One Woman’s Story Of Self-Managing Her Abortion In Ohio

One Woman’s Story Of Self-Managing Her Abortion In An Anti-Choice State

Managing your own abortion is not a crime in Ohio, but a politically motivated prosecutor might believe Julia should be punished for what she did.

By Alanna Vagianos

SOMEWHERE IN OHIO — It’s a pretty short drive to the polling site from the cabin where Julia has been self-managing her abortion. Julia took the last of her abortion pills the day before, which she believes have ended her unwanted pregnancy. She still has some minor cramping and is tired from the whole ordeal, but she feels reasonably OK — well enough to go vote on a ballot referendum that could help decide the fate of abortion rights in Ohio.

Issue 1, a ballot initiative to raise the threshold to alter the state constitution from a simple majority — the standard in Ohio for over a century — to 60%, is a preemptive attempt to block a pro-choice constitutional amendment that Ohioans will vote on in November.

“It comes down to control,” says Julia, who is being identified by a pseudonym. “They want to control us. They hate women and they want to use this to mobilize voters.”

She takes some satisfaction in knowing she induced an abortion all by herself — a small act of resistance as Ohio Republicans actively undermine democracy in order to roll back abortion rights.

“I think it scares them that women could self-manage an abortion all on their own,” she says. “Once they realize that we don’t need them, they panic.”

A few days prior, Julia was frantically rummaging through her closet, looking for the abortion pills she had ordered weeks earlier. After two extremely stressful hours, she found the mifepristone, the first pill in her self-managed abortion regimen, and downed it with a glass of water. Soon, she hoped, she would no longer be pregnant. 

Finally, I can get this over with, she thought, letting out a small sigh of relief. 

She told only a handful of friends what she was doing, texting them via the encrypted messaging service Signal and inviting a select few to stop by the cabin she was renting to keep her company. She brought some small dog waste bags to hold all of her used menstrual pads, which she planned to burn later to avoid leaving any evidence at the rental house.

Julia had to be this careful: A politically motivated prosecutor in a deep-red county could attempt to argue what she’s doing is a crime.

Hours before Julia took that mifepristone pill, a mom in Nebraska had pleaded guilty to a felony charge for helping her teen daughter self-manage an abortion at 29 weeks pregnant. Similar to Ohio, self-managed abortion is not explicitly illegal in Nebraska, although Nebraska did have a 20-week abortion ban in place when the teen self-managed. The mom faces up to two years in prison. The teen pleaded guilty to one felony charge of concealing or abandoning a dead body, and was sentenced to 90 days in jail plus two years of probation. A photo splashed across newspapers and media outlets showed the young woman crying as a bailiff took her away in handcuffs. 

Abortion is legal through 22 weeks of pregnancy in Ohio, but that doesn’t make the state a pro-choice safe haven. Ohio is notorious for some of the most extreme anti-choice legislation in the country. Cincinnati is the birthplace of the National Right to Life, the country’s oldest and largest anti-abortion organization. Ohio was one of a handful of states that attempted to ban abortion at six weeks in 2019 — a restriction that went into effect for a few months after Roe v. Wade fell last year. The ban has been temporarily blocked in court and awaits a ruling from the Republican-dominated Ohio Supreme Court.

Ohio is also home to some of the most radical anti-choice elected officials, like the lawmaker who just last year argued that pregnancy from rape is “an opportunity” for women. Or the state legislators who in 2019 introduced a bill that threatened physicians with murder charges if they didn’t “reimplant an ectopic pregnancy” into a woman’s uterus — a procedure that does not exist in the medical field. And then there’s the Republican state attorney general, David Yost, who went on Fox News and insinuated that the story of a 10-year-old rape victim who was forced to leave the state to get an abortion may not be real. Just weeks ago, Yost signed onto a letter with 18 other state attorneys general to President Joe Biden’s administration, claiming that their states have the legal right to medical records of their residents who travel out of state to get abortions. 

Self-managed abortion is a legal gray area in Ohio. It’s not specifically banned, and most of the abortion-specific laws contain immunities for the pregnant person. But that doesn’t mean someone couldn’t be arrested, charged and thrown in jail for managing their own abortion.

“There’s no law that explicitly makes self-managed abortion illegal in Ohio,” said Jessie Hill, an attorney who litigated against the six-week abortion ban and a professor at Case Western Reserve University School of Law in Cleveland. “However, there is a lot of legal peril around self-managed abortion because prosecutors can use other kinds of laws and often laws that don’t even directly apply to threaten and prosecute people who are managing their own abortion.”

It’s often rogue prosecutors, religious attorneys general or anti-choice lawmakers ginning up support ahead of election season who make it their mission to go after women like Julia.

‘I’m Very Ready To Not Be Pregnant Anymore’

Julia had rented a small cabin a few towns over because she knew she wouldn’t be able to take care of her young son at home while she was passing the pregnancy. And home, a farm in rural Ohio, came with a lot of work that she wouldn’t be able to keep up with while self-managing.

She packed the essentials: menstrual pads for the bleeding; Imodium, anti-nausea medication and a heating pad for the cramps and inevitable pain; her computer and phone charger since she planned to work when she could; blue sweatpants and a pink sweatshirt to wear while curled up on the couch; and lots of underwear. She had already taken her mifepristone pill, so she packed the remaining four misoprostol tablets she plans to take in a day or two.

“I’m very ready to not be pregnant anymore,” Julia tells me when I arrive at the cabin. Her boyfriend, Alex, greets me at the door and offers a drink and a snack, like I’m a friend coming over to hang out on a normal weeknight.

The cabin is small but spacious and has a sprawling back porch. When I drive up, there are several “Vote Yes on Issue 1” signs dotting the neighbors’ lawns — an indication that the neighborhood is likely not pro-choice.

Julia and Alex have only been dating for a few months, but Alex teases her like they’ve known each other for years. “I’ve never seen her sit still for this long. She has way too much energy, in the best way possible,” says Alex, who is also being identified by a pseudonym.

And from what Julia tells me, it’s true. Growing up on a farm and now living on her own, she prefers driving a tractor to watching Netflix. She can fix almost anything with her hands and she loves to take care of her animals: several horses, two dogs, a cat and a goldfish. She rarely sleeps more than four hours a night, staying busy running a small business and being a political activist in her community. She later laments that she didn’t think to bring a kayak to use in the lake nearby, seemingly forgetting for a minute that she’s about to be bent over in pain for the foreseeable future.

“She never stops. She just gives and gives and gives,” Alex says. “She’s got a fierceness about her.”

Julia’s wearing a green and white polka-dot sundress and her blond hair is down. She looks like someone who’s about to host friends for dinner, not someone who’s in the middle of self-managing an abortion. But her cramps haven’t started yet.

“I don’t think it’ll be that bad, but I was nervous for a minute yesterday. I was like, If this pregnancy is farther along than I thought, it’s gonna suck,” Julia says, a hint of anxiety coming through.

By Julia’s estimation, she’s just under eight weeks pregnant — a good time to be self-managing with abortion pills. The medication abortion regimen is one mifepristone pill followed by four misoprostol pills, taken at the same time, 12 to 48 hours later — the same steps someone would use if they went to an abortion clinic for a medication abortion. Abortion pills, like the handful Julia plans to take, are the most common in-clinic option — accounting for about 60% of all abortions up to 10 weeks of gestation in the U.S. They’re safe and effective for anyone less than 13 weeks pregnant, according to the World Health Organization.

The only difference between an in-clinic abortion and self-managing at home at eight weeks pregnant is that Julia didn’t take the first pill in front of a doctor and she won’t be talking to a physician throughout the abortion.

“All the evidence we have really indicates that self-managed abortion using these pills is very safe and effective, pretty much just as safe and effective as it is when they’re offered in a clinic,” said Dr. Daniel Grossman, professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco, and director of Advancing New Standards in Reproductive Health.

As a former nurse who’s had an in-clinic abortion prior to this, Julia isn’t too worried about what’s to come. She also takes some comfort in knowing she can call the Miscarriage and Abortion Hotline for medical support or the Repro Legal Helpline for advice if she needs it. She’s already scrolled through the abortion subreddit ― a space where people anonymously ask and answer questions about self-managed abortion and what to expect.

Her only fear is the bleeding. When she gave birth to her son, she hemorrhaged badly and was in the hospital for an extra week. But she has a plan if it gets to that.

“If I start bleeding to the point where I feel dizzy or lightheaded, then Alex is going to take me to a hospital where my OB-GYN is and it’s more progressive there,” she says.

“I know not to say the words ‘I self-managed.’ I would say, ‘I’m having a miscarriage’ ― end of story,” Julia says. Self-managed abortion and a natural miscarriage are medically indistinguishable.

Weeks earlier, before she even knew she was pregnant, Julia had ordered abortion pills from Aid Access, an Austria-based nonprofit, through a process known as advanced provision. They cost her $200 and took around 10 days to arrive. While she wasn’t expecting to use them this quickly, she’s extremely grateful she had them.

“From the minute I thought maybe I might be pregnant, I started planning the abortion. Because there was no question about it ― this is not what I want,” she says, sitting on the couch with Alex.

Julia could have gotten an appointment at a clinic, but she wanted to know what it’s like to manage her own abortion. Self-managed abortion may bring to mind gruesome imagery of pre-Roe back-alley abortions, but modern medicine — and the creation of abortion pills, like the regimen Julia is using — has made it a very safe, effective and increasingly common method. For Julia, choosing to do this from the comfort of a couch, surrounded by a few close friends, gives her back some of the autonomy she feels like she’s recently lost.

“I feel like over the last several years, as we have lost ground legislatively [in the abortion-rights movement], there is a feeling of ‘I don’t have control.’ That terrifying feeling of ‘What if I can’t get mifepristone? ... What if I’m too late?’” she says, alluding to the very real scenario that a right-wing judge could successfully pull mifepristone from the market.

“Knowing that I have the ability to control what happens with my body feels better. Being able to control this part feels really good.”

Despite the fact that mifepristone has been safely used by millions of pregnant people for over two decades, a group of anti-choice doctors filed a lawsuit against the Food and Drug Administration late last year claiming that the FDA rushed the approval process for mifepristone. A Texas federal court judge, an appointee of former President Donald Trump and a longtime abortion-rights opponent, ruled in favor of the anti-abortion physicians despite their lack of standing and evidence — putting mifepristone in a precarious legal limbo. A Supreme Court order ensured that the pill will remain available as the appeal process continues.

The day after taking the mifepristone, Julia had traded in her sundress for sweats. Her hair was pulled back into a messy ponytail and she wore glasses. She had started bleeding and cramping the night before and she was ready to take the next, and likely last, set of pills: the four misoprostol. (WHO advises pregnant people to take more misoprostol after the first four pills if they’re closer to 13 weeks, but Julia thinks she’ll be fine with just the four.)

The misoprostol is what softens the cervix and causes the bleeding that expels the pregnancy from the uterus. It’s also the pill that causes the more painful part of the abortion: extreme cramping and often a combination of nausea, migraines, diarrhea and dizziness.

The instructions that came with the pills advise Julia to put the four tablets between her cheeks and gums and let them dissolve. But she’s already so nauseated that just the thought of it makes Julia nearly throw up the one bite of toast she’s managed to keep down since I arrived. She decides to insert the pills vaginally, which is just as safe and effective, but could alert authorities that she’s had an abortion if she has complications and needs to go to the hospital.

“All right, let’s do this,” she says as she pops the four misoprostol tablets out of their plastic container.

Self-Managing In A State Hostile To Abortion Rights

Twenty states have implemented extreme abortion restrictions or bans since the Supreme Court repealed nearly 50 years of precedent last summer. And many of the bans actually empower law enforcement to scrutinize and surveil anyone with the capacity for pregnancy. Anti-choice laws are so extreme in certain states that patients and physicians are fearful to even say the word “abortion.”

The threat of criminalization is very real: for physicians, for friends who “aid and abet” and — despite anti-choice lawmakers’ promises to the contrary — for pregnant people, too.

From 2000 to 2020, Ohio had the second-highest number of people criminally investigated or arrested for allegedly ending their own pregnancy or helping someone else do so, according to research from If/When/How, a legal reproductive justice nonprofit.

In another part of Julia’s home state, a 21-year-old woman ordered misoprostol pills from India to self-induce an abortion in 2019. She was 28 weeks pregnant. She was later arrested and put in jail for four months while on trial on charges that included involuntary manslaughter and abuse of a corpse. She was sentenced to three years of supervision and lost custody of her young son, who just happens to be around the same age as Julia’s.

“From a medical perspective I don’t have any concerns about the safety of self-managed abortion but I am concerned about the legal risks,” said Grossman, the director of ANSIRH.

There are dozens of other stories of pregnant people being criminalized for self-managing, despite the fact that there are only two states (South Carolina and Nevada) that have laws explicitly criminalizing a pregnant person for inducing their own abortion. A Texas mother of two was held in jail on a half-million-dollar bail after police arrested and charged her with murder in 2022 for allegedly self-inducing an abortion. A Mississippi mother of three was arrested and indicted on second-degree murder charges in 2018 after she lost her baby at 36 weeks pregnant and police said that she’d searched for abortion pills online.

Women of color, low-income folks and people further along in their pregnancies are the most vulnerable to being surveilled and criminalized for self-managed abortion.

Last month, a Missouri woman named Love Holt testified in front of Congress about how she was forced to manage her own abortion because she could not afford to travel out of state to get care. A mother of five, Holt could also not afford to have another child. She self-managed with abortion pills, but unlike Julia, Holt was more than 13 weeks pregnant. She was rushed to the emergency room for severe blood loss.

“I nodded in and out of consciousness in the lobby for several minutes as blood began dripping down my legs,” Holt told members of Congress. “I sat in that wheelchair and instead of thinking about survival, I thought about not going to jail.”

Julia knows the risks of self-managing. But finding out that the Nebraska mom who helped her daughter self-manage had pleaded guilty to a felony charge just hours before she took her first abortion pill made the threat of criminalization feel much more real.

“I was a little worried. It felt like it upped the risk,” Julia said when she heard about the Nebraska case. “I’ve been careful — and luckily I knew to be careful in the way that I communicated about this — but I know that what I’m doing carries some risk.”

Criminalization for self-managed abortion is like a game of Russian roulette — it comes down to who gets to interpret and enforce the law and what their intent is.

“Prosecutors who may be politically motivated, who may have the sense that there must be something wrong with [self-managed abortion] ― whether or not it’s actually illegal ― have a lot of leeway to bring a prosecution which can still ruin someone’s life, even if it ultimately ends up being dismissed or the person ends up being acquitted,” said Hill, the attorney and law professor at Case Western Law. “That’s the really scary thing.”

‘Seeing That Much Blood… No One Can Prepare You’

“It felt like burning in my stomach,” Julia says, perched on the couch in the same sweatpants from earlier in the day.

After inserting the misoprostol pills vaginally, she had what she described as “pops of discomfort” in her abdomen. Not long after, the cramping started and she went to lay down. An hour later, she woke up shaking, sweating and in a lot of pain. She walked downstairs to the bathroom holding the walls because she was so dizzy.

“I felt like I was dying,” she says.

She sat on the toilet and passed six or seven blood clots, most of which were the size of her fist, she estimates. The largest one was about the size of a softball.

“Living on a farm, I see some really gnarly stuff, but seeing that much blood coming out of you… no one can prepare you for that,” she tells me. “As soon as that was done, though, I felt much better. I didn’t feel in danger at all. I didn’t feel scared.”

Most pregnant people who self-manage report similar symptoms and experiences to Julia. Some people have minimal bleeding after taking the mifepristone pill, followed by intense cramping once the misoprostol is ingested. Most women will expel the pregnancy a few hours after taking the misoprostol pills.

Managing an abortion from the privacy of one’s home is being discussed more now in part because mifepristone and misoprostol have become much easier to access in the last few years. Misoprostol, which can be used alone to self-manage, is accessible over the counter in many nations. In the U.S., the COVID-19 pandemic actually helped expand access to telemedicine, giving rise to online pharmacies in the country, like Hey Jane, and international websites that ship abortion pills from overseas, like Aid Access and PrivateEmma.

Expanded access has further proved just how safe and effective the mifepristone and misoprostol method is. A recent study found that the overwhelming majority of a group of women who self-managed using pills were able to end their pregnancies safely and without additional medical procedures, even if they were well beyond their first trimester.

“For many people, abortion pills are their first choice when it comes to abortion care,” said Kimberly Inez McGuire, executive director of URGE and co-chair of Abortion on Our Own Terms, a campaign that educates the public on the safety and effectiveness of self-managed abortion.

“People who want to make abortion a crime, they understand how revolutionary abortion pills are — and they know it is so much harder to stigmatize it if you can get it at Walgreens or CVS.”

Some people, like Julia, choose to self-manage because it provides more flexibility, especially when faced with ever-changing regulations and legal barriers in a post-Roe world. Immediately after the Dobbs v. Jackson Women’s Health Organization decision leaked in May 2022, internet searches for abortion pills increased by 162%, with more searches in states hostile to abortion rights, according to one study.

Other people are forced to self-manage because they simply don’t have any other options. The people who face the most barriers to in-clinic care are also the ones who tend to self-manage: people of color, genderqueer or transgender folks, uninsured people and low-income people, according to a 2023 brief from ANSIRH.

Around 7% of people born female in the U.S. will attempt to self-manage at some point in their lifetimes, according to a 2017 survey conducted by ANSIRH researchers. Grossman is currently conducting another survey at ANSIRH to see if that percentage has increased, but he expects it has.

“Barriers to access aren’t the only reason why someone chooses to self-manage, but it’s certainly an important reason. As those barriers increase, I anticipate we’ll see — and I think we are already seeing — an increase in self-managed abortion,” Grossman said.

The color has come back into Julia’s face since I saw her earlier in the day. The cramps have stopped and now she’s bleeding as if she’s on her period. It’s heavy bleeding for her, but nothing a pad can’t handle.

Julia called her local clinic, but wasn’t able to get in for an ultrasound to confirm she’s no longer pregnant. Since most people still test positive on pregnancy tests three to four weeks after an abortion, she likely will wait to take one. She’ll have an appointment a month after taking the pills to confirm she’s no longer pregnant. She’s not too worried; her pregnancy symptoms are completely gone since she passed the blood clots earlier in the day.

Now, two of Julia’s friends are hanging out drinking White Claws with her on the couch. Alex is making beef bourguignon because he thought Julia might be iron deficient after losing so much blood. Another friend brought over a box of tea and a charcuterie board she jokingly called a “charcoochie board.”

The mood is relaxed and cheerful — like it’s just another night laughing with friends. It feels so normal that I almost forget Julia has just done something that could be considered a crime. The contrast is jarring, but also speaks to the start of a quiet revolution happening in the homes of women and pregnant people around the country.

“This medication is such a powerful tool of resistance,” said Elisa Wells, co-founder and co-director of Plan C, an advocacy organization that provides people with information on how to obtain abortion pills. “It really feels good to have something we can tell people that they can do in the face of ongoing injustice.”

By managing her own abortion, Julia was able to take back some of that control she feels like she lost when Roe fell.

“It feels like freedom,” she tells me the next day as we talk about her experience self-managing.

“It’s feeling protected from their attacks,” she says of anti-choice politicians. “Like: ‘Fuck you, keep showing your asses in Columbus. You’re not gonna hurt me.’ And I want people to know that they can do that, too.”

Illustrations by Jianan Liu.

If you or anyone you know needs assistance self-managing a miscarriage or abortion, please call the Miscarriage and Abortion Hotline at (833) 246-2632 for confidential medical support or the Repro Legal Helpline at (844) 868-2812 for confidential legal information and advice.