Abstract
BackgroundPrior 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.MethodsWe 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 self-managed abortion for the current pregnancy among survey respondents, and describe interview participants’ decision-making and experiences with abortion self-management.Results6.9% (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 self-managing 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.ConclusionThese 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, self-managed 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.
Highlights
Prior research has shown that a small proportion of U.S women attempt to self-manage their abortion
None of the qualitative interview participants here reported that their selfmanaged abortion resulted in medical complications; we found in the survey of abortion patients that some women did report getting hit in the abdomen to try to end the pregnancy
We suspect that self-managed abortion may become more common if clinic-based abortion care becomes more difficult to access, especially among women in south Texas where misoprostol may be more accessible due to the proximity to Mexico, and among poor women - who make up more than half of all abortion patients [1] and face barriers to accessing reproductive health care
Summary
Prior research has shown that a small proportion of U.S women attempt to self-manage their abortion. A 2008 qualitative study examining the abortion self-induction experiences of 30 women recruited from health care facilities in four US cities found that participants reported several reasons for choosing to attempt to self-manage an abortion, including being unable to afford the cost of clinic-based abortion care, wanting to avoid clinic-based care, and being young and not knowing how or whether they could obtain a clinic-based abortion; others preferred self-induction because they thought it was easier or more natural [3]. The Texas survey found that women living in a county bordering Mexico, and who reported that they had ever found it difficult to obtain reproductive health services, for example because of high costs or lack of transportation, were more likely to report knowing someone who had attempted to self-manage an abortion or having done so themselves [2]. Women attempting to selfmanage their abortion report using a range of methods, including herbs and vitamins [1, 3, 4], birth control pills [3], various food products [3], alcohol or drugs [4], and misoprostol/Cytotec [1, 3, 4]
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