Women increasingly fear being prosecuted for using abortion pills, advocacy groups say

Love Holt, a reverend and single mother of five, was rushed to an emergency room in Missouri last year after her mother found her passed out in her car and “covered in blood.” When Holt arrived at the hospital, fear filled her instead of relief.  

“I just kept saying over and over, ‘Don’t f—ing die. Don’t say you took those pills,’”  Holt told NBC News. “I was in fear, honestly, that I was going to be carted away from my hospital bed to a jail cell had they found out.” 

A reproductive rights advocate who opposes the state’s near-total abortion ban, Holt, 38, had obtained abortion pills by mail and took them in her home at 13 weeks pregnant. Less than an hour later, she was bleeding heavily, cramping and feeling light-headed. To avoid frightening her children, Holt went outside and sat alone in her car, where she continued to hemorrhage. 

When she arrived at the hospital, she told staff she was having  a miscarriage but did not say that she had taken abortion pills. She underwent a procedure called a dilation and curettage — commonly referred to as a D&C — to remove the tissue from the uterus.

“All of these things crossed my mind, like I can’t go to jail. I’m a breadwinner for my family and they need me,” said Holt. She added that she felt lucky that no one at the hospital reported her on suspicion of self-managing an abortion.

Rising Fears

Abortion rights advocates say Holt is not alone  and that women in the twenty-one states that have banned or restricted abortion since the overturn of Roe v. Wade in 2022 fear that they will be prosecuted for using abortion pills. Last month, Louisiana became the first state to declare abortion pills dangerous controlled substances and to threaten jail or fines to anyone possessing them without a prescription. 

If/When/How, a nonprofit national legal advocacy group that supports abortion rights, exclusively told NBC News that its legal helpline recorded an 875% increase in calls in the 6 months after Roe was overturned, compared to the same time in 2021. Calls to the helpline — which assists people concerned about pregnancy outcomes — have continued to rise since then. 

The top question asked by callers was what are the legal rights and risks for people who take the abortion pills, the group said. Thirty-two percent of the callers were under the age of 18, and most calls were from or about states that limit or ban access to abortion services. 

Online requests for medication abortions have dramatically increased in those states as well, according to a study in the Journal of the American Medical Association. Most abortions in the U.S. are medication abortions, rising from 53% of abortions in 2020 to 63% in 2024, according to the Guttmacher Institute, a research group that supports access to abortion. 

“There’s this big sense of chaos and confusion, and this reality that your ability to get care in large part now very much depends on not just the state that you live in and the size of your bank account, but whether or not you can navigate substantial logistical and financial burdens to get an abortion,” said Kelly Baden, vice president for public policy at the institute.

Baden added: “We are in a fearful climate with increased hostility and legal risk for patients, providers and helpers. We have to be prepared for the ongoing targeting and criminalization of people who are seeking abortion care.”

All of the abortion bans and restrictions enacted since the overturn of Roe do not call for the prosecution of  women who self-manage abortions, like Holt. And leaders of the mainstream anti-abortion groups say their goal is to not punish women who obtain abortions, but many of the new laws do target people who provide or assist in providing abortions.

Missouri state Sen. Nick Schroer, the Republican co-author of the state’s near-total abortion bans, one of the strictest in the country, said women who get an abortion in the state will not face punitive measures. 

“Case law and our statutes show that women in the state of Missouri will not be prosecuted,”said Schroer. “The only ones that could be held liable are the companies and the physicians that are partaking in this and basically preying upon women of these very sensitive times.” 

But abortion rights advocates and attorneys warn that women who are self-managing their abortions because of the shuttering of clinics are now at greater risk of being reported, investigated and prosecuted due to stigma, misapplication of the law and criminalization of abortion.  

“People are afraid. People are afraid to even seek information,” said Farah Diaz-Tello, senior counsel and legal director at If/When/How. “Once a prosecutor decides that they want to punish someone for ending their pregnancy, they’re going to find a way to do so — they’re going to find a law that’s going to fit.”

Holt’s choice 

Like many people in states where abortion is illegal, Holt knew she had to look beyond her state lines to get care. She attempted to make an appointment for a medication abortion in Illinois, but there was a four-week wait. 

Holt would need a surgical abortion by then, which would require more resources — like time off from work and money — which she did not have as a single working mother, she said. In order to terminate her pregnancy she needed a “discrete, private and affordable” option, which led her to order the pills online. 

The initial order was stolen in the mail, according to Holt, and she quickly placed another one. The pills arrived about 18 days later, and Holt took them at home at 13 weeks and six days pregnant, she said, despite it being recommended by the FDA no later than 10 weeks.  

“I didn’t have any other choice. So desperate,” said Holt. “I wouldn’t be able to provide any real stability for my family. I would have been putting myself and my children at risk for not being able to supply them with income and food and housing because my work schedule would be curbed.” 

Holt is grateful that she was able to self-manage her abortion — and get subsequent care at the hospital — without criminalization. But she said others, particularly women of color, haven’t been as fortunate when navigating the shifting abortion landscape. 

“I wish my story was isolated. It saddens me to know that there are stories that are even more egregious than my story,” Holt said. “We’re just caught in the crosshairs. The target isn’t necessarily on our back. But we are the ones who don’t have the resources to take a flight to a safe haven state and get an abortion or pay for the attorneys fees if we get prosecuted in court.”

Past prosecutions

A long history of the prosecution of both abortion providers and women who self-managed their abortions before the overturn of Roe has also fueled fears, advocates say. 

From 2000 to 2020, 23 adults were convicted — either by pleading guilty or being found guilty at trial — for charges related to self-managing their abortion or helping someone else get one, including in states from across the political spectrum, like South Carolina, Massachusetts, Maryland, Arizona and Ohio, according to a study published by If/When/How in 2023 that examined public criminal court records and media reports. 

Health care providers and social workers were most likely to flag a suspected self-managed abortion to authorities, doing so in 45 percent of the cases. No state or federal laws require care professionals to do so, the report said. 

In most of the cases that led to convictions, medication abortion — either obtained online or received through a friend or relative — was allegedly used. 

Nearly half of the adults — 11 of them — faced a range of sentences, from 90 days to up to 20 years in prison. Meanwhile, the rest of those charged were placed on up to 10 years of probation, If/When/How found. The adults pleaded guilty or were found guilty of charges such as abuse of a corpse, child abuse and murder.   

Only one state — Nevada — criminalizes self-managed abortion after 24-weeks. But people are often investigated and arrested under charges not meant to be applied to allegations of self-managed abortions, such as child abuse, assault of an unborn child, practicing medicine without a license, or homicide and murder, said Diaz-Tello. 

After the overturn of Roe, a Nebraska mother, Jessica Burgess, was sentenced to two years in prison in 2023 for giving her pregnant teenage daughter medication for an abortion. 

Her daughter, Celeste Burgess, was also sentenced to 90 days in jail and two years of probation after pleading guilty to concealing or abandoning a dead body. 

Holt’s experience and those of other women drove her to decide to try to fight back politically at the state level. Together with Abortion Action Missouri and other reproductive rights groups, Holt collected enough signatures in May to advance a ballot measure that would enshrine abortion rights in the state constitution. 

Missouri is one of 10 states where organizers are hoping to put abortion rights in state constitutions through citizen-led ballot initiatives, according to the Guttmacher Institute. 

“We are able to sweep a lot of things under the rug in Black communities to just try to survive. But this is one that will not be swept under,” Holt said. “And it will affect every one of us in a way.”

Schroer, the Missouri state senator, said the anti-abortion movement isn’t backing down. “It’s going to be a different fight this year, as Republicans and Democrats, who are wanting to protect life from womb to tomb, are going to do a heck of a lot more education than we saw in those other states.”

Holt believes the ballot measure will “mobilize and unite communities, and most of all, it’s going to erect a strong force in women like we’ve never seen before.”

“We know what’s at stake,” she said. “This is going to be like the championship games for us.”

Read more on this story at NBCNews.com and watch “Hallie Jackson NOW” tonight at 5:30 p.m. ET/4:30 p.m. CT.