It’s been more than a year since Roe v. Wade was overturned. More than 20 states have banned abortion at some early stage, most with total bans in effect. For pregnant people across vast swaths of the South and Midwest, accessing a safe, legal abortion has never been harder. Pregnant people in these states are faced with limited, onerous options: travel out of state, quietly self-manage an abortion through pills, or be forced to continue a pregnancy they don’t want.
It’s heartening to see so much energy and support around increasing access to medication abortion. Campaigns like “Abortion On Our Own Terms,” a movement to support self-managed abortion through pills, and Shout Your Abortion’s fantastic promotion of abortion pills, are wonderful and much-needed contributions to destigmatize and increase availability of medication abortion. After all, medication abortion is safe, effective and revolutionary –– it allows pregnant people to safely terminate a pregnancy from the privacy of their own homes. For folks in states where abortion is heavily restricted or even banned, especially if they lack the means to travel to another state for care, medication abortion can be a uniquely convenient option to access a safe abortion.
But medication abortion isn’t the only kind of abortion. Procedural abortion (or surgical abortion, as it’s been known) is a safe and effective way to terminate a pregnancy, as it’s been for decades. The majority of abortions in the U.S. are done via abortion pills. But there are patients who don’t fit the criteria for a medication abortion — namely, those who are past 10 weeks gestation, the point at which most providers no longer use abortion pills for pregnancy termination.
Patients opt for procedural abortions for many reasons. They may be traveling to a clinic in a protected state from a state where abortion is banned and want to ensure that their pregnancy is terminated before they go home. They may prefer to have a shorter abortion process –– medication abortion can take up to 48 hours to terminate a pregnancy, whereas a procedural abortion is done in a matter of a few hours. Or they may be past the first trimester, the point at which medication abortion becomes less effective.
Those abortion seekers are the ones who are left out of the “medication abortion revolution.” While abortions later in pregnancy are extremely rare –– 93 percent of all abortions occur at or before 13 weeks — there are so many reasons why a pregnant person might not be able to have an abortion in the first trimester. There may be a fetal anomaly or health issue for the pregnant person. Perhaps the patient has struggled to raise the funds to have an abortion, delaying their ability to access one. Many states have mandatory waiting periods of 24, 48 even 72 hours between the initial visit and the abortion, which means someone may have to take multiple days off of work to have an abortion. They may not have a car to travel hundreds of miles out of state and need to find another mode of transportation.
Women of color, low-income women, young people, and queer and trans folks have long been denied the promise of Roe, even while it was the law of the land.
Accessing a procedural abortion means overcoming more hurdles, especially for patients in states where abortion is banned. Many of those hurdles aren’t new –– the Hyde Amendment, which bars federal funding for abortion care, has been in place since 1976. Bans on state Medicaid funding for abortion and even bans on private insurance coverage of abortion make it too costly for many. Women of color, low-income women, young people, and queer and trans folks have long been denied the promise of Roe, even while it was the law of the land.
These same communities are also more likely to be targets of criminalization in states where abortion is restricted or banned, and they have greater chances of facing the criminal legal system if they attempt to procure medication abortion underground. For these patients, procedural abortion in another state may seem like the safest (if not the only) option to terminate a pregnancy and keep themselves and their families safe. Medication abortion can enable some folks in banned states to access an abortion when they otherwise wouldn’t be able to, but it could also land them in jail.
Take Celeste Burgess, a Nebraska resident, who at age 17 used abortion pills to end her pregnancy. Using Facebook messages between her and her mother, Jessica Burgess, prosecutors were able to criminally charge them both with crimes. Now 19 years old, Celeste Burgess was recently sentenced to 90 days in jail; her mother, who pleaded guilty to “providing an illegal abortion,” among other charges, faces up to five years in prison.
A mother helped her daughter, a minor, to access safe, effective medication abortion. And because Facebook, owned by Meta, was willing to turn over the data of their private digital correspondence to law enforcement, both are now ensnared in the criminal legal system. And that was for an abortion that occurred before Roe v. Wade was even overturned.
Patients face potential criminalization even if they travel to another state for a medication abortion. Medication abortion is a safe and effective way to terminate a pregnancy, and complications are extremely rare. But if a patient does have a complication once they’re home in a state where abortion is banned, they could be putting themselves at risk of criminalization. Anti-abortion lawmakers have stated their support for criminalizing out-of-state travel for an abortion; states like Alabama and Idaho have advanced legislation that would criminalize travel or supporting those who travel out of state (providers in Alabama just filed suit against that very law). If a patient comes back to the state and completes a medication abortion procured in a safe state at home, or has complications once they get home, hostile hospital workers or an overzealous prosecutor could put that patient in serious legal jeopardy, even if the abortion was procured in a safe state.
Medication abortion is a safe and effective way to terminate a pregnancy, but if a patient does have a complication once they’re home in a state where abortion is banned, they could be putting themselves at risk of criminalization.
Traveling for a procedural abortion doesn’t include that same level of legal risk. However, it means having to get to a state where abortion is legal could mean traveling hundreds, even thousands of miles. That is a significant and unjust hurdle –– but if someone is able to travel, having a procedural abortion may be preferable. You go to the clinic, you have the procedure, and that’s it. When you travel home, the pregnancy has been terminated.
Simply put, there will always be a need for procedural abortions. It is a safe, effective, basic form of reproductive health care, and while it’s harder to access than any time in the past 50 years because of Dobbs, that doesn’t mean it isn’t worth championing. Pregnant people who rely on procedural abortion are the minority, but they are still a reality. They deserve to be represented and supported. They deserve to have a movement that is firmly in their corner, advocating for them and steadfastly refusing to abandon them. Medication abortion is fantastic and worthy of support. So is procedural abortion. Let’s make sure to champion them both as we move forward in this uncertain, post-Roe terrain.