Dr. David Burkons remembers how his classmates got abortion care when he attended Ohio State University in Columbus in the 1960s.
“There was a corner on Cleveland Avenue,” Burkons says. “You got there and a car drove by, you got in, you gave him the money, he took you to have an abortion, you came back.”
By the time he graduated from medical school in 1973, the United States Supreme Court had just rendered its decision on Roe vs. Wade, legalizing abortion care nationwide. Burkons continued to deliver and terminate pregnancies, serving patients’ choices, whatever they decided. Now, nearly 50 years later, as the court is poised to overturn its landmark decision, Burkons worries about how Ohioans will have access to abortion care in a world post-Roe.
“There are going to be deaths involved with this. There will be very serious consequences,” Burkons says.
Rather than people slipping into a car to be taken to a secret abortion site, Burkons says the new version of the clandestine abortion procedure will begin online when patients order pills to end a pregnancy from out-of-state and black market sellers. .
“The internet has changed everything,” Burkons says.
Most people who end a pregnancy do so with a series of prescribed pills – about 47% in Ohio, about 54% in the United States. This number has risen sharply in recent years; in 2015, only four percent of abortion treatments in Ohio were performed using medication. The first pill usually prescribed is mifepristone (brand name Mifeprex), while the second pill, misoprostol (brand name Cytotec), is taken 24 to 48 hours later.
Burkons, who runs three abortion clinics — two in the Cleveland area, one in Toldeo — said about 75% of the abortion care he provides is via the pill.
“Part of it depends on how we run our clinic. We try to get people in very, very quickly,” Burkons says.
According to Burkons, that timing will be jeopardized if patients are forced to find pills to end their own pregnancies online. The abortion pill is currently only an option during the first 10 weeks of pregnancy. After nine weeks and six days, Burkons says patients are at risk for more severe cases of bleeding, cramping and more complications that may require medical attention.
While pregnancy tests can detect pregnancy very early, Burkons says most women don’t know they’re pregnant until after their first missed period, which can last well beyond six weeks. If Ohio’s trigger bans are passed and abortion care is banned, it will force patients to wait for out-of-state or overseas pills to be shipped in time to take the safe pills. Burkons doesn’t like these 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 in and it’ll take a week or two to get the pills, so they are already going to be more advanced and there will be a much greater chance that they will have problems. And there will be no one to call,” Burkons says.
Patients who take the right abortion pills in the first ten weeks are likely to have a successful experience, Burkons says, but uncertainty about how long a pregnancy will last could be associated with the delay in shipping medications. 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 will be legit, some won’t,” Burkons says. “If you go online now and search for ‘abortion’, you get these crisis pregnancy centers that have very professional and misleading websites that are there to confuse women and prevent them from having abortions. I guarantee you these anti-choice people are going to make websites like this, and if people get drugs, they’ll probably be Smarties [candy] or something.”
Burkons says that even if a patient can’t get their hands on both misoprostol and mifepristone, only misoprostol might work in some cases — but the two drugs are more effective together. If the supply of pills is limited, Burkons says there will be a higher rate of incomplete abortions, which will put patients at major risk of medical emergency and – depending on new laws that may arise – criminal proceedings.
“Infection, massive bleeding, that sort of thing,” Burkons says. “There are products left, and they will bleed and have to go to the emergency room.”
An ER nurse spoke to CityBeat at a Planned Parenthood rally in Cincinnati in May. She did not want to disclose her name for fear of being reprimanded by her employer.
“We don’t receive any training for this,” says the nurse. “They put their bodies at risk, their lives at risk.”
She says current ER staff have worked almost entirely in a world where abortion care is accessible. Now, she says, they must prepare for patients who manage medical abortions without the assistance of a physician or who undergo surgical abortions in nonmedical settings.
“They won’t be able to give information about what was done to them,” she said of the staff. “We are talking about permanent bodily harm. Infection. Death.”
Whether or not Ohioans will be able to legally order medical abortion pills by mail in a post-Roe world remains a legal gray area. Burkons says that because the state cannot prosecute doctors outside of state lines, it’s only a matter of time before lawmakers prosecute patients who seek to terminate their own pregnancies.
“Anti-choice people always say they’re not after women. They call me the criminal,” Burkons says. “But my parking lot is full and I don’t advertise. People are looking for us. When there are no doctors in the state to sue because it’s all from out of state, you know they’re going to go after women.
Fear of trouble from doctors or the law is what Burkons fears is keeping some patients who need help away from emergency rooms. He advises those looking for abortion pills online to try ordering from a website with a customer support phone number – something patients can call to speak to a doctor or nurse.
“I would look for a place that at least seems to have a doctor involved,” Burkons says. “If you have a problem there is a number to call and someone will answer who might actually be able to help.”
Burkons points out that misoprostol and mifepristone are extremely safe and effective, but patients taking blood thinners or who are anemic should be careful as they could lose a dangerous amount of blood.
He points out that even if they are not pregnant, many people are being given abortion pills ahead of the looming US Supreme Court ruling, which is expected in June.
“They have a long expiration period,” says Burkons. “Women are very intelligent people. They will find a way.