Aug. 22, 2008 -- While many may believe that the landmark 1973 Roe v. Wade Supreme Court decision that overturned laws restricting abortion put an end to improvised abortions, the medical community worries there will still may be a problem.
Now advocacy groups Gynuity and Ibis Reproductive Health are launching a study in San Francisco, New York and Boston to find out how many women go outside the normal clinic abortions, and why.
Though 38 states have laws mandating that only a physician can perform an abortion, there have been several anecdotal cases of improvised abortions in recent years.
In 2005, a migrant farmworker living in South Carolina was convicted for an unlawful abortion. It was illegal because the woman, Gabriela Flores, performed the abortion by taking several anti-ulcer pills called Cytotec with known abortifacient effects.
In early 2007, an 18-year-old Dominican immigrant living in Massachusetts was also charged with illegally inducing an abortion. She, too, had taken Cytotec, the brand name of misoprostol, before delivering a live 1-pound girl. The girl died four days later, and the teen was arrested.
In a similar case in July, police in Galena Park, Texas, dug up an entire backyard looking for a fetus after a 16-year-old told relatives her mother had forced her to take pills to induce a miscarriage.
And this month, a former volleyball player at Mercyhurst College in Erie, Pa., was arrested in a similar situation, with more serious charges. Teri Rhodes, of Commerce, Mich., pleaded guilty to voluntary manslaughter after she gave birth to a full-term baby in her dorm room and then smothered it. On her computer, police found Internet searches of "alternative methods of ending pregnancy," "what can kill a fetus" and "herbal abortion techniques."
Normally a Quiet Tale
Despite Roe v. Wade and the Food and Drug Administration's 2000 approval of mifepristone, the so-called abortion pill, some doctors have seen cases that have caused them to worry that the phenomenon of underground abortions is still a reality.
Before coming to Ibis Reproductive Health and St. Luke's Hospital in San Francisco a few years ago, Dr. Daniel Grossman lived and worked in Mexico.
"A few months after I was back, I had a case where I was called to the hospital," said Grossman.
When he got there, he saw a situation eerily similar to what he thought he'd left behind. That day, a 33-year-old immigrant woman came to the emergency room bleeding and pregnant.
"She had been given a misoprostol from her friend in San Francisco," said Grossman. "She got a big work up, and she ended up going to my office and everything was taken care of there."
Misoprostol was approved by the FDA as an anti-ulcer drug to protect people taking high amounts of pain medication. Pfizer, its manufacturer, has opposed such off-label use.
In an e-mail to ABCNews.com, Pfizer media representative Shreya Jani said, "Pfizer only promotes the use of its medicines for approved indications. Cytotec is off-patent with at least two generics, and we are not actively marketing the brand."
Jani added, "Pfizer has not studied Cytotec for the purpose of labor induction or for the early termination of pregnancy, nor do we intend to."
Yet Cytotec's contraindication for pregnancy was quickly seized upon in areas where abortion remains illegal, especially in Latin America. Not only is the anti-ulcer medicine legal, but it is relatively cheap compared to the several hundred-dollar price tag of a surgical abortion.
Grossman remembered that a person in Mexico could buy a bottle of misoprostol for $125, although only eight pills (at $5 a pill) are needed to cause an abortion. Often, Grossman said, women used less.
"Sometimes, people talk about this as a passport to the ER," said Grossman. "They take enough so it looks like they're having a miscarriage, and then they have an aspiration procedure."
Although the woman in San Francisco didn't need to feign a miscarriage to legally obtain an abortion, Grossman said other factors motivated her: She didn't know the law, or even how the system worked.
"She talked about how when she first came to the U.S., she came to the pharmacy to get birth control pills and she was told she needed a prescription," said Grossman.
In Mexico, Grossman said, women don't need a prescription to buy birth control in pharmacies, and his patient wasn't sure how to get a prescription. Then, once she was pregnant, the woman was more confused.
"She knew that abortion was legal in the U.S.," Grossman said, "but she thought that is was only for people who are legal residents."
But that case study only gave a "why" and a "how" to one woman. Grossman and his colleagues at Ibis Reproductive Health would like to get a cross-country view of self-induced abortions to see differences.
For example, more than 2,000 miles a way, a woman in a very different situation tried a very different method for different reasons.
Police found evidence that Rhodes, the former college volleyball player, was searching for an alternative to end her pregnancy.
Unlike the women who took the anti-ulcer medication, the 19-year-old turned to the Internet and found "herbal abortion techniques."
Like Cytotec, the use of herbs is no secret. Herbs and plants with abortifacient effects have been found and used for hundreds, if not thousands of years. However, with the Internet, old-fashioned knowledge of the "emmenagogues" -- herbs named with a euphemism meaning to help blood flow -- has resurfaced.
Ancient Knowledge, Now in HTML
"I've seen a real increase in the blogs and the chatter in the herb chat rooms about this lately," said Dr. Tieraona Low Dog, a physician, herbal expert and former midwife.
Low Dog sees more talk about abortion alternatives when abortion issues surface in politics and in election years.
While Low Dog said she has never given women abortifacient herbs for safety reasons, she has seen her share of women seeking these alternatives since she started as a midwife apprentice in New Mexico 25 years ago.
"Women came in a lot asking for herbs to causing a miscarriage," said Low Dog. "I was shocked, actually, how many women came looking for natural abortifacients."
Later, as a physician, Low Dog treated herbal abortions gone wrong. As Susun Weed, another herbal expert, explained extensively in her book "Wise Woman Herbal for the Childbearing Year," some common herbs thought to induce an abortion early in pregnancy are basically poison, such as tansy and pennyroyal tea.
"The most common way is that women take herbs that are poisonous and take enough to poison the baby, but not themselves," said Weed. "This is not easy to do. Unless the woman is sick enough to be throwing up and in serious pain, it's not going to work."
Other herbs, like blue cohosh, act in the same way as misoprostol by starting uterine contractions.
Low Dog said that although blue cohosh is less likely to cause fetal abnormalities if the pregnancy doesn't terminate, the herb will make women sick.
"I had a woman come in with spotting, bleeding and she was throwing up. She was really sick," said Low Dog.
Upon greater investigation, she found that the woman had been taking blue cohosh.
"The pregnancy didn't terminate," Low Dog said.
Grossman expects the Ibis Reproductive Health study will find a common root to the underground abortions -- whether it's off-label, under the table or out of the backyard.
"We want to find what some of the barriers [to reproductive health] are," said Grossman. "I think that's really what this issue is all about."