This story is part of CityBeat's and Cleveland Scene's feature package about what the June 24 reversal of Roe v. Wade means in Ohio. Read more stories in our abortion series.
Dr. David Burkons remembers how his classmates got abortion care when he attended The Ohio State University in Columbus in the 1960s.
“There was some corner down on Cleveland Avenue,” Burkons says. “You showed up there and a car came by, you got in, you gave him the money, he takes you to have an abortion, you came back.”
By the time he graduated from medical school in 1973, the U.S. Supreme Court had just issued its decision on Roe v. Wade, legalizing abortion care nationally. Burkons has since delivered babies and terminated pregnancies, serving the choices of patients no matter their decision. Now, with the court overturning Roe 50 years later, Burkons worries about how Ohioans will access abortion care.
“There are going to be some deaths involved with this. There will be very serious consequences,” Burkons says.
Burkons says that rather than people slipping into a car to be whisked to a secret abortion site, people will order pills online to end a pregnancy from out-of-state, both through legal channels and from black-market sellers.
“The internet has changed everything,” Burkons says.
Most people — about 47% in Ohio and 54% in the United States — who end a pregnancy do so with a series of prescribed pills, data shows. The first pill usually prescribed is mifepristone (brand name Mifeprex), while the second pill, misoprostol (brand name Cytotec), is taken 24-48 hours later.
Burkons, who runs several abortion clinics in Cleveland and Toledo, says about 75% of the abortion care he provides is via the pill.
That timing will be compromised if patients are forced to find pills to terminate their own pregnancies online, Burkons says. The abortion pill currently is only an option during the first 10 weeks of pregnancy. Burkons says that after nine weeks and six days, patients risk heavier cases of bleeding, cramping and other complications that could require medical attention.
Burkons notes that while pregnancy tests can be used very early, most people don’t even know they are pregnant until after their first missed period, which can be well beyond six weeks. Patients must wait for pills to ship from out of state or overseas, which may not be safe to work before reaching Ohio’s six-week abortion ban that just went into place — or for the even stricter laws in the pipeline.
Burkons doesn’t like those odds.
“I think what’s going to happen is people will find out they’re pregnant. They’ll find these sites, they’ll order the pills, the pills will come, and it’s going to take a week or two to get the pills, so they’re already going to be further along and it’s going to be a much higher chance they’re going to have problems. And there’s going to be no one for them to call,” Burkons says.
Patients who take the right abortion pills within the first ten weeks are likely to have a successful experience, Burkons says, but the uncertainty of how far along a pregnancy might be coupled with the delay of shipping the meds is still only part of the risk.
Making sure you’re getting the right pills online is Burkons’ next fear.
“What you’re going to see are a lot of websites — some are going to be legitimate, some are not going to be legitimate,” Burkons says. “If you go on to the internet now and look up ‘abortion,’ you get these crisis pregnancy centers that have very professional and misleading websites that are there to confuse women and keep them from having abortions. I guarantee you these anti-choice people are going to be putting up websites like that, and if people get any medication, it’s probably going to be Smarties [candy] or something.”
Burkons says that even if a patient can’t get their hands on both misoprostol and mifepristone, taking just misoprostol could work in some cases — but the two drugs are most effective together. If the pills are limited in supply, Burkons says there will be a higher rate of incomplete abortions, putting patients at major risk for medical emergencies and — depending on new laws that may crop up — criminal charges.
“Infection, massive hemorrhage, that sort of stuff,” Burkons says. “They’re going to be bleeding and need to go to the emergency room.”
We talked to an emergency room nurse during a Planned Parenthood rally in Cincinnati in May. She didn’t want to disclose her name for fear of reprimand from her employer.
“We don’t receive training for this at all,” the nurse says. “They’re putting their bodies at risk, their lives at risk.”
She adds that current emergency room staff have almost entirely worked in a world in which abortion care is accessible. Now, she says, they must prepare for patients who are managing medication abortions without the assistance of a doctor and receiving surgical abortions in non-medical environments.
“They’re not going to be able to give information on what’s been done to them,” she says. “We’re talking permanent bodily harm. Infection. Death.”
Whether or not Ohioans will be able to legally order medical abortion pills through the mail remains a legal gray area. Burkons says that because Ohio can’t prosecute doctors from outside state lines, it’s just a matter of time before lawmakers go directly after the patients seeking to stop or terminate their own pregnancies.
“The anti-choice people always say they’re not after the women. They call me the criminal,” Burkons says. “But my parking lot is full and I don’t advertise. People seek us out. When there’s no physicians in the state to prosecute because all this is coming from out of state, you know they’re going to go after the women.”
Burkons fears that potential trouble from doctors or the law will keep some patients away from emergency rooms. He advises those searching for abortion pills online to try ordering from a website with a customer support phone number to speak to a doctor or nurse.
He also emphasizes that misoprostol and mifepristone are overwhelmingly safe and effective, but patients who are on blood thinners or are anemic should be careful, as they could lose a dangerous amount of blood.
Burkons adds that even people who aren’t pregnant have been ordering abortion pills.
“They have a long expiration period,” Burkons says. “Women are very smart people. They’re going to find a way.”
With Roe now reversed, CityBeat is exploring what comes next for Ohioans seeking abortion resources and reproductive care. Click below to read our in-depth stories about each topic.
- Part 1: Here's Where Abortion Currently Stands in Ohio
- Part 2: More Legal Rights in Ohio and Beyond Are on the Chopping Block with the Fall of Roe v. Wade
- Part 3: Ohio's District Maps and Ballot Seats Continue to Shape Abortion Laws Within the State
- Part 4: Statewide Abortion Bans Will Lead to Bleeding, Infection, Even Death in Ohio, Experts Say
- Part 5: Already-Disadvantaged Ohioans Are Poised to Disproportionately Suffer from an Abortion Ban
- Part 6: With an Abortion Ban in Place, Ohio's Attempts to Court Large Companies May Stall
This feature is a collaborative effort by reporters and editors at CityBeat in Cincinnati and Cleveland Scene in Cleveland, including Sam Allard, Allison Babka, Madeline Fening, Vince Grzegorek, Gennifer Harding-Gosnell, Maggy McDonel, Ashley Moor and Maija Zummo.
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