Abstract
BackgroundA growing body of evidence indicates that some people seek options to terminate a pregnancy without medical assistance, but experiences doing so have largely been documented only among people accessing a clinic-based abortion. We aim to describe self-managed abortion (SMA) experiences of people recruited outside of clinics, including their motivations for SMA, pregnancy confirmation and decision-making processes, method choices, and clinical outcomes.MethodsIn 2017, we conducted 14 in-depth interviews with self-identified females of reproductive age who recently reported in an online survey administered to Ipsos’ KnowledgePanel that, since 2000, they had attempted SMA while living in the United States. We asked participants about their reproductive histories, experiences seeking reproductive health care, and SMA experiences. We used an iterative process to develop codes and analyzed transcripts using thematic content analysis methods.ResultsMotivations and perceptions of effectiveness varied by whether participants had confirmed the pregnancy prior to SMA. Participants who confirmed their pregnancies chose SMA because it was convenient, accessible, and private. Those who did not test for pregnancy were motivated by a preference for autonomy and felt empowered by the ability to try something on their own before seeking facility-based care. Participants prioritized methods that were safe and available, though not always effective. Most used herbs or over-the-counter medications; none used self-sourced abortion medications, mifepristone and/or misoprostol. Five participants obtained facility-based abortions and one participant decided to continue the pregnancy after attempting SMA. The remaining eight reported being no longer pregnant after SMA. None of the participants sought care for SMA complications; one participant saw a provider to confirm abortion completion.ConclusionsThere are many types of SMA experiences. In addition to those who pursue SMA as a last resort (after facing barriers to facility-based care) or as a first resort (because they prefer homeopathic remedies), our findings show that some individuals view SMA as a potential interim step worth trying after suspecting pregnancy and before accessing facility-based care. These people in particular would benefit from a medication abortion product available over the counter, online, or in the form of a missed-period pill.
Highlights
A growing body of evidence indicates that some people seek options to terminate a pregnancy without medical assistance, but experiences doing so have largely been documented only among people accessing a clinic-based abortion
What we know about this experience comes from studies focused on people who go to clinics
In addition to people who end a pregnancy on their own as a last resort or as a first resort, a third group values having an interim step to try after suspecting pregnancy and before accessing facility-based care
Summary
A growing body of evidence indicates that some people seek options to terminate a pregnancy without medical assistance, but experiences doing so have largely been documented only among people accessing a clinic-based abortion. Estimates of the prevalence of self-managed abortion (SMA) in the US come primarily from studies of people seeking care in abortion clinics or other primary or reproductive health care clinics These studies found that between 2% and 13% of people accessing facility-based care reported having taken or done something to end a pregnancy on their own without medical assistance [1,2,3,4]. Guttmacher’s 2014 survey of patients accessing facility-based abortion found that 1.3% and 0.9% reported ever having taken misoprostol or other substances, respectively, without guidance of a healthcare provider, to terminate a pregnancy [5] These estimates may not capture the experiences of people who never access facility care. Abortion providers report caring for a growing number of SMA patients in the last 5 years [11, 12]
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