It was January 2020, and Roe v. Wade was still the law. I lived in the most liberal city in the United States, and I was about to find out how hard it was for a white woman with no hesitation of what they wanted, disposable income, control of her schedule, reliable transportation and a working knowledge of her rights to get what was guaranteed to me under the law: an abortion.
I was astounded at everything I realized I didn’t know about pregnancy and maternal healthcare. I was college educated, I had attended sex ed classes, had seen generations of friends through child bearing, and had considered myself a lifelong advocate for access to healthcare. I was 43 years old, and had spent immense resources avoiding becoming pregnant my entire life. The next 11 days of my life became an absurdly frustrating and bewildering race to meet an arbitrary deadline. Here’s everything I wish I’d known about how to get an abortion.
It’s not always obvious that you’re even pregnant
Pop culture would assure you that every single pregnant person experiences morning sickness, and only idiots with uteruses don’t immediately get a pregnancy test if they throw up. Male politicians would suggest that every ovulating person has a regular period and the time to track it, so they’d know immediately if they were pregnant by being a day late. But the NIH reports that only 70-80% experience morning sickness, and it can happen any time of day. Recent studies using data from period tracking apps show only 13% of people who ovulate have a regular 28-day cycle.
Emergency contraception exists, but is not 100% effective, and may be less effective depending on your weight. So even if you’ve taken Plan B or Ella, you could still be pregnant. I was, and my friend’s morning-after-pill baby just graduated college.
If you’re trying to get pregnant, you’re likely looking for signs of pregnancy and tracking signals. For the rest of us, you might have absolutely zero signs. I didn’t have a second of nausea, and spotted enough to think I’d had a light period and put a red x on my calendar.
One way to ensure you know if you’re pregnant is to practice surveillance testing, which is to take a pregnancy test once a month. Pregnancy tests, when used correctly, are 99% accurate. The problem is, using your test at home drops the accuracy to 75%. In a professional medical setting, the number remains high, at 95%, but getting a test in a medical setting comes with some risks. First, ensure you’re receiving your test in an actual health center. The nation is flush with “pregnancy centers” where one can obtain pregnancy testing for free from non-medical staff, and counseling for every option but abortion. Second, if you’re in a state with laws around abortion, going to a medical professional may create a record of your pregnancy.
Research your medical options where you live
As of June 2022, when Roe fell, each state in the U.S. has different rights and laws around obtaining healthcare if you are pregnant. The first thing is to find out exactly what those rights and laws are, which you can do starting here. You may need to travel to obtain healthcare in a neighboring state.
And this is where you’ll need to start doing some math, because not only do your options differ based on how far along your pregnancy is, but your state might also have a waiting period to obtain an abortion, meaning you need to see a provider, wait 1-3 days, and then return to actually receive the healthcare. (While you are waiting for your second appointment, you can pick up some guns, since most of America has no waiting period to do so.)
If your state restricts how long you have to decide if you’d like to terminate your pregnancy, you’ll need to get both visits done before the deadline the state imposes. For instance, if your state restricts abortion to 10 weeks, that means that you’ll need to find out you’re pregnant, get an appointment for that first consultation, and have the appointment for termination all before you are 10 weeks pregnant.
But ALSO, you need to learn some new math, because how pregnant you are is not based on when you got pregnant, but the first date of your last period. If your last period started May 1, even if you can provide the Venmo receipt for the dinner you had before you got laid on May 24, the clock started on May 1, not May 24. That’s an extra three weeks and change.
BUT ALSO, you need to check what the parental consent laws are if you’re under 18. Some states require parental notification, but in some of those cases, you can pursue judicial bypass, which means you go to a judge and ask permission instead of getting it from your parents. There are people who can help you with this option.
Consider your digital security
In some states, there may be criminal repercussions to obtaining healthcare related to your pregnancy, either for you, or those who assist you like your healthcare provider or even someone who drives you to obtain healthcare. You may also just not want anyone else to have access to information related to your healthcare. Lastly, you need to consider who has access to your phone bill or internet history. Are you sharing locations with anyone via your phone?
For all of these reasons, you need to consider how to protect yourself and those who help you obtain healthcare. So much of your activity is tracked online through your phone and internet browser, including what advertisements you respond to, and what locations you visit. That activity can actually be recovered through a search warrant, an increasingly common occurrence.
Runa Sandvik, an internet security expert, member of the Global Cybersecurity Group and founder of Granitt, whose literal mission is to protect the digital security of at-risk people, offered this advice to keep your healthcare information private as you research your options and communicate with providers: “For calls and messages, you’ll want to use Signal or WhatsApp with disappearing messages set. For browsing, you can use incognito mode to hide your search history, which may be helpful if you’re sharing a computer. To also encrypt the traffic leaving your computer, use a VPN like ProtonVPN or Mullvad.”
Even if you don’t have a concern right now about criminalization or reprisal from those around you, circumstances around healthcare change rapidly, and it may be wise to be proactive about securing your data. All of the apps mentioned above are free, and easy to install.
Find a provider and get an appointment
From here, everything starts with an appointment. Even if you are going to need financial help and want to apply for aid, usually, you’ll need an appointment first. So, you’ll need to find a provider that can accommodate you within the time frame that local laws allow. If you are going to Arizona to obtain healthcare, you’ll need to adhere to the time frame in Arizona, not the state you’re coming from, although you want to keep in mind laws in the state you’re coming from regarding restrictions. Some states, like Texas, allow private citizens to sue those who help someone obtain healthcare for a pregnancy.
You can also consider telehealth services, even if you’re in a state that outlaws in-clinic abortions.
How to plan for, pay for, and prepare for an abortion
Your costs for this healthcare will vary widely based on what kind of abortion you’re going to receive, whether you have to travel for it, and whether your insurance covers it.
No one was more surprised than I was to discover my insurance covered some of the cost of my abortion. If you have health insurance, you can call your insurance and ask. If you don’t have health insurance, some options exist that might be able to help you pay for your procedure. In some states, Medicaid will also pay for abortion.
The procedure, on its own, is your first cost. A medical abortion can run between $40 and as much as $800. Telehealth services are dramatically cheaper, starting around $150, versus in clinic, such as Planned Parenthood which says, on average, it costs $580.
In-clinic procedures start around $600 at Planned Parenthood, but depending on how far you are in pregnancy, can go as high as $2,000. A reminder: There are services to help defray the costs, which are detailed below.
Abortion costs are more than simply the procedure. They include any travel costs, childcare, and time off work, which can drive the number into the thousands.
If you have the time and bandwidth available, it is advised to shop around for the most affordable healthcare. It’s also OK to be upfront with the clinic about your ability to afford it, and ask for any discounts possible.
If you cannot afford to pay for your abortion, you need to get into contact with an abortion fund. The National Network of Abortion Funds is the place to start. From here, you can find funds in your state and in the state in which you are seeking an abortion. You can request assistance from multiple funds. It’s unlikely one will be able to fully fund all your costs, but they are likely to be able to assist. Some companies will assist with these expenses as well.
Consider the resources around you—namely, the other uterus-bearing people in your life. A few months after my abortion, I decided to post about it on social media. I expected nothing, and was even embarrassed about how loud I was being about it in the middle of a worldwide crisis. But within a few days, I had heard from almost every single woman I knew either about an abortion they had never told anyone about, or how they’d helped someone close to them with one.
Actually getting to a clinic
If your abortion involves a clinic visit, you now have another issue to contend with. Some clinics have people outside when you approach: clinic escorts and protesters. Protesters are there to try and block you from accessing services, and escorts are there to help ensure you have access.
Before you arrive, it’s likely your clinic will advise you about escorts and/or protesters. Escorts wear vests that will identify themselves, and do their best to drown out the noise of protestors using umbrellas, music, and other shields. Protesters may approach your car, but you are not obligated to speak to them, and Planned Parenthood advises you don’t.
If someone else is driving you, consider wearing headphones and sunglasses as you approach the clinic. Wear a hoodie pulled up, a hat pulled down low, whatever will help you avoid eye contact.
Protesters often have literature they’ll try to give you, and it does not come from medical professionals, so keep your windows up. You do not need to accept anything from them.
Do not be summoned away from the clinic by anyone. Escorts will take you into the clinic, not to another location.
When in doubt, call your clinic and explain the situation. Ask for help getting into the building.
What it’s like to get an abortion
An abortion is healthcare that terminates a pregnancy, regardless of why you are doing so. It’s a medical term, and there are multiple ways to receive this healthcare. If you are early enough in your pregnancy, you can have what’s referred to as a medical or medication abortion, which is either one or two medications taken in pill form (sometimes referred to as the “abortion pill”). If you can no longer receive a medical abortion due to the stage of pregnancy, you can receive an abortion procedure, depending on local laws. Generally, medication abortions can only be received through the 10th week of pregnancy.
What to know about medication abortion
Before you take the pills, your provider will advise you to take Tylenol (not aspirin, because it can cause more bleeding). Taking anti-nausea medication can help as well. Cramping and nausea, ranging from uncomfortable to the intensity of your worst period cramps can be normal, but should only last 24 hours and will usually only start after the second medication.
The first pill you’ll take is mifepristone, which blocks your body’s ability to produce progesterone, a hormone that is needed for a pregnancy to continue. A second medication, called misoprostol, can be taken right away, or up to 48 hours later. When you take the pills will depend on how you want to administer them—you can dissolve them under your tongue or between your gums and cheek, or you can insert them into your vagina. Your provider will help you decide what’s best for you and how to time them. Sometimes, people need a second dose of misoprostol, and in those cases, your provider will help you with the signs you need to reach back out to them for additional help.
Sometimes, due to the ambiguity of pending court cases, medical abortions will only prescribe one medication: misoprostol. In that case, you’ll take three or four doses of misoprostol over twelve hours. Using misoprostol alone is slightly less effective than the two medications in combination, but medical abortion is still very safe.
What to know about an in-clinic procedure
An in-clinic procedure, sometimes thought of as a “surgical abortion,” although there is no cutting of the body involved, means the pregnancy will be ended manually by a qualified medical provider. Sometimes people purposefully choose an in-clinic procedure over medical abortion.
There are two methods for doing so. Both involve using gentle suction, and in some cases (D&C) they will also use instruments to empty your uterus. Which you receive depends on how late you are in the pregnancy.
In-clinic abortions are 99% or more effective. Less than 2% of people experience complications from abortions, but they carry the same risks as all medical procedures, such as bleeding, infection, or an allergic reaction to medication.
Before an in-clinic procedure, you’ll meet with a healthcare professional to make sure you understand the process, and have had an opportunity to ask any questions, and make sure you fully understand your options. You might receive some additional tests, like an ultrasound.
When you come for your in-clinic procedure, depending on where you go, you might receive some pain medication or anesthesia, which means you won’t even be awake or might be in a “twilight” state. You might receive antibiotics. While you don’t have to have someone with you during the procedure (that’s up to you), most places will allow you to have someone accompany you, and in some places, you might be able to have an abortion doula with you. Most clinics will require you to have someone who will drive you home after your procedure.
For the procedure, you’ll be in a gown, lying on an exam table, much like during your annual exams. The provider will examine your vagina and uterus, using a speculum. Your cervix will need to be open during the procedure, so your provider may administer medication or use a dilator to do so. They might give you a numbing shot, internally, near your cervix.
A thin tube will be inserted into your uterus and then a device will use suction to remove the pregnancy tissue. In either a traditional suction procedure or a D&C, additional tools may be used to remove the pregnancy tissue and ensure your uterus is empty. Both procedures take less than 20 minutes.
You can often arrange ahead of time to have birth control devices like implants or IUDs done at the same time as your procedure.
What to expect after an abortion
If you have a medication abortion, in addition to any travel time you need, you’ll want to plan for your recovery, which means a day of rest and no heavy exercise or work for a few days, though you can return to work when you feel ready, as soon as 24 hours after. You can take medication abortion pills at home or in a provider’s office.
Any symptoms you are still experiencing after 24 hours, from bleeding to cramping, but particularly a fever, should be reported to your provider for further help.
For in-clinic procedures, you may or may not experience bleeding afterwards, and it can vary from spotting to clots. You may have no bleeding for the few days after your abortion, and then start bleeding around the third to fifth day and start having cramps. Bleeding can last anywhere from two to six weeks.
Cramping, discharge, and bleeding are all normal, but if discharge is painful, itchy, or odorous, that may be a sign of infection, so call your provider. Severe pain that isn’t helped by medication is deserving of a call to your provider. Also call if you have fever or chills, or nausea or diarrhea lasting more than 24 hours.
Almost all medical procedures carry an emotional toll. There’s the stress of the procedure itself, but also all the preparation involved, and stress related to the costs. In the case of an abortion, there are also hormonal shifts that may cause you to feel a whole lot of emotions. Most people do not experience these feelings for long, and while less than 5% of people experience regret over their abortion, all the feelings you feel are valid and normal. Your partners, if informed, may also experience a range of emotions.
It’s important to take all the medications you were prescribed, and to avoid sex for a week. You can also get pregnant right away, so as soon as you’re sexually active again, protect yourself.
How to prepare in advance
Under even the best conditions in the U.S., abortion is extraordinarily taxing emotionally and financially to arrange. It is still less taxing than birthing a child in a nation where there is no mandatory maternity leave, where healthcare can bankrupt you, where there is no free childcare, where child protective services agencies are overwhelmed and understaffed, where there is no nationalized infant or maternal support, where our foster care system is woefully inadequate, and where our maternal mortality rate is embarrassingly high (and higher for Black women).
You can minimize your exposure to these risks by always being up to date on your birth control—if you can’t afford yours, get help. You can pre-order emergency contraception, and most health plans (particularly those on the ACA exchange) have to pay for it. You can pre-order abortion pills, particularly if you live in a state with restrictions, because it takes longer for them to arrive. If you live in Oregon, pills can arrive the next day. If you live in Texas, they have to come from overseas, so it takes time. With a five-year shelf life, it’s better, if you can afford it, to be prepared. If you live in a restricted state, you can do surveillance testing to find out as early as possible if you’re pregnant, so you still have options.