With reproductive rights under threat, Women Help Women gives legal and medical advice to women who may be taking matters into their own hands 
 
 New website offers US women help to perform their own abortions 
 
 Fearful that Donald Trump’s presidency poses a once-in-a-generation threat to US reproductive rights, an international advocacy group this week is unveiling what is sure to be a controversial response: a web portal dedicated to helping US women terminate their own pregnancies with abortion-inducing drugs they have obtained outside of a medical setting. 
 
 ‘Please, I am out of options’: inside the murky world of DIY abortions Read more 
 
 The project, launched by Women Help Women, is a nod to the fact that many US women may already be taking matters into their own hands as abortion options in this country contract. 
 
 “Women in the US have been and are using the pills without good guidance,” said Susan Yanow, the US spokeswoman for the group, Women Help Women. “If a woman is anxious and has the pills in her hand, and doesn’t know what to do … we can help her understand what to do. We can help her understand what signs to look for, and what’s going on.” 
 
 Research suggests that there is a small but significant number of US women who attempt to induce their own abortions without any medical supervision. 
 
 Several studies have shown that many of these women, particularly those living along the US-Mexico border, are using misoprostol, a miscarriage-causing drug that can be legally purchased over the counter in many Central American pharmacies. In the US, it is illegal to administer the drug outside of certain medical clinics. 
 
 Rules for taking misoprostol are easy to find online. What Women Help Women has done differently is connect US women with counselors who can provide step-by-step instructions, and answer questions, in real time. 
 
 Their counselors are trained by medical professionals to walk women through the process of using misoprostol for a DIY abortion. Counselors will also strive to connect women with abortion funds if payment is the main obstacle for getting an abortion in a clinic. 
 
 But the main goal is to support the unknown numbers of women who are performing their abortions themselves. 
 
 Part of the inspiration, Yanow said, came from an article the Guardian US published in November. The story followed a young Texas woman who, unable to afford an abortion in the US, traveled to Mexico to purchase an abortion-inducing drug over the counter. 
 
 “There’s just so many questions,” the woman told the Guardian. “I would so much rather have a health professional help me in this and kind of guide me through it versus DIY.” 
 
 New Brunswick becomes first Canada province to offer free abortion pill Read more 
 
 Those words stuck in Yanow’s mind. And as she grappled for a way to respond to November’s election, it occurred to her that Women Help Women could tailor its services to the needs of women in the US. 
 
 The project will be titled Self-managed Abortion, Safe and Supported, or SASS, and use the website abortionpillinfo.org. 
 
 Women Help Women is already a longstanding provider of abortion pills and instructions in other countries. Every month, its staff members answer 5,000 emails from women around the globe seeking to end their own pregnancies. 
 
 The group will not provide abortion-inducing drugs to women in the US. And it has made other changes to its methods because of the United States’ uniquely hostile, anti-abortion atmosphere. 
 
 In the US, at least 18 women have been charged with a crime based on allegations that they attempted to induce their own abortion. A handful of states have made it explicitly illegal for anyone but certain medical professionals to administer abortion-inducing drugs. 
 
 Enterprising prosecutors have found other, creative ways to levy charges, through the use of laws against child endangerment, practicing medicine without a license, or drug possession. 
 
 Women Help Women counselors will inform clients of some of the legal risks that come with self-administering misoprostol, as well as some of the limitations. 
 
 But the legal implications of the project are far from certain. 
 
 “This area of the law is nothing if not complicated,” said Jill Adams, the chief strategist of the the Self-Induced Abortion Legal Team, a project associated with Berkeley Law. Her group has shared legal information about self-induced abortion with Women Help Women, but stopped short of legally vetting the information that counselors will provide to US women. 
 
 In general, the act of looking for or giving out information about self-inducing an abortion is protected by law, Adams said. And she knows of no one who has been prosecuted merely for seeking information. 
 
 Still, it could compound the risk of prosecution. Purvi Patel, the first US woman to receive a significant prison sentence for inducing her own abortion, was convicted after prosecutors obtained emails that showed her purchasing an abortion-inducing drug from a Chinese pharmacy. 
 
 With those facts in mind, Women Help Women designed its portal to delete conversations between clients and counselors after seven days.Its servers are located abroad – out of easy reach for US prosecutors, the thinking goes – as are all 23 of its counselors. 
 
 The legal risks are thought to loom larger than the medical risks. 
 
 “In general, I would say there’s kind of a growing recognition that from a safety or a medical perspective, we have very few concerns about” women using abortion drugs on their own, said Daniel Grossman, a clinical professor of obstetrics and gynecology at the University of California–San Francisco who researches self-induced abortion. 
 
 “Especially if we’re talking about women using misoprostol on their own. It’s a very safe and effective medication,” he continued. “If women have information about how to use it, then women can safely use it on their own.” 
 
 When women go to an abortion clinic, they are typically given two drugs: mifepristone, a drug that blocks hormones necessary to sustain a pregnancy administered in person, and misoprostol, which is taken many hours later and causes the uterus to contract and expel its contents. The Food and Drug administration permits women to leave the clinic and take misoprostol at home. 
 
 
 
 
 
 Researchers believe that women who self-administer abortion drugs are most likely taking misoprostol by itself, because it is easy to obtain from foreign pharmacies. Misoprostol used without mifepristone is less likely to cause an abortion but still has a high success rate. 
 
 There are certain medical risks in self-administering an abortion drug without the involvement of medical professionals. An ultrasound is often necessary to confirm a pregnancy and assess how many weeks a woman has been pregnant. Misoprostol is less effective and requires a different drug regimen later in the first trimester. 
 
 Medical professionals will also inform women about how to recognize complications, like excessive bleeding, that could occur after they leave the clinic and require medical attention. And using the drug improperly – say, at a high dose in the second trimester – can lead to serious medical complications. 
 
 Grossman argued that a project like Women Help Women’s could minimize those risks. “I think that it’s worse to just remain silent while we know women are doing this,” he said. 
 
 But abortion rights opponents cite these safety concerns as reasons to oppose any project that makes abortion drugs available outside a clinical setting. 
 
 In response to a study, first reported by the Guardian, that tests the efficacy of sending women abortion drugs by mail, a spokeswoman for Americans United for Life said, “We have grave concerns about handing out dangerous, life-ending drugs without medical supervision because women face great risks for chemical abortions.” 
 
 Carol Tobias, president of the National Right to Life Committee, asked, “Who are they supposed to call if they have a problem?” 
 
 Yanow says that’s exactly the point of Women Help Women’s new portal. 
 
 “People are not being advised to use the pills,” she said. “They’re being advised if they’ve already decided to use the pills. What drives this project is the knowledge that women have been managing this on their own.” ||||| Of the thousands of emails that come to Women on Web, 40 to 60 a month now originate in the United States, Gomperts said, double the number from two years ago. On the first day I was in the office, she showed me a recent email from Florida. “Please tell me where I can get miso without a prescription,” the email read. “I live in the United States and have no health insurance. I have two children and I am currently out of work, there’s no way I can afford another child. Please help. I’m desperate.” 
 
 Gomperts is sympathetic but firm in her refusal to get involved in the United States. “We’re sorry, the doctors of Women on Web cannot provide the service in any country with safe abortion services,” reads the response American women receive from the help desk. She told me: “I know that it’s difficult, because abortion is not accessible to them. But this is not our work. I think this is a problem the U.S. has to solve itself. There are so many resources, so much money available there for abortion rights groups, I think they should be able to work on this. Starting on paper, with changing the laws.” 
 
 The laws regarding access to medical abortion have been contested in the United States since the drugs became available in the 1980s. Mifepristone was initially licensed in France in 1988. Abortion opponents lobbied to keep the drug out of the United States, and in 1990, the administration of George H. W. Bush made it illegal to bring the drug into the country for personal use. In 2000, however, after a long Clinton-era fight, the Food and Drug Administration approved mifepristone under the name RU-486. Doctors could dispense the drug, but the F.D.A. imposed restrictions that persist to this day. Before doctors can order the medication, they must provide information about their qualifications. Patients have to be given the medication at a doctor’s office instead of picking it up at a pharmacy. Mifepristone also carries a black-box label, the F.D.A.'s strongest alert for life-threatening effects. It has been used in 2.3 million procedures resulting in 11 reported deaths of women. Misoprostol, which is 85 percent effective on its own, is available in the United States by prescription. 
 
 The F.D.A. approved mifepristone through the seventh week of pregnancy. Many doctors, though, prescribe the medication off label through 10 weeks, based on recent research showing it remains effective. Medical abortion now accounts for approximately a third of all abortion through that period in this country. Ohio and Texas require abortion providers to follow the more restrictive F.D.A. protocol; a similar law will go into effect in Oklahoma in November. 
 
 A medical abortion in the United States usually involves two office visits. At the first, a woman often has an ultrasound, to date the pregnancy. She is given mifepristone in the office and misoprostol to take at home 24 hours later. Then, at a follow-up visit, the woman has an examination to make sure the abortion is complete. (The F.D.A. protocol, however, calls for three visits and recommends that the misoprostol be taken under medical supervision; Texas requires four visits.) Some clinics in the United States and abroad are experimenting with cutting the number of office visits by making the follow-up visit optional — if the woman isn’t sure whether an abortion is complete, she can either take a home pregnancy test or return for an examination. 
 
 A number of clinics have explored the option of allowing women, particularly those who live in remote areas, to receive the drugs without seeing a doctor in person. In one program set up by Planned Parenthood in 2008 in Iowa, doctors in Des Moines have used videoconferencing to treat more than 6,500 patients in rural clinics, talking with them on-screen and viewing test results. By pushing a button on their computers, the doctors can remotely open a drawer that holds the needed dose of pills. The patient takes the mifepristone with the doctor watching and a nurse or medical assistant supervising on site, and then the patient leaves, with the misoprostol, to miscarry at home. A study of the program found that the telemedicine patients had the same outcomes — high rates of successful abortion and low rates of complications — as women who saw their doctors in person. In 2010, the Iowa Medical Board found that the telemedicine program was safe and met the prevailing standard of care. After complaints from Iowa Right to Life, however, Terry Branstad, the Republican governor, replaced the board last year. The new members voted to halt the telemedicine. Planned Parenthood challenged the board’s decision, but a judge upheld it earlier this month. ||||| Australian women will now be able to access medical abortions without visiting a doctor or pharmacist, with the launch of a new telephone service that advocates say could dramatically improve access to pregnancy termination. 
 
 The Tabbot Foundation will assess women over the phone and then post them the medications they need, with the only in-person consultations being for ultrasounds and blood tests at local clinics. 
 
 Reproductive Choice Australia says the service may more than halve the exorbitant costs many women face for abortion, as well as allowing those in regional areas to receive treatment previously denied to them. 
 
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 Link A new service offering easy-access medical abortions has been overwhelmed by callers. Photo: Supplied 
 
 A Tabbot Foundation spokesman said tele-health, or treatments using phones and computers, was increasingly common in Australia. 
 
 "Medical pregnancy termination through teleconference is one of the most appropriate medical conditions you can use this for because you don't have to examine the patient," he said. "It will also mean women who might have felt intimidated going into an abortion clinic don't have to." 
 
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 Instead, the woman would call the service's toll-free number –1800 180 880 – and would be referred to local, preferably bulk-billing, providers to test her blood and give her an ultrasound to ensure the pregnancy was suitable. The doctor would get the results to use in a phone consultation. 
 
 In states such as NSW where a psychological assessment is required, this would also be done over the phone. If the treatment is approved, the women is posted a package including the medications mifepristone and misoprostol (commonly known as RU486), prophylactic antibiotics, painkillers and anti-nausea drugs, all at a cost of $250. 
 
 A nurse would phone to check on her one day later, and she could also call a 24-hour help line run by the Tabbot Foundation. 
 
 The foundation is named after Tony Abbott, who was health minister when RU486 was approved after he was controversially stripped of his right to veto it, and Tanya Plibersek, who publicly funded the drugs in 2013. 
 
 The medications have been safely used by millions of women globally, although in 2010 an Australian woman died after taking RU486 and developing an infection. The spokesman said this remained a risk if the body did not fully expel the embryo and other pregnancy tissue, and she did not receive ongoing medical care such as the follow-up blood tests Tabbott would provide. 
 
 "We won't discharge the patient until we are happy with the end result," he said. 
 
 Reproductive Choice Australia co-president Jenny Ejlak said that despite mifepristone and misoprostol being publicly subsidised, GPs had been reluctant to prescribe them, leaving it to established surgical abortion clinics that were few and far between and had higher costs. 
 
 "It's a little bit of a postcode lottery for women," she said. "I think this will make a really big difference. 
 
 "It will provide access to medical termination in a lot of parts of the country where it's not available at all, but it will also provide an option for women that is probably going to be a lot cheaper than the other clinics." 
 
 But she said it was unfortunate that women still had to pay high fees for medical termination, when the medications themselves cost very little. 
 
 "For a lot of women, students, people living on unemployment benefits or the disability pension, $250 is a significant amount of money," she said. 
 
 The service will only be offered for pregnancies of fewer than 63 days, and generally only for women who do not experience severe periods, as the drug often causes more heavy or painful bleeding. 
 
 A study of more than 13,000 other women who were given the medications by Australian provider Marie Stopes found they were effective in 96.5 per cent of cases. Serious bleeding occurred in 0.1 per cent of cases and suspected infection in 0.2 per cent.
– A Dutch organization that advises women on reproductive rights has now launched a website to help US women terminate pregnancies on their own. The Guardian reports on the "Self-Managed Abortion: Safe and Supported" portal, or SASS, set up by Women Help Women. Through it, 23 trained counselors will answer questions and give advice if women have already decided to take the drug misoprostol. The medication, which, when taken alone or in combination with mifepristone, keeps a pregnancy from happening, is only legal in the US at medical facilities, though it can be purchased OTC in Central American nations. A Women Help Women rep says the idea for the site came about after a Guardian story documenting a Texas woman's trip to Mexico to get the drug, and all the questions she had once she got it. The site won't provide pills, and organizers say they won't even suggest women take them—they're just there to keep women safe if they've already decided to. "It's worse to just remain silent," says a UC San Francisco obstetrics professor who calls misoprostol a "very safe and effective" drug (though it's more effective taken with mifepristone, which isn't as easy to obtain). For women who do have complications and must seek medical care, the Washington Post notes they'll be advised that drug-induced and spontaneous abortions typically look the same, and that the drug isn't detectable via drug test. Abortion foes note the meds can be dangerous if not taken correctly or if taken late in the gestation period, and that this site could put women at risk by providing info on taking them. Women Help Women is being cautious in case of legal ramifications: Its servers are located outside the US, as are its two dozen or so staffers.