Enabling Self Managed Abortion in Your Community

and they've so far been successful. Inness was kind of looping around Roe v. Wade by essentially deputizing regular Texans to uh get ten dollar bounties on their their fellow citizens by reporting people who get abortions after six weeks um, in addition to kind of shutting down an illegal avenue to do that. So the Supreme Court has so far punted on taking any action on that, and it's it's

a pretty desperate situation. There's now rumblings that Florida is going to try to do the same thing, and as a result, there's never been a more um important time to talk about the subject of today's episode, which is self managed abortion UM. And in order to talk about that, because I'm certainly no expert, we've got Susan Yano, who was a co founder of Women Help Women UH and Self Managed Abortion Safe and Supported UM. Susan, thank you very much for coming on the show and talking with

me today. Sure, it's nice to be here. And UM. Maybe a place to start is to talk about what self managed abortion is. Yeah, because one of the things that is shocking, even though abortion pills have been allowed by the FDA in this country since two thousand, lots of people don't know that there are pills that essentially

cause a miscarriage. They have been available in clinics since the year two thousand, but even more importantly, they've been available out side the clinics since the nineteen eighties, and people in other countries have been using them on their own safely and effectively, and increasingly over the last decade, people in this country have been using these exact same

pills UM safely and effectively on their own. So I just want to be clear because people when they hear the words self managed abortion might flash on unsafe methods like sharp objects or herbs, which can be safe but can be unsafe but haven't really been scientifically documented. These pills have been studied more than almost any other medicine on the planet. And so we know from science that misaprostal with or without methoprista, that's the names of the

pills UM causing a safe abortion. And you know, I was listening to an interview with you earlier today and you brought up something that I was unaware of, which is that these medicines kind of got their start being used for self managed abortion in Latin America, where abortion is legal, abortion at least is in many places just not available. UM and women it was this it was initially an ulcer drug. Am I remembering that correct. Misa

Prostel was originally registered for ulcers. And it was women in Brazil who noticed that right on the pill container it said do not use if you're pregnant, could cause undine contractions. And as in every country in the world for generations, if people don't want to be pregnant, they try to figure out a way to add that pregnancy, regardless of the law. So women started experimenting with taking

misa prostal. Ultimately, the World Health Organization has studied these pills and come up with the most recommended protocols, which people can find on our website abortion pill info dot org or in many many places in the Internet if they google the words and Lisa Prostal and abortion and you're you're going to sation doesn't provide the pills, but you do provide people information on how right the idea of sunds because there are restriction there are some legal

risks in people in these pills on there on, even before this draccone in law in Texas which tries to criminalize everybody, um, but it is legal to share information that's published in scientific journals and by the world's health organization. So on the website abortion pill infot dot org are the protocols for how to use mice acrosto alone or in combination with metho christo, because it is a little more effective with when combined with methochristo, but the metho

cristo is harder to get to get. And I you know, people I think are often frightened about just the idea of self managed abortion, in part because when people talk about the bad old days before Roe v. Wade, they're talking about something that I think people would think about when they hear self managed abortion, if they're not aware

of kind of what it actually is. But one of the points you make that I think is so valid is that just a in its own like if you do nothing about pregnancies self terminate on their own, and this is what the pills are doing. It's nothing different than what happens if you just kind of have an embryo stop. Exactly. The pills caused the unse to contract and push out whatever is in there. Um. I think it's I think you raise a really important issue because

there's two things. One is these abortion pills have been so tightly regulated and controlled by our medical um institutions that people aren't as familiar with them as they could and should be. I mean, these pills are so safe that they could be in people's medicine cabinets. Um. But in this country, sexuality is really restricted. We should have over the counter birth control pills that biled. So the first thing is I think is just to demystify these

pills and to say that they're safe and effective. But the other is the stigma around abortion. Yeah, the anti abortion people have worked really hard to make people ashamed about their sexuality and ashamed about a pregnancy that they didn't want, as if people can do it all by themselves without somebody else being involved. And so this burden on women is they don't even they're so shamed that they have a lot of fear and stigma around, um,

trying to get an abortion, even outside of Texas. But then you compound it with this fear that has been raised by the anti abortion people, all this misinformation, Oh these pills aren't saying, oh they could cause breast cancer, Oh they can impair future fertility, all of which has been debunked and is not true. But as we all know, misinformation has a long shelf life, a longer shelf life than the truth in a lot of cases. Exactly, I wanna talk a little bit about just kind of the

facts about how this stuff functions. So particularly from IM we have a lot of listeners in Texas. I'm sure a decent number of the people listening right now are are very rightfully concerned. The present law essentially criminalizes uh medical abortion after six weeks um at what's how how late through do these pills work? Um? And then the second question I have is obviously a lot of women who get pregnant, don't realize they're pregnant for until after

six weeks. It can take a while. So what options. I know you have some options to recommend for tracking uh that that that that are helpful as well an app. So the first thing I just want to say is UM, a lot of people don't know how to calculate the number of days of pregnancy, and they hear this term l MP last menstrual period. Basically, people can count from the first day of their last menstruation to figure out

how pregnant they are. UM. We do have an app that I want to recommend called Yuki e u k I comes from the word eucalyptus, which is a menstrual tracker, but also has information about how to use contraception, how to use abortion pills. It is private and secure. UH. The the information is not available to anybody. It was not commercially developed, was developed by grants. So even we don't know other than how many people download it, we

don't know how people are using it. So I really I think it's really important that people understand how their bodies work, understand how to figure out how pregnant they are, and then understand how to use these pills. You asked a really important question, which is how late can these pills be used? Um, The w h O has studied the use of these pills through twelve weeks, and there is a set of protocols for how to use them for twelve weeks and basically, with mice across alone, a

person would need twelve tablets two hundred micrograms each. They would put four pills under their tongue, let them dissolve thirty minutes and then swallow, wait three hours to do it again, four pills under the tongue thirty minutes and then wait three hours and then use the last four pills. However, after twelve weeks, the pills can also be used to end up pregnancy. Mice acrostal can be used for labor induction.

Counter Intuitively, however, the large longer the pregnancy, the less mice across them is needed, and a person doesn't want to take too much. Exactly, you and I probably think, oh, I have a headache, I'll take to ask for it. Oh it didn't go away, I'll take two. More counter intuitively, as the uterus stretches with pregnancy, it's more sensitive to mines approsto and actually can be dangerous to use as much as one would use in the first twelve weeks.

Anybody who wants to learn more can either go on the website abortion pill info dot org or use that website and contact skilled counselors from Women Help Women who are based overseas, who answer over twelve thousand emails a month about how to use these pills, and they will counsel people regardless of the number they need to know, how many weeks pregnancies they will they will adapt the

information to that situation. But most people in this country who have gone to clinics for abortion do it in the first nine or ten weeks, and these pills are extremely safe and effective to use with these w H protocols up to twelve weeks. So while you're correct that most people don't know they're pregnant at six weeks, they at the time they're they've missed a period usually and they're they've taken a pregnancy test, and the urin pregnancy test that people buy in the dollar store over the

pharmacy are pretty are pretty accurate. Yeah, you brought up something, which is that who have these people who can help provide advice and their overseas, and you you kind of specify that every time I see you, I hear you talk about it, and you also specify the degree of security um which you which you put on these conversations UM. And it's a degree that I think is uncommon for what should be a pretty basic medical procedure. And it's

obviously because of there's potential consequences here. I'm interested in kind of what are some of the present legal consequence is and what are some of your worries when you adopt these very stringent security measures for people who come to you. So let's leave Texas aside. Prior to the Texas law, approximately twenty four people in the United States have been prosecuted for using abortion pills without a clinician involved,

in other words, for self managing their abortion UM. It's important to say most of the people who were prosecuted were not ultimately convicted, but somewhere because many states criminalize the use of these pills without a clinician involved. That being said, thousands and thousands of thousands of people are obtaining mys acostal or mio cristal plus myz acrostal in the United States. We have some websites where that actually share the number of pills that they're sending into the US.

And we also know about my acrostal sales um going way up in the countries where it is available of an encounter, so there's no doubt. And also people have shared their stories, so there that twenty four is a tiny percentage of all the people who have been who have used these pills. However, these pills are safe and

effective and nobody should have legal risk in using them. Therefore, when we set up SASS, which is self managed abortion, safe and supported and it's a project of this international organization Women Help Women, we were very aware that in the U s there's a lot of surveillance of people's bodies, there's a lot of potential to pack into people's emails.

So we set up a very secure system where people can email our overseas counselors UM on a very secure server and get back a an answer that will disappear within seven days, so there's no evidence in their phone or electronic device that they ever sent this email. We just thought, you know, it's an extra step. Um. Most people probably aren't even aware they're going through a secure site, but we want to make sure that nobody who who

contacts us can ever be prosecuted. Yeah, and it's I mean, it seems like you're were especially given the nature of the Texas law, you're worried about vigilantes as much as anything, not necessarily even the state, but but you know, the kind of people who show up outside of planned parenthoods with guns. The good thing about an international organization running this is none of the people answering the email are in the US. Yeah, pretty difficult for these Texas vigilantes

or frankly anybody else to file a lawsuit. First of all, it's all anonymized. They don't we don't. Women Help Them doesn't advertise who our staff are, and none, none of them are in this country. I mean, that's very smart. When did when was it set up this way? Like how long ago were you kind of thinking about the direction, because it seems like you you had a pretty blunt understanding of where things were headed. So Women Help Women was founded in and we work in eighty two countries.

We work in countries like the Philippines where any kind of drug deal dealer has been called. Yeah, work in Poland where abortion is not legal. In anywhere in the country. We work in many places in Latin America where abortion is highly criminalized, so we had security set up from the beginning. It was actually shortly after the election of h I'll call him Orange forty five because I've sworn that this our ex president's name, will never cross my lips.

Uh from Poland said, you know, we used to have legal abortion and we lost it, and you're gonna lose it too. People in the US better, you know, we should do something for people in the United States, and that's why so SAS was founded shortly after the inauguration of the last president and has been in place ever since. A lot of our work is not just the website and answering, it's really raising the awareness of our colleagues. We also before COVID went into communities. Now we do

it for via Zoo. We actually do three hour trainings to teach people how to use these medicines and how to teach others' we uh, you know, we have manual Spanish. We have people doing these trainings all over the US UM and have reached thousands of people directly with this information UM sort of prophylactically with the belief that it shouldn't be when a person is pregnant that they understand how these pills work. This is basic information that gotten

in high school. It's like knowing how to put on a tourniquet or something. It should be part of your first stage. How do you when to put on a band aid and when to take an aspirint? You know, how do you treat a cold? So the knowledge about these pills, we've worked very hard to make it very accessible. We actually have load we you know, we've done these trainings and countries where there's not a lot of literacy, so with graphics, we have videos. We have lots of

ways to teach. Many aren't appropriate for the u S where there's more literacy but sometimes less understanding about how bodies work. So um. So our goal has been to you know, we also go to professional conferences and so channels and try to raise awareness within the reproductive rights and reproductive justice movement about the importance of self managed

abortion as an intol of empowerment and breaking stigma. Not as hey, if you can't get to a clinic, tribes, but why why is this option not available to me? In a state of Massachusetts where I live where there's plenty of clinics, But why can't I just walk down to the to the Walgreens and get these pills if a doctor tells me it's okay, or without a doctor, Yeah, they're so safe. So we've really, we really advocate for self managed abortion as a viable option. UM. It should

be viable regardless of the law. Obviously for many people it's the only option in places like Texas. UM. But it's as good, it's a better. Some people don't want to go see a clinician. Yeah, they don't want to go through a bunch of protesters. They would just like

to get a package in the mail with their medicines. Yeah, I mean it's and that's I mean, there's there's both the the tool of an immediate need that there's there's desperate people who need access to this, but it's also in a broader sense, like building power within individuals and within communities to manage their own reproductive healthcare, which I think is really important exactly. And there are people who could get to a clinic and have them needs to go to a clinic, who are opting not to go

to a clinic. And two because they feel confident in their ability to take these pills as directed to manage it. And I just want to say, we started this conversation with talking about of all praises end in a miscarriage.

Most people have a miscarriage don't get medical care. Yeah, they can manage the bleeding and they know when it's over and they know that fine, which I think is an important point because I know people who have had very difficult miscarriages, but that's not most of the most of them are are mild enough that yeah, like you said, you don't need medical care. Well, I just so, I

just want to be clear. You know, using the abortion pills does cause cramping and bleeding, but it is not so far out of most people with the uterus is experience to have cramping and bleeding every month. This is heavier cramping, heavier bleeding, but we we know how to deal with this. Another point you make that I think is really important is that you know, with any medication, there's a chance it will be used wrong or it'll

have an expected effect. If you have to if you take this stuff and you have to go to the doctor, you don't need to tell the doctor. This is what I've taken you you like, could you talk to that about a little bit how someone would if they needed to go to the doctor as a result of an interaction or something, what they would would be best to say. There are two kinds of complications that can happen in very very rare cases. The person can bleed too much,

have a hemorrhage, and they absolutely mean medical care. The chance of a hemorrhage with these pills is exactly the same as the has a chance of the hemorrhage with a natural miscare. So it happens. Doctors in every e r know how to treat it. The other complication that can happen is in infection. You know, there's some retained tissue and the bleeding continues and they need to get antibiotics.

So what's really interesting about these pills is they move through the body relatively quickly and there is no test of blood or urine for them as long as the person, especially if the person followed the directions and use them under the tongue or in the cheeks, they've gone through the stomach, they're gone. Yeah. In some directions say to

use the MISA prostal vaginally. The problem with that is the inert substances, and the pills could stay in the vagina for up to three days, and then there's evidence, right because the doctor could see the crumbs if they do a pelvic exam. But as long as the person used the pills, either used the mice aprostal one swallows the mephopristom, as long as they use it in the and that's absorbed through the mouth, there are no tests.

So the person can say I'm bleeding and I don't know why, which, by the way, many people with a miscaracter now they were pregnant. Happens all the time, or they could say I was pregnant and I think I'm having a miscarriage. Yeah, we are really trying to work with some professional groups to increase awareness that people shouldn't be vigilanties, healthcare providers should not be vigilanties. But the only way a person is going to get in trouble

is if they say they use the medicines. Even if the doctor says, did you use the medicines, there is no reason to say it. The treatment is exactly the same as for a natural miscarriage. I wanted to ask kind of how listeners, particularly listeners who you know may not personally need this medicine but may want to support what you're doing, or may need the medicine and still want to support what you're doing. Are there ways in which people can either financially or otherwise help support y'all?

Absolutely again. Abortion pill info dot Org is our website. There's a whole section of what people can do. They can they can learn about these pills and tell other people. They can get stickers to let people know they exist. Because remember, most people don't know there are abortion pills, so they don't even know how to look on the internet for this thing, you know, so sharing information is

really important. There's also a donation button there, but the biggest thing that people can do in this moment, apart from donating, is to educate themselves. They can either sign up to take one of our trainings and become a We call them trainers, but it's really information sharing. You know, you and I have just talked about these pills. You understand them more than you did half an hour ago.

Training a little too formal of a term for what we do, but afterwards people will understand these pills very well and be able to support others who either want to know about them or are using them. And the last thing I'd kind of like to ask you, if you don't mind sharing, is how did you get into this personally? Like what brought you into this line of good question. So I've been doing abortion access work since the eighties. UM. I was involved in the big demonstrations

in front of the clinics, etcetera. But I've also spent a lot of time in Mexico where these pills are over the counter and no, And it wasn't until and I'm a little embarrassed to say this, but it wasn't until about fifteen years ago that it's suddenly occurred to me, Wait a second, I wonder why people in the US aren't doing what what people in Mexico are doing. I'm just, you know, it just it's like I was crossing the border,

but the idea hadn't crossed. And I started working with another international organization of Women on Waves that was supplying these pills all over the world, and I learned more about them, and I eventually gave up my other day job UM and started doing this work more directly over the last ten years. Awesome, UM, Well, Susan, I think that's everything I had to ask. Was there anything else

you wanted to make sure to get out today? No, I just want to be really clear that well, this is a human right and that they're people should have the option of going to a clinic. And the closing of the what you know, this is going to result in clinics in Texas being down essentially nobody who's you know, and they can't keep their doors open with a few

people who happen to get in before six weeks. And I think we have to do everything possible to support there being access to clinicians, that this is an option that we all need to learn more about and to think about why why is this so controlled? If this was a medicine, like it's more controlled than than opiates. It's certainly more controlled than beyond and it's crazy and

it's a misogynistic that these pills are not in our hands. So, um yeah, I would encourage your listeners to get on the website if they want more information there is you know, they can easily email through the website and learn whatever they want. Um. But it's all of our responsibility to learn this and to help get this information out absolutely, Susan Yano, thank you so much for talking with us

today and thank you all for listening. This has been It Could Happen Here and we'll be back tomorrow UM with another episode. Thank you so much, season you're very well. It Could Happen Here as a production of cool Zone Media. For more podcasts from cool Zone Media, visit our website cool zone Media dot com, or check us out on the I Heart Radio app, Apple Podcasts, or wherever you listen to podcasts. You can find sources for It Could Happen Here, updated monthly at cool zone Media dot com

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