Makayla went to the restroom after a job interview only to find she’d bled through her skirt during the meeting. About three days prior, she took misoprostol, an abortion pill, at her home in San Antonio, Texas, to end her pregnancy less than six weeks into her first trimester in August 2018. She was still bleeding heavily as her body expelled the pregnancy, but she wanted a chance at the job opportunity.
She didn’t end up getting the job. But she told BuzzFeed News she considers it a blessing because she went on to start her own abortion fund. Makayla, 22, started the organization, known as the Buckle Bunnies Fund, in April 2020 and began educating people about self-managed abortions, the process of ending a pregnancy on one’s own without the help of medical professionals. The fund has raised at least $200,000 to support abortion access in Texas. Since her own procedure, she has given information about self-managed abortions to more than 400 people, said Makayla, who asked that, for privacy reasons, she only be referred to by her first name in this story.
Amid a heightened crackdown on abortion access in Texas, pregnant people are increasingly seeking answers from young advocates like Makayla about how they can end their own pregnancies, fearing a state law that could bar them from care at traditional clinical settings. The US Supreme Court allowed Texas to implement a six-week abortion ban, known as SB 8, in September.
SB 8 bans nearly all abortions after fetal cardiac activity can be detected, usually around the sixth week of a pregnancy. Pregnancy terms are counted from the first day of a person's most recent period, so week six is typically two weeks after a missed period, which is when many people realize they're pregnant.
Early-term state abortion bans are often referred to as “heartbeat” laws, but the term is misleading, since a fetus’s heart valves haven’t formed yet; an ultrasound at that stage is detecting electrical activity. So without the ability to go to a clinic to end their pregnancy, many people are turning to at-home alternatives out of sheer necessity.
Self-managed abortion options have always existed; according to Advancing New Standards in Reproductive Health, about 7% of US women will undertake one in their lifetimes. But attention to self-managed abortion has heightened since SB 8 went into effect. Plan C, which provides information about how to obtain abortion pills, reports that over 170,000 people have visited its website since SB 8 went into effect, and nearly 30% of that traffic has been from people in Texas.
“People who had never heard of [a self-managed abortion] are now asking about it,” Makayla said. “Girls in the strip club are talking about it. People who already have four kids and are in their 40s are talking about it. I think while this has been an option, out of necessity for so many people it’s becoming mainstream.”
Even though self-managed abortions are not a new phenomenon, young people are at the forefront of spreading awareness about the option, said Tamara Marzouk, a program director at Advocates for Youth.
“We’re really seeing a desire for people to have an abortion on their own terms, whatever that means,” she said. “The work around [self-managed abortions] is how you talk about it. … We don’t set up a hierarchy of methods. It’s so important to acknowledge the history of generations of people who have used other methods.”
Marzouk works with a group of about 300 people aged 14 to 24 who she said have seen an increasing number of people asking about self-managed abortions, learning what the concept is, and sharing their own experiences.
Marzouk said she’s noticed that younger people are more “comfortable” with the idea of a self-managed abortion as a safe and effective option, whereas other generations may be more reluctant to accept the idea of an at-home abortion.
“It’s not a one-size-fits-all model,” Marzouk said of abortion. “The whole purpose of self-managed abortion is to set up a circumstance in which folks can access abortion wherever they feel safe with the control in their hands.”
She has also noticed more and more young people have joined the fight for reproductive rights in the last few years.
“It’s a response to feeling helpless regarding policy and feeling like, This is something we can do,” she said.
Sharing information is a popular way to do that advocacy work, but Marzouk said young advocates she works with stray away from giving advice because of the “gray area” of legal risks surrounding self-managed abortions.
Oklahoma, South Carolina, and Nevada already have laws that criminalize self-managed abortions. And across the US, people have been arrested and charged for managing their own abortions, Marzouk said.
“People are criminalized for the bodies they’re in,” Marzouk said.
Makayla said pregnant people in Texas are also in the “unfortunate position” of having to ask themselves what legal risks they would be willing to take to end a pregnancy.
“These are the corners people have been pushed into,” Makayla said, adding that SB 8 hasn’t stopped people in Texas from trying to have abortions; it’s just posed new challenges for abortion access advocates to provide resources for those who cannot go to clinics. Her fund has also noticed an influx of people needing emergency contraception and pregnancy tests because, under the new law, they want to know if they’re pregnant much sooner.
“People over six weeks are still getting abortions because they’re taking matters into their own hands,” she said.
Makayla added that the criminalization of pregnant people in Texas is more likely to affect people living in poverty and communities of color, especially undocumented immigrants.
“I’m in a great position of privilege as a white [cisgender] person to be able to talk about [self-managed abortion] and not fear incarceration,” Makayla said. “A lot of people of color in Texas do have that fear.”
She added: “Because they’ve already been put in this box, it will be easier to surveil them. Those are the people who are likely going to be targeted first.”
“I felt that I deserved better and I deserved it on my own terms.”
The incident after the job interview was Makayla’s second abortion. The first time she became pregnant she was 18, when she was dancing at a strip club three nights a week. When she sought an abortion, she told the clinician that she was a sex worker and had a lot of strain on her body.
“In their eyes, I believe that they thought I was being careless, and that’s not what I needed at the time,” Makayla said. “I needed somebody to care for me as a full human being without judgment.”
When she became pregnant the second time, she knew the clinical setting wasn't for her. She didn’t have a lot of money and had “prior trauma” from her previous visit.
“I felt that I deserved better and I deserved it on my own terms,” she said.
Makayla had never heard of a self-managed abortion before until a reproductive justice organization posted about it on social media.
“I was feeling that self-managed abortion was sketchy … [and] was less-quality care than if I went to a clinic. Now I know that that’s not true, but it was an internalized stigma I had to deal with,” she said.
At the time, Makayla did not know about increasingly popular online pharmacies, such as Aid Access and Abortion on Demand, that mail people safe, generic versions of medication abortion at an affordable price. Instead, she obtained the abortion pill misoprostol for free from someone she knew.
She took the single pill at home after work. Although a friend had brought her a care package, Makayla said she was lonely throughout the process, especially in the Texas summer heat when her power went out. It was initially scary to initiate her own procedure, she said, but after about two weeks (she got her period right after) of bleeding she felt relieved she didn’t have to bear any financial burden to end her pregnancy. An abortion pill at a clinic typically costs about $600, while online pharmacies charge between $150 and $350.
Self-managing her abortion showed Makayla she could do more with her life.
“I don’t think I would be the advocate or the person I am today without my self-managed abortion, specifically,” she said.
Aryn, 24, also recalled a transformative feeling after administering their own abortion. When they became pregnant at 19 during their sophomore year of college, it was one of the first times they began to understand their gender dysphoria. They have since come out as nonbinary and pursued a full-time career in reproductive justice. They also asked to only include their first name in this story for privacy reasons.
A self-managed abortion is a cheaper option, and it provides the freedom for someone to take their healthcare into their own hands; for people who choose to self-manage their abortion, these two variables might outweigh the actual efficacy of the method, Aryn told BuzzFeed News. Being someone with a disability without much of a disposable income, they opted for an at-home experience that felt safe, private, and affordable.
“We should be open to folks who are not using efficacy as their number one concern,” Aryn said.
Through online research, Aryn came across herbal methods to induce an abortion. They took the remedy in their dorm room during a long weekend. Their roommate was out of town, so they curled up with water, snacks, The Office, and an electric blanket while the abortion proceeded.
“I think we need to move away from the narrative that self-managed abortion just means [misoprostol]. Self-managed abortion is anyone who is not going to a physician,” Aryn said, adding that it’s vital for people to think about what the best method is for them. “For me, I wanted something as natural and holistic as possible. ... I wanted to keep it as anonymous as possible.”
The COVID-19 pandemic initiated an early wave of new attention to self-managed abortion, but SB 8 has propelled that forward, according to Daena Horner, an abortion doula and founder of Holistic Abortions, which provides resources, security tips, and other support. She also said she’s noticed how young people are more equipped to access information online.
But state-level restrictions aren’t the only reason some turn to self-managed options, Horner said. Many people, she added, simply prefer the home-based option because they want privacy and agency over the process. Even picking the time and day of the week of the abortion can make a major difference for patients, she said.
“The more people that are doing it, they are realizing they can create a space however they want,” Horner said.