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Oberman noticed that federal prosecutors in El Salvador visited hospitals and encouraged doctors to report to authorities any women who were suspected of self-inducing their abortions. When the reports rolled in, however, Oberman found they were all from public hospitals. Doctors in public hospitals, which treat poor women, were younger, less experienced, and eager to please the hospital’s hierarchy. “They were attentive to the government’s request, and they willingly made the reports,” she told me. “Meanwhile, there was not a single report from a private hospital.” In other words, poor women were much more likely to be reported for their illegal abortions than rich women were.
However, most doctors can’t tell the difference between a miscarriage and an abortion induced by misoprostol, so they would occasionally report genuine miscarriages, rather than abortions. If police searched a woman’s house and found a fetus, they have sometimes brought charges against the woman. Oberman says 129 women have been charged in this way, and about 36 have been sentenced with homicide. Fewer than five of the 129, she estimates, were actual abortions.
Certainly, the experience of some countries suggests that self-induced abortions can be dangerous in their own right. In Brazil, where abortion is also illegal, it’s estimated that 250,000 women are hospitalized from complications from abortions, and about 200 women a year die from the complications. Most women there buy misoprostol—a WhatsApp group has started up to help in the process—but those further along in their pregnancies or who have more money might visit an illegal abortion clinic. If women are hospitalized, they can be reported to the police by their doctors. About 300 abortion-related criminal cases were registered against Brazilian women in 2017.
Debora Diniz, a professor of law and public health at the University of Brasilia, says the 200 deaths might be an undercount, since families often won’t admit when a woman dies from an abortion. The deaths, she says, are “a reduction from 20 years ago, but at the same time, I’m not confident that we have good data. What I know is that women put their lives at risk buying medicine on the clandestine market, not knowing how to use it, and going to a hospital because of complications.”
Compare this picture to Ireland, which only repealed its abortion ban this past May, though the procedure remains illegal in Northern Ireland. Abigail Aiken, a University of Texas health-policy professor who has studied abortion rights in both countries, says women there would travel to England to get their abortions—often using a fake English address so they could get the procedure for free on the U.K.’s National Health Service. Others would order abortion pills from Women on Web, a Canada-based service that ships the pills to women in countries where abortion is illegal. More rarely, women there would attempt to induce a miscarriage by using herbs and teas.