Guide to Having An Abortion in the U.S.
First & Early Second Trimester Abortion
Mifepristone + misoprostol are the medications most commonly used for medication abortion, and there are a number of legitimate sites where you can purchase them online (aidaccess is a good option). They will typically come together, although sometimes they are used alone. This combination is safe for first and second trimester abortions, although it may be less effective in the second trimester (or sometimes even earlier, after ten weeks). These pills can be taken sublingually (underneath the tongue) or vaginally (guide to taking abortion pills).
Avoid purchasing miffy or miso from sites that want more information from you than an address & payment method, that don't provide information about how to safely take the pills, or that use inflammatory or sales-pitch-y language. Don't take pills that come in open/unsealed packaging. Planned Parenthood (in states with legal abortion) is the most widespread reputable distributor of medication abortion.
Later Term Abortion (Surgical)
If you find yourself unable to access medication abortion, remember that, at this point (November 2024), it is still legal to cross state lines to have an abortion, and, if it becomes illegal, you can still cross state lines under another pretense, as people have been doing for decades. There are abortion provision organizations that can help you with the costs of travel and abortion services (national network of abortion funds, midwest access coalition). Planned Parenthood is the largest provider system, with clinics in many states, and the largest abortion clinic in the U.S. is located in Illinois.
Avoid institutions that call themselves "crisis pregnancy centers" or "women's health clinics," especially if they don't directly say they provide abortion services on their website. There are a number of predatory pro-life clinics that will give you misinformation about abortion or deliberately waste your time, and you don't want them to know that you are seeking an abortion, especially if you are living in an area where abortion is illegal or highly restricted.
You will be asked for informed consent when receiving an abortion procedure. Make sure that you read and understand everything before signing, keeping in mind that marginalized people (particularly Black, Indigenous, Puerto Rican, and disabled people) in the U.S. have historically been coercively sterilized when requesting abortion procedures. If you feel that your consent involves coercion to agree to something you don't want, try to find access somewhere else first. Trying to find abortion access can make you feel very desperate, but your autonomy and safety are paramount considerations. See if a provision service can help you find an alternative if at all possible.
Illegal Providers
In some circumstances, you may need to get a surgical abortion from an illegal provider. Surgical abortions are typically called dilation and evacuation (D&E). This will most likely be a vacuum aspiration abortion (sometimes euphemistically called menstrual extraction), in which a cannula removes the content of the uterus using suction. In procedures with properly constructed cannulas, there is no way to pass air into the uterus, and the procedure is typically very safe. Forceps may be used to clear out additional contents.
In some later term abortions, curettage may be used as well, in which a curette (similar to a scalpel) is inserted into the uterus to remove the uterine lining. This carries more risk for infection and/or laceration than suction evacuation alone, but has been used by both legal and illegal abortion providers for decades, and usually does not involve harm.
When evaluating an illegal abortion provider, keep these things in mind: do they keep paperwork (within reason)? do they use the correct medical terminology? do they ask you questions about how long you've been pregnant/conditions of your pregnancy/concerns you may have? Do they describe the procedure to you beforehand? Do they answer your questions? Do they discuss your options for pain management? Does the surgical room appear properly sterilized? Does the provider wear gloves & other PPE? Is there an exit strategy in the event that police show up?
What To Do When An Abortion Goes Wrong
Here are some normal & safe side effects that you may experience after an abortion (particularly later abortions):
vaginal bleeding (up until/through the next regular menstrual period)
abdominal cramping/pain (similar to period cramping)
fatigue (feeling more tired than usual, can last several weeks)
nausea (in the first one-two days)
vomiting (in the first day)
diarrhea (in the first day)
feelings of grief, sadness, joy, relief, regret, confusion, or no strong feelings at all - there is no abnormal emotional response to abortion
Here are some side effects that can be cause for concern:
fever more than 24 hours after the procedure
vomiting more than 24 hours after the procedure, or excessively
diarrhea more than 24 hours after the procedure, or excessively
past the first two hours following the procedure, excessive vaginal bleeding through more than two maxi pads per hour
extreme abdominal pain (significantly worse than pain you experience on a normal period) - this may be harder to determine if you have PCOS or endometriosis
persistent sensation that something is 'stuck' in the uterus/vaginal canal
You can call the miscarriage/abortion hotline for confidential advice about what to do/counseling for emotional distress.
If you are ill after your abortion, you will need to go to your nearest emergency room, as you may have an infection, remaining tissue, or laceration within the uterus. If you go to an emergency room, you can ALWAYS tell the medical providers there that you had a miscarriage. Miscarriage and safely performed intentional abortion are indistinguishable from one another. After an abortion is completed, there is no way to tell that mifepristone/misoprostol or D&E was used. It is unlikely, but you may be threatened by medical providers who tell you they can tell - this is NOT true. They have no way of telling. Do not admit to abortion in a state where it is illegal, or if you do not want to.
It is possible you will find yourself in a situation where medical providers are hostile to you/suspicious that you received an abortion. In this case, you may find it helpful to refer to the pregnancy as "the baby," and present more distressed than you may actually be in order to garner more sympathy.
You will likely be treated with more suspicion if you are single, have previously had a (legal, documented abortion), or are openly/visibly trans. Whenever possible, bring a trusted friend to act as your medical advocate, to corroborate your story of unexpected miscarriage, and to help you navigate the experience if you lose lucidity.
Most serious injury and death related to abortion happens to those who don't go to the hospital when they experience symptoms of infection. It is important to get emergency care if you need it! You will most likely be okay, and you never have to tell anyone that you had an abortion, doctors included.
Other Notes
The FDA has recently approved an over-the-counter birth control pill, the O-Pill, which can be purchased without a prescription. Many Planned Parenthoods provide contraceptives such as condoms, spermicide, and oral birth control for free or at low cost, even in places where abortion is illegal. Plan B is legal in all 50 states , D.C., and Puerto Rico (although partially restricted in Louisiana), and is most effective in 24 hours after having sex. There is some research suggesting it is less effective for people who weigh 165lbs or more. Ella (Ulipristal) is another emergency contraceptive option, but requires a prescription. It can be taken up to five days after having sex. It is less effective in people who weight 195lbs or more.
Odds are high that a local reproductive justice organization near you needs volunteers/members/donors, so look into it BEFORE you need it. It takes a village.
