OPINION | Self-Managed Abortions Don’t Often Kill People. Abortion Bans Do. Here’s Why.

by Megan Burbank

Last week, the story of Amber Thurman, who died because of Georgia’s abortion ban, was rightly all over my social media feeds. People were outraged to hear of Thurman’s death, which could have been prevented by extremely basic health care had she received it in time. But the state’s abortion ban ensured that she didn’t, and now her 6-year-old child will grow up without a mother.

As a reporter covering abortion policy in the absence of Roe, I don’t always pursue or share heartbreaking stories like this one. I do a lot of triangulation in my coverage, because I question the news value of a story that could potentially harm the people whose real names and experiences appear in it, no matter how many page views it gets.

And when we focus on just the most heartbreaking stories, it can give the impression that more ordinary reasons people seek abortion care — like if they’re pregnant and don’t want to be — are less valid.

I also understand all too well the fatigue that can set in for folks who want to keep up with the issue: If you overwhelm yourself by focusing on just the most devastating reporting, at best you’ll miss a lot of context along the way, and at worst, a feeling of vicarious trauma can settle in. As Naomi Klein argues in her 2023 book Doppelganger, it’s difficult to take meaningful action when you’re flooded with shock.

But I think you should read Thurman’s story, reported with infuriating, step-by-step clarity by Kavitha Surana at ProPublica, because it’s one of the most powerful accounts I’ve read of what happens when abortion bans prevent people from receiving abortion care. It’s also an example of how journalists can cover these stories with care and awareness of the systemic conditions that cause harm under abortion bans in the first place.

So I was surprised and disappointed when I read Surana’s companion piece ProPublica published on the death of Candi Miller, another Georgia woman who died from complications after an abortion that would’ve been resolved by a dilation and curettage (D&C), a common procedure used in both abortions and miscarriages.

Miller, who had a number of health conditions that made pregnancy dangerous for her, sought out abortion pills from the Dutch organization Aid Access, which sends pills into states with active abortion bans. According to the ProPublica report, Miller “avoided doctors and navigated an abortion on her own — a path many health experts feared would increase risks when women in America lost the constitutional right to obtain legal, medically supervised abortions.”

I raised my eyebrows at that phrasing.

These “experts” aren’t identified by name, and the framing suggests that self-managed abortion in general is something risky and unsafe and never involves guidance from a health care provider.

But that’s not the reality. For years, self-managed abortion through a system of abortion accompaniment has been a crucial resource for people living in abortion-hostile countries.

Even before the reversal of Roe v. Wade, mainstream health care organizations, like Ibis Reproductive Health and the World Health Organization, reported that self-managed medication abortion using the same pills distributed by clinicians can safely and successfully terminate a pregnancy.

According to an Ibis study of misoprostol-only medication abortion, “Self-managed medication abortion using misoprostol provided by an online telemedicine service has a high rate of effectiveness and a low rate of serious adverse events. Outcomes compare favorably to other service delivery models using a similar regimen.”

And while not every site advertising abortion pills online is a reliable source, many are staffed by medical professionals or can refer to them.

So what makes Miller’s story so tragic is not that she had a self-managed abortion, especially one facilitated by an organization that distributes pills through a pharmacy and offers clients clinician involvement. That’s actually a common experience, and often an unremarkable one.

Her story is a tragedy because she made a choice that was calculated and resourceful, not needlessly risky, but when she did experience rare complications as a result of her abortion, she wasn’t in a state where it was safe to seek additional help — or where it was even available.

“ProPublica’s new reporting makes clear, for the first time, that in the wake of bans, women are losing their lives in ways that experts have deemed preventable,” writes Surana in the piece on Miller.

That may well be true — although plenty of reproductive health policy reporters have been sounding the alarm on the severe and deadly impacts of these laws, and policies that preceded them before Dobbs, whether in abortion-hostile states or Catholic hospitals in blue ones.

And when we tell these stories, we need to be clear what’s causing the harm in the first place: not a woman who quite reasonably seeks out support where she can find it, but the conditions that force her into making that choice in the first place and mean she has no options in the rare situation where something goes wrong.

Self-managed abortion is a much safer option than it used to be. But if procedural abortion isn’t available in emergencies, people will die of rare complications, and it’s crucial that reporting on this issue acknowledges that when they do, responsibility lies with the laws that put them in harm’s way in the first place, not with self-managed abortion itself.

In fact, both stories demonstrate this: Candi Miller was afraid to seek medical support, but Amber Thurman was honest with her provider when she presented with complications from her self-managed abortion. In the end, it didn’t matter: Georgia’s state policy punished Thurman’s honesty. Both women died.

Candi Miller and Amber Thurman should still be alive. And it’s important to be clear that they didn’t die because they self-managed their abortions, which was arguably the most reasonable option available to them in a state that had gutted their rights. They died because abortion bans operate by making sure medical infrastructure no longer can.

The law worked exactly as it was intended to.

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Megan Burbank is a writer and editor based in Seattle. Before going full-time freelance, she worked as an editor and reporter at the Portland Mercury and The Seattle Times. She specializes in enterprise reporting on reproductive health policy, and stories at the nexus of gender, politics, and culture.