Ali Newby was 21 when she had her first abortion. She had been with her boyfriend for only a couple of weeks, but she knew she had to tell him, though she was ashamed. She caught her pregnancy early, at just four weeks, and only had to take the second of the two abortion medications — misoprostol, which empties the uterus and terminates the pregnancy. 

Medication abortion has been available in the United States since 2000 when the US Food and Drug Administration (FDA) approved the use of mifepristone for early abortion. Mifepristone blocks a hormone called progesterone that is needed for a pregnancy to continue. Unlike procedural abortion, medication abortion does not have to be done in a clinical setting; the pills—mifepristone, followed by misoprostol—can be taken at home. By 2020, medication abortion accounted for more than half of all abortions obtained in the United States, up from 39% in 2017. Still, after Roe was overturned, abortion bans took effect in most Republican-controlled states. Fourteen states now prohibit it with few exceptions, while three others bar it after about six weeks of pregnancy. Luckily for her, misoprostol was easily attainable for Newby, and she had very little pain and minor bleeding. 

One year later, when Newby was 22, she discovered she was seven weeks pregnant. 

Being a California native and having had an abortion before, she knew she would be okay. But she winced at the idea of having to go through the emotional and physical exhaustion again, knowing it would be worse this time because she was farther along. She went to Planned Parenthood before work, and it proved to be much more challenging than she initially thought. “They had to do an ultrasound, which is very invasive,” Newby said. “She [the nurse] turned the screen, and that’s when it hit me. Anyone can say they are pregnant and know they are pregnant. But seeing it, hearing I was seven weeks was out of body.” 

After her appointment, Newby took a plane home to the Bay Area. She took her mifepristone earlier at Planned Parenthood and planned on taking her misoprostol once she got home. She inserted her pills vaginally around 10 pm before bed, hoping that all of her uterine lining would pass in her sleep.

“I was over the toilet all night crying my eyes out, passing clots. It was very traumatic to see. Every time I looked down, I wondered if it was just lining or the actual cells of my baby,” Newby said. Along with extreme exhaustion, it was the worst pain she had ever felt.

Currently, 14 states have implemented total bans on abortion at all stages of pregnancy. Additionally, about a dozen states have specific regulations restricting the use of mifepristone, such as mandating in-person consultations with a physician or requiring separate counseling on the drug’s potential risks. According to the FDA label, mifepristone is effective in completing an abortion 97.4 percent of the time. The failure rate for a medical abortion using both mifepristone and misoprostol is between 0.3% and 1.5%. The success rate of a medication abortion using these drugs is between 91.6% and 99.7% when taken before 64 days of gestation.

Newby happened to be a part of the slim percentage of women in the failure rate. 

Three weeks after she took her second pill, she started heavily bleeding again and immediately knew something was wrong. When she went back to Planned Parenthood, she was told that she was having an incomplete abortion and she would have to take misoprostol again. Luckily, because she was in California, she was able to access immediate care and pass her pregnancy, again, somewhat comfortably and safely.  

 “My incomplete abortion could have caused septic shock or a multitude of infections. If I had traveled to another state that has strict abortion laws, not knowing it was incomplete, I could have died,” Newby expressed. During an incomplete abortion, fetal parts or other products of pregnancy may not be completely emptied from the uterus, requiring further medical procedures. Incomplete abortions may result in infection and bleeding, which is what Newby was concerned about. The reported rate of such complications is less than 1 percent after a D&E, whereas, following a labor induction procedure, the rate may be as high as 36 percent.

It is also important to note that Newby has been on the birth control pill since she was in high school and that contraceptives are not always effective. If used perfectly, the pill is 99% effective. But people aren’t perfect, and it’s easy to forget or miss pills — so in reality, the pill is about 93% effective. That means about 7 out of 100 pill users get pregnant each year. Though it is rare to go through what Newby did while being on the pill, it is not impossible. But it brought her shame, knowing she did “everything right” and still got pregnant. 

The identity of Newby is anonymous, and her real name is not being used. She told me, “I didn’t want to tell anyone after my first abortion because I was ashamed that it was with someone that I wasn’t with for a very long time. I felt like everyone would question, ‘Well, what did you do wrong?’ I felt like the blame would be put on me.” Though her close friends and family know about her experiences today, she feels uncomfortable with her name attached to her story. “I honestly went back and forth on permitting you to use my name in this. Part of me felt it would be empowering to stand behind my decision with no shame — but sadly, I fear that it might come back to bite me someday. I am looking for a job, and I worry that my interviewers or recruiters may Google me, and if an article came up, and they didn’t support my choice, it could negatively affect the outcome of my position,” Newby said.