
reproductive status remained doctors, in sharp contrast with earlier eras when
women themselves had made the decision to abort. Indeed, legalization of abortion
has so entrenched the public, medical interest and authority in reproduction as to
render abortion virtually inconceivable outside of the realm of medicine, except as
an aberrant and stigmatized practice. Abortion practiced outside of the medical
domain is now illegal in most of the United States, thus women are being prosecuted
for attempting to self-induce their abortions.
The benefits of physician-controlled abortions are clear from a public health
perspective, and from the relief and satisfaction that most women feel in being able
to access these safe, clinical spaces. But it is not the only way. Historians have
documented the existence prior to legalization of safe, non-physician abortion
providers, most famously the Jane feminist collective of Chicago, which performed
over ten thousand abortions between 1969 and 1973 [12, pp. 300–3]. Jane’s
members espoused a feminist vision of women being able to secure their own
reproductive health. One woman from the collective described their goals as such:
‘‘By taking the abortion tools—curettes, forceps, dilators—in our own hands, we
had effectively demystified medical practice. No longer would we see doctors as
gods but rather as skilled practitioners, just like us’’ [13, pp. 215]. Yet Jane, and
other practices like it, were shut down after Roe. For all of its merits, Roe v Wade
and subsequent rulings, such as Mazurek v Armstrong (1997), which reaffirmed that
only doctors could perform abortions, failed to ensure abortion rights on the basis of
a woman’s unfettered right to choose. Supreme Court Justice Ruth Bader Ginsburg,
who came to the high courts after the ruling, herself criticized the decision 15 years

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later, stating that it was ‘‘weakened…by the opinion’s concentration on a medically

approved autonomy idea, to the exclusion of a constitutionally-based sex-equality
perspective [2, pp. 6].’’
Frederick S. Jaffe, the former director of a Planned Parenthood Center for Family
Planning Program Development acknowledged this tension shortly after abortion
legalization, conceding that the idea of justifying abortion solely on medical
grounds was antithetical to the idea of a woman’s right to choose. Yet, for Jaffe,
failure to medicalize abortion would ultimately lead to its disqualification from
funding and position as a necessary procedure, which would amount to an erosion of
accessibility [22, pp. 293–294]. Perhaps as a result of this recognition, and the
realization that safe, non-medical abortions were difficult to procure, the feminist
agenda in the country for the last three decades has focused on ensuring access to
clinical abortions for all women, in keeping with Roe. A casualty of this focus,
however, is that doctors have become the naturalized authorities over women’s
bodies, such that women as agents and actors of reproductive choice have, to a large
extent, left the public landscape.
But characterizing certain conditions as necessarily medical—heart surgery, spinal
injury—nevertheless fails to ensure that all citizens will have access to sound medical
treatments. Indeed, with over 45 million uninsured Americans, the notion that deeming
something a medical necessity will make it universally accessible is hardly pragmatic.
Yet patients who choose, for social or financial reasons, however constrained, to seek
alternative therapy, be it acupuncture, herbal treatment, or self-administered stitches,
are not criminalized or prosecuted, while women who abort outside of the clinical
setting face very real legal sanction. The few publicly documented examples of women
who self-induced abortion discussed here suffered not because of the medical
consequences of their actions—indeed, Gabriela Flores and Amber Abreu, for
example, safely and effectively terminated their pregnancies using the drug
misoprostol—but because of the legal framework in which women are not authorized
to make such decisions about their pregnancies without the approval of a doctor.
The apparent rise in self-induced abortion necessitates a reconsideration of the
terms in which abortion is conceived and argued. Technological changes, in the
creation of effective, abortofacient pharmaceuticals, such as RU-486 and miso-
prostol mean that women are now able to induce their own abortions at a level of
safety unimaginable previously [9]. Furthermore, the increased availability of
information on the internet about non-clinical methods of abortion means that
women seeking to avoid the politicized discursive and spatial terrain of the abortion
facility may look for alternative methods. The example of Terry Rhodes, the
Pennsylvania student who attempted to bring about her own abortion through
internet-derived sources, illustrates that improving geographic or financial acces-
sibility alone may not convince all women to seek medical methods.

Conclusions

One of the arguments in favor of legalizing abortion was that it would eliminate the
need for dangerous, self-induced abortions by turning the practice into a safe,

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medically regulated one. For the most part this is true, and complications arising
from abortions are now rare in the United States, where it is one of the safest
commonly performed medical procedures. But the current existence of self-induced
abortions is alarming to feminists and women’s health advocates, for whom the re-
privatization of this reproductive practice harkens back to a time when abortions
were not safe, when women suffered alone and without medical supports, and were
criminalized for terminating their pregnancies. This worry is not without reason. As
this paper has demonstrated, self-induced abortions do, in fact, point to the financial,
geographical, and cultural constraints which women face when seeking out legal
abortions.
Yet the biggest flaw which self-induced abortions illustrate in current legislation
is the lack of recognition of women’s autonomy and right to make decisions over
their own bodies. While medically approved and administered abortions may be the
most desirable in terms of safety and efficacy, the realities of America’s economic
and cultural landscape ensure that not all women will choose or be able to go to
clinical settings. These women who self-induce abortions should not be viewed as
irrational, uneducated, or poverty-stricken, as the media and even concerned doctors
have suggested. Rather, they are responding both to very real legal, cultural, and
economic constraints, and changes in reproductive and information technologies
which make it safer and easier to self-induce abortions.
Nevertheless, these women are victims of a very real campaign of intimidation
and criminalization of their reproductive choices, however constrained. The
collusion of doctors with police and prosecutors, as in the case of Amber Abreu,
is reminiscent of the attempts to intimidate women in the years prior to Roe into
revealing the identities of their abortionists. Yet prosecution of women themselves,
who were often depicted as victims of abortionists, predatory men, or unfortunate
circumstances, was in fact rare in the years prior to Roe. Today’s situation in which
women are subject to imprisonment, fines, and media exposure therefore represents
a new and coordinated effort to stigmatize and control women’s already limited
choices. These ‘‘bottom-up’’ efforts complement the top-down attempts to de-fund
and re-criminalize abortion at the state and federal levels. Women are not simply
victims by virtue of failing to seek medically sanctioned abortions, therefore, but
rather are victimized by the police and judicial systems which actively seek to
intimidate, arrest, prosecute, and imprison them for performing abortions.
While women who perform self-abortions may be in a minority, for now, they
underscore the need to fight for the rights already guaranteed under the law, and
increase access to legal, medical abortions, something which numerous lawyers,
organizations, and activists are diligently doing. ‘‘The right to choose’’ does ring
empty if the conditions within which choices are made are so limited as to leave
very few real options, and fighting to change such conditions is an important
element of the feminist agenda. But while a limited legal ‘‘individual rights’’
perspective is insufficient grounds for securing reproductive choices and freedom, it
is the base minimum needed to ensure that women are not criminalized, humiliated
by state authorities, and imprisoned for making choices about their bodies. The
criminalization of women who induce their own abortions demonstrates that true
reproductive freedom must be premised on and articulated in the language of

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women’s rights, equality, and bodily self-determination. This may entail, at times,
arguing that women have the right to make what seems like a worse choice—the
choice of taking pills, drinking a potion, seeking a friend’s help—for terminating a
pregnancy. But if women are to be treated as rational citizens, capable of making
reasonable decisions about their health, abortion cannot be subject to such radically
different legal standards from other physical conditions. The restriction of self-
induced abortions that is actively in place throughout the country cannot be viewed
as a measure put in place to protect the health of the woman, as various state
legislatures would argue. It is clearly another measure premised on the logic that
women are not capable and should not be entitled to making decisions about their
pregnancies, bodies, and reproductive health.

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Author Biography

Tiana Bakić Hayden is a graduate student in the anthropology department at NYU. Her research is on
issues of reproduction, food habits and policies, and gender in Latin America and the United States.

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