At first, the health workers used the manual vacuum aspiration syringe, a device that had been introduced by the U.S. Agency for International Development as a “hindsight method” of fertility control. More recently, Bangladesh incorporated a medical option for M.R. using mifepristone and misoprostol.
“I was thinking about how M.R. came about in a place like Bangladesh,” Ms. Sheldon said. “And it made me think that even where abortion is legal, some women might like to have that option — to be able to avoid the stigma and the shame.” And indeed, perceived benefits associated with emotional well-being were frequently cited in survey responses as a reason for interest in the pills.
One participant said that such a service would be “a psychological cushion” for those women “who may be unsure of their own feelings on abortion.” Another said that she thought it would result “in less moral conflict,” and a third that she would feel “less guilty of my choice.”
Over the past several years, abortion-rights advocates have sought to destigmatize abortion by calling on women to talk about it openly. Groups like We Testify and Shout Your Abortion have collected stories online, and thousands of people have rallied around #YouKnowMe, a hashtag started last year by the actor Busy Philipps.
The notion behind M.R. — that a person wouldn’t know if she had an abortion and therefore no one else could know if she did, either — is, in one sense, the antithesis of what many in the reproductive rights movement hope to achieve.
“There’s a tension there, absolutely,” said Dr. Abigail Aiken, an associate professor at the University of Texas at Austin and an expert in reproductive health, though she said demand for M.R. underscores the importance of stigma as a barrier to reproductive health care. “It’s incredibly powerful,” she said. “Some people will always want to shout their abortion, and some people will always want to keep it a secret — perhaps even from themselves.”
Based on their findings, Ms. Sheldon and colleagues have begun a second study of “missed-period pills” in partnership with Carafem, a nonprofit network of abortion clinics now offering “missed-period pills” to its clients in the Washington, D.C., area. On its website, Carafem describes the service as “a new medication option” available as soon as 28 days from a person’s last period. “We can do a pregnancy test, we can do an ultrasound, or we can do neither,” said Melissa Grant, Carafem’s chief operations officer. “The client decides how much or how little she knows.”