Texas women’s decisions and experiences regarding self-managed abortion

Abstract

Background: Prior research has shown that a small proportion of U.S. women attempt to self-manage their abortion. The objective of this study is to describe Texas women's motivations for and experiences with attempts to self-manage an abortion. The objective of this study is to describe Texas women's motivations for and experiences with attempts to self-manage an abortion. Methods: We report results from two data sources: two waves of surveys with women seeking abortion services at Texas facilities in 2012 and 2014 and qualitative interviews with women who reported attempting to self-manage their abortion while living in Texas at some time between 2009 and 2014. We report the prevalence of attempted selfmanaged abortion for the current pregnancy among survey respondents, and describe interview participants' decisionmaking and experiences with abortion self-management. Results: 6.9% (95% CI 5.2-9.0%) of abortion clients (n = 721) reported they had tried to end their current pregnancy on their own before coming to the clinic for an abortion. Interview participants (n = 18) described multiple reasons for their decision to attempt to self-manage abortion. No single reason was enough for any participant to consider selfmanaging their abortion; however, poverty intersected with and layered upon other obstacles to leave them feeling they had no other option. Ten interview participants reported having a complete abortion after taking medications, most of which was identified as misoprostol. None of the six women who used home remedies alone reported having a successful abortion; many described using these methods for several days or weeks which ultimately did not work, resulting in delays for some, greater distress, and higher costs. Conclusion: These findings point to a need to ensure that women who may consider self-managed abortion have accurate information about effective methods, what to expect in the process, and where to go for questions and follow-up care. There is increasing evidence that given accurate information and access to clinical consultation, selfmanaged abortion is as safe as clinic-based abortion care and that many women find it acceptable, while others may prefer to use clinic-based abortion care.

Prevalence of Self-Managed Abortion Among Women of Reproductive Age in the United States

“…Finally, our results highlight how SMA encompasses many different types of methods with vastly different and sometimes unknown 40 levels of safety and effectiveness. Consistent with prior research, 4 herbs were the most common method used. However, others took misoprostol, drugs or medications other than misoprostol, EC after confirming a pregnancy, or used a physical method, often in combination.…”

“…One-third of participants who had ever attempted SMA indicated that their attempt was unsuccessful and they sought a facility-based abortion. This suggests that SMA attempts identified at the time of abortion care–seeking may represent only one-third of all SMA attempts; accordingly, estimates of SMA among people recruited in clinic settings, which currently range from 2% to 13% depending on the study, 4 , 5 , 15 should be interpreted as underestimates of the frequency of SMA.…”

“… 1 People’s reasons for SMA are varied, and include both difficulty accessing facility-based abortion care and a preference for a more private or natural abortion experience. 2 , 3 , 4 …”

COVID‐19 Abortion Bans and Their Implications for Public Health

“…While the U.S. Supreme Court struck down key components of House Bill 2 in 2016, the impact that ‚temporary‛ closure had on clinics was not reversible-in the months prior to the bill there were 41 clinics operating in Texas, but by 2019 there were only 24. 23 Similarly, we fear that COVID-19-related bans are likely to reduce access to care even after they are lifted.…”

Abortion attempts without clinical supervision among transgender, nonbinary and gender-expansive people in the United States

“…15 Recent research has focused on demonstrating the effectiveness and safety of self-managed abortion with standardised abortifacient medications -specifically, misoprostol and mifepristone. [16][17][18][19] While self-managed medication abortion using mifepristone and/or misoprostol is safe and effective, 16 18-23 other methods -such as physical trauma and substance useare known to be harmful, or lack reliable evidence. 15 18 People attempt to end their pregnancies without clinical support for many reasons, including an inability to access clinic-based abortion care; fear of stigma or mistreatment within clinical settings 18 ; a preference for ending a pregnancy in the privacy and comfort of a place of one's choosing; and a preference for using methods not associated with contemporary allopathic medicine.…”