Self-Managed Abortion in the United States

Abstract

Purpose of Review This review aims to provide up-to-date information about self-managed abortion in the USA. Recent Findings Evidence indicates that there is growing demand for self-managed abortion in the USA as obstacles to facility-based care increase, especially since the Supreme Court overturned Roe v. Wade . Self-managed abortion with medications is safe and effective. Summary Based on a nationally representative survey, the lifetime prevalence of self-managed abortion in the USA in 2017 was estimated to be 7%. People experiencing barriers to abortion care, including people of color, people with lower incomes, people in states that have restrictive abortion laws, and those living farther from facilities providing abortion care are more likely to attempt self-managed abortion. While people may use a range of methods to self-manage abortion, there is growing use of safe and effective medications, including mifepristone used together with misoprostol and misoprostol used alone; use of traumatic and dangerous methods is rare. While many people attempt to self-manage their abortion because of barriers to facility-based care, others have a preference for self-care because it is convenient, accessible, and private. While the medical risks of self-managed abortion may be few, the legal risks may be significant. Sixty-one people have been criminally investigated or arrested between 2000 and 2020 for allegedly self-managing their abortion or helping someone else do so. Clinicians play an important role in providing evidence-based information and care to patients considering or attempting self-managed abortion, as well as minimizing legal risks.

Medication abortion for adolescents in the United States: Strengthening the role of pediatric primary care providers

“…Therefore, from a harm‐reduction approach, we believe it is important for pediatric primary care providers to be familiar with self‐managed abortion in addition to medication abortion within the healthcare system in order to support patients, direct them to appropriate resources, and minimize their risk of complications (see Figure 1). 24 …”

“…Instances of prosecution for self‐managed abortion are rare, with a recent report reviewing criminal investigation or arrest for people who self‐managed abortion or aided others in doing so identifying 61 cases between 2000 and 2020 43 . Despite being infrequent, there is clear evidence of inequitable persecution of individuals who choose self‐managed abortion, influenced by racism, xenophobia, and classism, with criminal investigations of self‐managed abortion occurring more frequently among BIPOC women and those living on low‐incomes 24 . Given that care for complications after a self‐managed abortion with medication abortion drugs is medically equivalent to care for complications of miscarriage, providers should utilize this similarity to minimize risk of prosecution for patients 45 …”

“…43 Despite being infrequent, there is clear evidence of inequitable persecution of individuals who choose self-managed abortion, influenced by racism, xenophobia, and classism, with criminal investigations of self-managed abortion occurring more frequently among BIPOC women and those living on lowincomes. 24 Given that care for complications after a self-managed abortion with medication abortion drugs is medically equivalent to care for complications of miscarriage, providers should utilize this similarity to minimize risk of prosecution for patients. 45 To counter rising abortion restrictions across the country, some abortion-supportive states have passed Shield Laws, defined as laws that protect abortion providers from civil, criminal, and/or licensure consequences of providing abortion care.…”

“…In the US, self-managed abortion is often defined as any intervention to end a pregnancy that occurs outside of the formal health care system, including selfsourcing of medications, consumption of herbs or toxic substances, and physical methods. 23,24 Because of the current legal environment, many adolescents may need to navigate abortion care without access to a consistent medical provider. 17 This underscores the importance of abortion care knowledge among pediatric and adolescent primary care providers, who may need to counsel adolescents regarding abortion and post-abortion care, even if they do not directly provide abortion care themselves.…”

“…The current US legal landscape will drive more adolescents who desire abortion care to travel out of state, seek abortion pills through the mail, or self‐manage their abortion. In the US, self‐managed abortion is often defined as any intervention to end a pregnancy that occurs outside of the formal health care system, including self‐sourcing of medications, consumption of herbs or toxic substances, and physical methods 23,24 . Because of the current legal environment, many adolescents may need to navigate abortion care without access to a consistent medical provider 17 .…”