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A self-induced abortion (or self-induced miscarriage) is an abortion performed by the pregnant woman herself or with the help of other, non-medical assistance. Although the term includes abortions induced with legal over-the-counter medication, it also refers to efforts to terminate a pregnancy through alternative, sometimes more dangerous means. Such practices may present a threat to the health of women. If the abortion does not result in termination of the pregnancy, damage to the fetus can occur.
Self-induced abortion is often attempted during the earliest stages of pregnancy (the first eight weeks from the last menstrual period). In recent years, significant reductions in maternal death and injury resulting from self-induced abortions have been attributed to the growing use of misoprostol (known commercially at "Cytotec"), an inexpensive, widely available drug with multiple uses, including the treatment of post-partum hemorrhage, stomach ulcers, and induction of labor. The World Health Organization has endorsed a standardized regimen of misoprostol to induce abortion up to 9 weeks of pregnancy. This regimen has been shown to be up to 83% effective in terminating a pregnancy.
Women in India are reported to use the following to induce abortion:
There are a number of narratives that have described self-induced abortions. Many of the following methods present significant danger (see below) to the life or health of the woman:
In a letter to the New York Times, gynecologist Waldo L. Fielding wrote:
The familiar symbol of illegal abortion is the infamous "coat hanger" — which may be the symbol, but is in no way a myth. In my years in New York, several women arrived with a hanger still in place. Whoever put it in — perhaps the patient herself — found it trapped in the cervix and could not remove it...However, not simply coat hangers were used. Almost any implement you can imagine had been and was used to start an abortion — darning needles, crochet hooks, cut-glass salt shakers, soda bottles, sometimes intact, sometimes with the top broken off.
Charles Jewett wrote The Practice of Obstetrics in 1901. In it, he stated, "Oil of tansy and oil of rue are much relied on by the laity for the production of abortion, and almost every day one may read of fatal results attending their use. Oil of tansy in large doses is said to excite epileptiform convulsions; quite recently one of my colleagues met such a case in his practice."
In the 1994 documentary Motherless: A Legacy of Loss from Illegal Abortion, Louis Gerstley, M.D., said that, in addition to knitting needles, some women would use the spokes of bicycle wheels or umbrellas. "Anything that was metal and long and thin would be used," he claimed. He stated that a common complication from such a procedure was that the object would puncture through the uterus and injure the intestines, and the women would subsequently die from peritonitis and infection. Later in the film he mentioned that potassium permanganate tablets were sometimes used. The tablets were inserted into the vagina where they caused a chemical burn so intense that a hole may be left in the tissue. He claimed the tablets left the surrounding tissue in such a state that doctors trying to stitch up the wound couldn't do so because "the tissue was like trying to suture butter." Dr. Mildred Hanson also described the use of potassium permanganate tablets in the 2003 documentary Voices of Choice: Physicians Who Provided Abortions Before Roe v. Wade. She said, "the women would bleed like crazy because it would just eat big holes in the vagina."
Attempts to insert hazardous objects into the uterus are particularly dangerous, as they can cause punctures leading to septicemia. Ingesting or douching with harmful substances can have poisonous results. Receiving blows to the abdomen, whether self-inflicted or at the hands of another, can damage organs. Furthermore, the less dangerous methods – physical exertion, abdominal massage, and ingestion of relatively harmless substances thought to induce miscarriage – are less effective, and may result in the fetus developing birth defects. However, abdominal massage abortion is traditionally practised in Myanmar, Thailand, Malaysia, the Philippines, and Indonesia.
The prescription synthetic prostaglandin drug misoprostol – used in the U.S. to treat gastric ulcers – is often used as an abortifacient in self-induced abortion in Latin American countries where legal abortions are unavailable, and its use has also been observed in immigrant populations in New York. Although proponents of this method deem it to be safer than those using insertion of objects or chemicals into the uterus, they also note that failure to effect an abortion by this method can lead to the child being born with serious birth defects. Furthermore, the drug causes a drastic drop in blood pressure, and women may hemorrhage as a result of misusing the drug for the purpose of abortion.
Methods of inducing abortion vary globally. An estimated twenty-five million unsafe abortions occur each year. Approximately 69,000 women die of unsafe abortion each year, though not all as a result of self-induced abortions.
Survivors of self-induced abortion can have long-term consequences related to their health. From 1995 to 2003 the number of total abortions including those supervised by medical personnel and those that were self-induced declined. While maternal morbidity and mortality from unsafe abortion has continued to increase due to population growth, in Latin America, from 2005 to 2012, there was a 31% decrease in the number of complications from unsafe abortion, from 7.7/1,000 to 5.3/1,000. Researchers believe that this may be due to the wide availability of misoprostol in Latin America.
The practice of attempted self-induced abortion has long been recorded in the United States. Turn-of-the-20th-century birth control advocate Margaret Sanger wrote in her autobiography of a 1912 incident in which she was summoned to treat a woman who had nearly died from such an attempt.
A study concluded in 1968 determined that over 500,000 illegal abortions were performed every year in the United States, a portion of which were performed by women acting alone. The study suggested that the number of women dying as a result of self-induced abortions exceeded those resulting from abortions performed by another person. A 1979 study noted that many women who required hospitalization following self-induced abortion attempts were admitted under the pretext of having had a miscarriage or spontaneous abortion.
WHO estimates that approximately 22 million abortions continue to be performed unsafely each year, resulting in the death of an estimated 47,000 women and disabilities for an additional 5 million women. Almost every one of these deaths and disabilities could have been prevented through sexual education, family planning, and the provision of safe abortion services. Abortion pills, which began be used by women themselves in Brazil in the 1980s, can prevent many of these deaths from unsafe abortion.
Although Roe v. Wade made abortion more readily available throughout the U.S., it remains a crime in most jurisdictions for a woman to attempt to perform an abortion on herself. In May 2005, Gabriela Flores – a 22-year-old Mexican immigrant farm worker and mother of three living in Pelion, South Carolina – was charged under such a statute, which carried a maximum penalty of two years in prison. She had induced abortion at roughly 16 weeks by ingesting misoprostol under the brand name Cytotec, an ulcer medication with abortifacient potential. She was sentenced to 90 days in jail. Mississippi classifies self-induced abortions as deaths which affect the public interest, requiring that physicians report them to the local medical examiner. By contrast, New Mexico's "Unborn Victims of Violence Act" exempts self-induced abortion from the criminal liability the act creates.