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Court case could decide abortion, feticide precedence

Purvi Patel’s premature fetus was found in a dumpster behind the Moe’s Southwest Grill her family owns in Mishawaka, Ind.

The 33-year-old Granger, Ind., resident had been at least six months pregnant with a baby she didn’t want, state prosecutors say. At that late stage, abortion is illegal.

Patel attempted to take matters into her own hands, ordering abortion-inducing medication online from Hong Kong, according to St. Joseph County Detective Galen Pelleteir’s affidavit testimony.

Her attempt failed, and, according to the prosecution, Patel then delivered a fetus prematurely on July 13, 2013. Patel arrived bleeding at St. Joseph Regional Medical Center that night and obstetricians believed she had just delivered a baby.

Patel first denied she had given birth, but after being questioned, said she’d miscarried and placed the body in a dumpster, according to court documents.

On Feb. 3, a jury found Patel guilty of neglect of a dependent, a Class A felony, and feticide, a Class B felony. Her attorney declined to comment.

Patel’s story illustrates the desperate measures experts say women are taking as legal abortions are restricted, and the Internet provides easier access to drugs overseas.

And while self-induced abortions are only a small portion of all abortions, the potential harm they can cause to women’s health has some experts worried.

“Women are turning to get it their own ways,” said Sue Ellen Braunlin, co-president of the Indiana Religious Coalition for Reproductive Justice.

Patel’s case is highly publicized because of the tragic outcome, but it’s unknown how many Indiana women have used medication to self-abort earlier in their pregnancies.

Planned Parenthood of Indiana spokeswoman Tammy Lieber said there is no way the organization can track the number of women ?self-aborting.

California-based obstetrician Dan Grossman found in a national study of four major cities that 2.6 percent of women who came to abortion clinics had previously tried self-abortion.

Activists believe mounting legal abortion limitations will increasingly bring the pill over the border and into the United States through the ?Internet.

“The reality is that making abortion illegal does not make it less necessary,” said Jessica Mason Pieklo, senior legal analyst for Reproductive Health Reality Check. “People are looking for ways to terminate pregnancies they need to terminate. Medication is one way to do that, and medication is the safest and most ?effective way.”

The Abortion Pill

Herbs, punches to the abdomen, overdosing on vitamin C and the ?ulcer medication Cytotec.

These are all methods women have traditionally used to self-abort.

Studies have shown that misoprostol, known in the U.S. as Cytotec, is the most common medication used for self-abortion.

The drug is a legally prescribed ulcer medication. But it can also legally be used off-label — in restricted clinical settings — to stimulate uterine cramps, resulting in abortion.

The drug’s manufacturer, Pfizer, says use of the medication by pregnant women anywhere in the world is “strictly forbidden.” The company points to a Food and Drug Administration warning on the package that says the drug can cause abortion, premature birth or birth defects.

Doctors, however, use Cytotec in clinical abortions before 63 days as a follow-up to an FDA approved abortion pill.

On its own, Cytotec has about an 85 percent chance of inducing abortion. The World Health Organization recommends the drug in regions where abortion is restricted.

Women who self-abort often take just Cytotec, instead of the combination used in clinics, because of its price and availability as an ulcer medication.

Dixie Swan, nurse manager at the Crisis Pregnancy Center of Wabash Valley in Terre Haute, said the largest danger in self-abortion is not having a doctor’s supervision. Swan said an abortion procedure should begin with a doctor’s visit and an ultrasound to determine the pregnancy is not on the outside side of the uterus.

A doctor’s supervision reduces the risks of potential side effects such as infection and heavy bleeding, she ?added.

“You’re not supposed to be able to get these pills except for at an abortion clinic,” she said. “But I know you can get anything online now, and the risk is great.”

A ‘low-access state’

In Indiana, self-induced abortion is illegal and punishable by a Class C felony.

St. Joseph County Police Lt. Matt Blank said such cases rarely come to the attention of the police because the woman can commit the crime in private. The St. Joseph homicide unit investigated the ?Patel case.

Though private use may go unnoticed, Indiana recently attempted to restrict abortion drugs in clinical settings.

Last year, Gov. Mike Pence signed a bill mandating that clinics offering abortion drugs meet the same requirements as surgical abortion facilities.

Proponents believed the bill would improve the safety of the procedure, while opponents argued that the law would only make it more difficult for a woman to obtain a legal abortion.

On Jan. 7, a U.S. District Court judge ruled the law could not be enforced in Indiana clinics only offering medical abortions, including Planned Parenthood’s Lafayette facility.

Planned Parenthood operates four of the 10 clinics that provide abortions in Indiana. The Mishawaka Planned Parenthood clinic closest to Patel provides only abortion referrals.

Lieber said imposing restrictions on accessing the abortion pill in a clinic would lead to more women trying to find the pill on their own.

“If its not available in a health care setting, will people find it in other ways?” ?Lieber said. “That’s definitely a concern. We think that people will go elsewhere if they can’t find it, like the Internet.”

Robin Marty, a contributor to Reproductive Health Reality Check, added that restricting a clinic leaves many women without access to a legal abortion.

“When you shut down one clinic, it shuts off a whole area,” she said. Marty referred to Indiana as a “low-access state” in regards to abortion.

Coupled with high costs of legal abortions, ranging from $300 to $400 for a surgical asphyxiation procedure, women may go online in desperation for abortion medication, she added.

“The idea of spending $40 to $50 on the abortion medication online is really appealing,” Marty said. “The question starts to become, where does the danger of obtaining drugs outweigh the danger of what a women would do if she couldn’t get them?”

Ordering online and ?overseas

United States pharmacies require a prescription to buy Cytotec.

But in many Latin American countries, including Mexico, the drug can often be purchased over the counter and brought into the U.S.

Foreign-born women were twice as likely as those born in the U.S. to report ?having ever using the drug, according to a 2011 study in the American Journal of Obstetrics & Gynecology.

The website Women on Web openly distributes these drugs to countries where abortions are restricted. The website will not mail abortion drugs to the U.S., but a spokeswomen said the organization believes every woman has the right to self-abortion, regardless of the laws of her country.

A page on the website recommends ways to access the drug in the U.S., noting it is illegal to self-induce abortion or aid another in the act.

“If the pharmacist asks, you can say that it is for your mother’s ulcers or for your grandmother’s arthritis,” the page says. “If a pharmacy will not sell the misoprostol to you, you can try a different pharmacy.”

It also explains how to ask for the pills in a Mexican pharmacy. Francine Coeytaux, director at the Public Health Institute, says the availability of the abortion drug internationally is a victory for women.

“The word has spread by women to other women all over the world,” she said. She believes the drug is both safe and effective — her only worry is that drugs sold over the Internet may not be pure.

“You can reduce the impact of unsafe abortion, but you can’t really reduce that need for abortion, because that need is there,” she said. “We have capabilities to do all sorts of things at home without your provider.”

Her viewpoint is, instead of ordering the medication online from other countries, women should have access to it in the U.S.

“In some ways, the irony that the women from other countries have more knowledge about a science and technology that is life-saving is an interesting point,” she said.

Looking ahead

Not all supporters of abortion access believe making the drug available in the United States is the answer.

“Any form of self-abortion is risky,” Marty said. “Successfully aborting is possible. So is losing your life.”

But with abortion legislation in Indiana tightening, Grossman predicts the rates of self-abortion will increase.

“As abortion becomes more restricted in certain states, women will do whatever they can to end their pregnancy,” Grossman said. “There will be more self-abortion attempts from a variety of different sources, including the Internet.”

Patel will be sentenced Monday at St. Joseph County Superior Court. Felony child neglect carries a maximum 50-year sentence, and feticide carries a maximum 20-year sentence.

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