Abstract
ObjectiveStudies on self-managed abortion conducted at abortion clinics may exclude those facing the greatest barriers to care. We aimed to assess association of attempted self-managed abortion with reported barriers to abortion care. Study DesignWe used data from the Google Ads Abortion Access Study, a prospective cohort study that recruited people searching for abortion care on Google between August 2017 and April 2018. We used a stratified sampling design recruiting by state to ensure representation from all 50 states. Participants completed an online baseline survey and follow-up 4 weeks later. We modeled the adjusted odds of attempting self-managed abortion using multivariable logistic regression, with random effects for state of residence. We assessed attempted self-managed abortion at follow-up by asking: “Did you take or try to do any of the following to try to end this pregnancy?” with a closed-ended list of methods. ResultsAmong 856 participants with follow-up data, 28% (95% confidence interval [95% CI]: 25%–31%) reported attempting self-managed abortion. Most common methods used were: herbs, supplements, or vitamins (52%); emergency contraception or many contraceptive pills (19%); mifepristone and/or misoprostol (18%); and abdominal or other physical trauma (18%). Participants still seeking abortion at 4 weeks were more likely to attempt self-management (33%) than those planning to carry to term (20%, p < 0.001). Reporting having to keep the abortion a secret, fearing for one's safety/well-being, needing to gather money for travel or the abortion, or living further from an abortion facility as barriers were associated with higher odds of attempts. ConclusionsAttempted self-managed abortion is higher among people facing barriers to abortion care. ImplicationsReducing financial and distance barriers, such as by removing legal restrictions on abortion, could help reduce attempted self-managed abortion. Additionally, removing restrictions on telehealth for abortion could reduce attempted self-managed abortion. Efforts are needed to permanently remove United States Food and Drug Administration (FDA) regulations and state policies prohibiting telehealth for medication abortion, thereby allowing individuals to end their pregnancies without a clinic visit.
Highlights
Growing barriers to abortion care in the United States (US) have increased interest in self-managed abortion [1,2], defined as attempting to end one’s own pregnancy without clinical supervision [3]
This study suggests that prevalence of attempted self-managed abortion among people searching online for abortion care may be higher than the general population
Over the 9-month recruitment period, our Google Ads made 678,256 impressions, with 11,552 total clicks, representing a 2% click-through rate (CTR) (Fig. 2)
Summary
Growing barriers to abortion care in the United States (US) have increased interest in self-managed abortion [1,2], defined as attempting to end one’s own pregnancy without clinical supervision [3]. Barriers to abortion care and incidence of attempted selfmanaged abortion among individuals searching Google for abortion care: A national prospective study, Contraception, https://doi.org/10. 1016/j.contraception.2021.09.009
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