By Rebecca Shabad -
NBC News
WASHINGTON - KT Volkova tested positive for pregnancy just days before the controversial Texas law banning most abortions went into effect.
The 23-year-old, who identifies as non-binary and uses the pronouns they / them, was nearly six weeks pregnant and immediately knew she wanted to have an abortion.
But Volkova was already on the cusp of the limit set by the new law, which prohibits abortions in clinics after the detection of a fetal heartbeat, or after six weeks.
The options for abortion were limited.
Volkova imagined it would be impossible to perform the procedure in a Texas clinic, flooded by other people wanting to have an abortion, before the law went into effect on Sept. 1.
But his busy schedule kept him from traveling out of state.
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Volkova's solution: order abortion pills online to terminate the pregnancy at home.
“It was almost like an online shopping experience with a customer service representative.
Personally, I would say that it was even easier than having to go to a real clinic, ”he said.
But Volkova, who used a second last name for privacy, has been concerned about possible legal ramifications and declined in an interview to give personal information or name the source of the pills.
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For many women seeking an abortion, who often have low incomes, traveling out of state to undergo the procedure is not feasible, not only because of the cost and travel, but also because they cannot take time off work or organize the procedure. child care.
Instead, women living in states that impose restrictions on the procedure are turning to ordering the pills online to induce abortion at home, for their affordability and convenience, and for some, out of desperation.
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They are circumventing laws that make obtaining abortion pills burdensome and complicated, as in Texas, where women must pick up medications in person and cannot obtain them through an online appointment.
Another Texas law that goes into effect in December will further tighten restrictions on the pill, reducing the time for use from up to the 10th week of pregnancy to the 7th, and prohibiting the drug from being shipped by mail.
Increase in online traffic
Plan C, an organization that provides information on how to order abortion pills online and advises on how to avoid legal trouble, says traffic to its website has skyrocketed since Texas' fetal heartbeat law went into effect, the so-called Senate Law 8.
The organization, which does not distribute the pills, offers a list of suppliers of the drugs, including some online pharmacies that the organization's co-founder, Elisa Wells, acknowledges may raise questions at first glance.
But his organization has tested the pills from every website he promotes and verified their reliability and safety.
"The increase and interest in our website and the visits to our abortion pill search service that we offer is an indication that people are really looking for options," Wells explained.
"So I think there is a lot of interest in this," he added.
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Aid Access, the only physician-run service in the United States that provides pills to those seeking a self-managed abortion, is one of the most popular providers.
The service does not include video or phone consultations, nor does it require ultrasounds that are required in some states.
Instead, it uses electronic forms that ask patients about the first day of their last menstrual period and any possible bleeding disorders.
If patients live in one of the 20 states where it is legal to obtain abortion pills through telemedicine services, they receive a prescription from a US provider who works for Aid Access and fill it through an over-the-counter pharmacy by mail.
Those who live in restrictive states like Texas can still get their medication from the organization, which is based in the Netherlands.
There, the group's founder, Dr. Rebecca Gomperts, and her team ship the prescriptions of these patients to a pharmacy in India, a major pharmaceutical manufacturer, which then ships the pills directly to their homes in the United States.
In those cases, the pills cost $ 105 and can take an average of two weeks to arrive.
For women who cannot afford the price, Aid Access accepts any donation or covers the cost in full.
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Although the Food and Drug Administration (FDA) during the Trump Administration required Aid Access to cease and desist from its shipments of abortion pills, there is little the government can do to prevent the transactions, experts say. .
It would be completely impractical for the government to try to seize the packages, given that millions of Americans routinely circumvent the US ban on importing most drugs, they say.
"All [Aid Access] medications, whether they're in Texas or out of state, are discrete packages," said Christie Pitney, a women's health nurse practitioner who is a US pill supplier for Aid Access.
“There is no way for the post office or the postman to know what is being delivered
.
There is no way this can be intercepted like that. "
Although Plan C and other experts claim that the pills are safe.
The FDA told NBC News, the sister network of Noticias Telemundo, that it is concerned about their sale because they have not been approved by the agency or properly inspected.
Drugs that circumvent these standards "may be contaminated, be counterfeit, contain varying amounts of active ingredients, or contain totally different substances," they noted.
Although data shows that the pill has become an incredibly popular abortion method, it is difficult to keep track of the exact numbers of self-managed abortions in the United States.
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Abigail Aiken, an associate professor at the University of Texas at Austin who has studied self-managed abortions, found that Aid Access, which launched in 2018, received more than 57,500 applications in its first two years of service in the United States.
When the Governor of Texas, Republican Greg Abbott, imposed a week-long ban on abortions and other procedures that he deemed "not immediately medically necessary" in March 2020, as a way to conserve medical resources During the COVID-19 pandemic, requests to Aid Access from Texas nearly doubled, according to Aiken.
Their study revealed that applications increased in several states with "severe and longer-lasting restrictions" amid the pandemic, although Texas showed the largest increase in applications "despite a relatively low burden of coronavirus cases during the time frame. of the study ".
Risk of criminalization
Most people who request an abortion are more focused on trying to terminate their pregnancy safely and effectively than on fearing potential legal repercussions, said Aiken, who has studied the issue.
“I think those concerns are not the first on the list of people trying to manage themselves.
They are just looking for an affordable and safe way to get the care they need, "he said.
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But although studies have shown that the vast majority of women who self-manage abortions at home do not need further medical attention, complications, although rare, do arise, and in some cases patients or others were detained after follow-up care.
The If / When / How group, a network of lawyers focused on abortion rights, found at least two dozen cases in which people were prosecuted for engaging in self-managed abortions since 2000. A woman in Pennsylvania, for example , was sentenced to up to 18 months in prison in 2014 for obtaining abortion pills online and giving them to her teenage daughter, who suffered complications.
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Texas fetal heartbeat law does not criminalize abortions, but allows anyone, even someone outside of Texas, to sue abortion providers or others who help people abort after the six-week limit for at least $ 10,000 per defendant.
Abbott also signed Senate Bill 4 earlier this month, making it a state felony, punishable by jail time, for doctors to provide medical abortions to people more than seven weeks pregnant.
The bill also seeks to clamp down on the delivery of the pills to Texas residents.
But while Texas, like most states, does not specifically criminalize the fact that people self-manage their abortions, there have been criminal investigations in more than 20 states related to these types of abortions because prosecutors take advantage laws that are not directly related to procedure, according to If / When / How CEO Jill E. Adams.
Those charges have spanned the gamut, from unlicensed practice of medicine and pharmacy to possession of a dangerous substance, and from child abuse to neglect or endangerment of a minor.
There have also been charges related to the laws on the disposal of fetal remains, the abuse of a corpse and the concealment of a birth.
Adams warned that the Texas law on fetal heartbeat could "indirectly lead to further criminalization of people who terminate their own pregnancies outside of the formal medical system," because as more people self-manage their abortions, the potential increases. complications - and therefore the risk of prosecution under other laws.
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After the law came into force, the group received an increase in calls from people trying to get by in the new environment.
"We want people who end their pregnancies to know that they have the right to do so, but that it carries some legal risk, and that they could be unfairly detained, investigated and jailed, prosecuted and eventually imprisoned," Adams said.
A "terrible" environment
The environment for abortion seekers and providers in Texas since the heartbeat law went into effect has been demoralizing, said Amy Hagstrom Miller, founder of Whole Woman's Health, which runs four abortion clinics in Texas and has been complying with the law.
Its clinics were still performing abortions minutes before the ban went into effect.
At their Fort Worth location, they confronted protesters who were lighting up the clinic and parking lot with a spotlight and pointing flashlights at patients' cars “just to let us know that we were under surveillance and that they were prepared to catch us. you know, we paid attention after midnight, ”he said.
"It's a terrible environment with this kind of vigilant bounty hunter system."
His staff meet people who come to his clinics and "when we give them the results of their ultrasound and tell them that they cannot have an abortion in Texas, they are simply shocked."
“They are scared.
Some feel really desperate, "he said.