Self-managed Abortion Research Articles

'The abortion gave me my life back': the long-term impact of access to self-managed medication abortion through telemedicine on women's lives in legally restricted countries.

Approximately 753 million women (38%) of reproductive age live in countries with restrictive abortion laws. To overcome these legal constraints, women access safe self-managed medication abortions through telemedicine abortion services. This study aimed to explore the long-term impact of accessing a self-managed medication abortion through telemedicine service on women's lives in countries with restrictive abortion laws. We conducted interviews with eleven women (from eleven different countries) who accessed a self-managed medication abortion through online telemedicine between 2014 and 2018 in a legally restricted country. We analysed interviews thematically. Three key themes were developed: (1) access to abortion positively impacted life plans; (2) the negative influence of the legally restricted environment wore off and their well-being improved; (3) participants are now using their own experiences to help others by either sharing information or facilitating access to abortion. In summary, our findings highlight the positive impact of access to self-managed medication abortion and underline the importance of ensuring access to abortion for everyone.

Self-reported follow-up care needs can be met in both facility and self-managed abortion: Evidence from low- and middle-income countries

ObjectivesTo understand in-facility follow-up care-seeking behavior among both people who self-managed medication abortions and those who obtained facility-managed care in low-and-middle-income countries. We explore factors that contribute to meeting individual self-reported follow-up care needs, core to person-centered care. Study designWe conducted a qualitative, codebook thematic analysis of 67 in-depth interviews conducted with people who self-managed medication abortions or obtained facility-managed medication abortion care. We first classified individuals as having their follow-up care needs met (not seeking care when the participant felt confident that additional care was not warranted or desired or receiving care if it was desired) or not. Our a priori analytic domains came from the Anderson model of health services utilization - predisposing, enabling, or need factors (perceived and evaluated need for health services) that contributed to having follow-up care needs met or not. We also describe emergent themes within each domain. ResultsMost participants (n=59, 88%) had their follow-up care needs met; half (n=33, 49%) sought follow-up care in a facility. Prior birth or abortion experiences emerged as predisposing factors for having follow-up care needs met. Having accompaniment support (from activists or hotlines who provide abortion guidance outside of clinical settings), knowing what to expect, and information sources were key enabling factors for having follow-up care needs met. Need factors included flexible follow-up care guidelines. Those who did not have their follow-up care needs met described predisposing negative health system experiences; enabling factors including health system challenges, stigma from providers, and legal risk; and need factors of required follow-up care guidelines. ConclusionsMedication abortion follow-up care experiences are diverse, and individual needs can be met both in and outside of health facilities. Understanding prior experiences, enabling accompaniment support, and considering flexible follow-up care guidelines can support meeting individual follow-up care needs, which is essential to person-centered abortion care. ImplicationsFollow-up care needs, essential to ensuring access to high-quality abortion services, can be met in both self-managed and in-facility medication abortion models. Policies that require follow-up care when it is not needed or desired by the person can reinforce ideas that self-managed abortion is not safe or effective, despite existing evidence.

Self-Managed Abortion Attempts Before vs After Changes in Federal Abortion Protections in the US

With decreasing access to facility-based abortion in the US, an increase in self-managed abortion (SMA) using various methods is anticipated. To date, no studies have examined changes in SMA in the shifting policy landscape. To estimate changes in SMA prevalence among the general US population from before to after the Supreme Court's June 2022 decision overturning federal abortion protections. Serial cross-sectional surveys were administered throughout the US from December 10, 2021, to January 11, 2022, and June 14 to July 7, 2023. Participants included online panel members assigned female sex at birth, ages 18 to 49 years (or ages 15-17 years if a household member), who were English- or Spanish-speaking. Year of the survey (2021-2022 vs 2023). Participants were asked whether they had "ever taken or done something on their own, without medical assistance, to try to end a pregnancy" and, if so, details of their experience. Changes in the weighted SMA prevalence between survey years were examined, factors associated with SMA experience were identified, and projected lifetime SMA prevalence was calculated using discrete-time event history models, accounting for abortion underreporting. Median age of the participants was 32.5 (IQR, 25-41) years in 2021-2022 (n = 7016) and 32.0 (IQR, 24-40) in 2023 (n = 7148). Across both years, approximately 14% were non-Hispanic Black, 21% were Hispanic, and 54% were non-Hispanic White. The weighted adjusted proportion that ever attempted SMA was 2.4% (95% CI, 1.9%-3.0%) in 2021-2022 and 3.4% (95% CI, 2.8%-4.0%) in 2023-an increase of 1.0% (95% CI, 0.2%-1.7%; P = .03). Projected lifetime SMA prevalence accounting for abortion underreporting was 10.7% (95% CI, 8.6%-12.8%). In adjusted analyses, SMA experience was higher among non-Hispanic Black (4.3%; 95% CI, 2.8%-5.8%) vs other racial and ethnic (2.7%; 95% CI, 2.2%-3.1%) groups (P = .04) and sexual and gender minority (5.0%; 95% CI, 3.4%-6.6%) vs heterosexual or cisgender (2.5%; 95% CI, 2.0%-2.9%) participants (P < .001). Approximately 4 in 10 (45.3% in 2021 and 39.0% in 2023) SMA attempts occurred before age 20 years. The methods used included herbs (29.8% [2021-2022] vs 25.9% [2023]), physical methods (28.6% [2021-2022] vs 29.7% [2023]), or alcohol or other substances (17.9% [2021-2022] vs 18.6% [2023]). Few participants (7.1% [2021-2022] vs 4.7% [2023]) sought emergency care for a complication. In this serial nationally representative survey study, increased SMA was observed following the loss of federal abortion protections. The findings revealed increased SMA use among marginalized groups, most often with ineffective methods. These findings suggest the need to expand access to alternative models of safe and effective abortion care and ensure those seeking health care post-SMA do not face legal risks.

Self-Managed Abortion and Criminalization in the Post-Dobbs US

Self-Managed Abortion and Criminalization in the Post-Dobbs US

Experiences of the Irish model of community medical abortion: adherence to self-managed, people-centred abortion care

ABSTRACT The Irish abortion model of care, implemented in January 2019, is distinctive for being located primarily in the community and relying principally on medical abortion outside a clinical setting. The model facilitated mapping onto existing healthcare structures and thereby allowed abortion provision to commence quickly after Repeal of the 8th Amendment. This article considers the operation of the Irish model of abortion care under 12 weeks gestation which has been characterised as a community medical abortion model. It draws on data gathered through 46 in-depth interviews with people accessing abortion care under twelve weeks gestation between December 2019 and April 2021. These qualitative accounts of experiences of first-trimester abortion care portray what the Irish model of care entails in practice from the abortion seeker perspective. The community model of medical abortion is portrayed as involving a hybrid of self-managing abortion outside of clinical settings in the context of legally regulated provision of medication delivered through a network of community-based primary care doctors. The Irish model of care anticipated a significant shift in how self-management of medical abortion is viewed by the World Health Organization whose 2022 updated abortion guidelines included self-management of medical abortion for the first time as a fully recommended model of abortion care. The paper considers how the Irish model of community medical abortion relates to self-managed and people-centred abortion care and whether this hybrid model facilitates or circumscribes these features.

The Struggle for Bodily Autonomy: A Historical Perspective on Self-Managed Abortion in the United States

Current activism around self-managed abortion (SMA) in the United States is born out of innovation, resistance, resilience, and necessity. This article examines the historical origins of SMA in the United States from an activist perspective and outlines the opportunities and challenges that SMA presents to people having expanded control over their reproductive lives.

Prior knowledge and experience with self-managed abortion among people seeking abortion care in US Midwestern states

ObjectivesThis study seeks to understand what methods people use and/or have heard of others using for self-managed abortion (SMA) prior to coming to a health facility for abortion care. Study designWe collected survey data on sociodemographics, gestational stage, and SMA awareness and methods from patients seeking care in 17 abortion facilities in Ohio, West Virginia, Kentucky, Pennsylvania, and Illinois from April 2020 to April 2022. We used descriptive statistics to examine the proportion of participants who had attempted SMA and, separately, who had heard of people attempting SMA. ResultsIn total, 71 respondents (4.2%) had attempted SMA, and 416 (25.5%) had heard of others attempting SMA. The most frequently attempted methods for self-management were taking herbs and/or vitamins (31% each) or hitting oneself/being hit (22.5%). About a third of those who tried SMA reported trying more than one method (30%). ConclusionsOur findings suggest that people who attempt SMA are committed to self-managing their abortion. More research is needed to better understand sociodemographic characteristics of people who have attempted or heard of people attempting SMA research.

Women's rescuers network: Community support for self-managed abortion in Argentina

The availability of medications to induce abortion, especially in contexts of restricted access, has transformed practices and allowed women and/or their community organizations to assist other women in obtaining abortions, whether or not they interact with the healthcare system. This study recovers the experience of a feminist community organization that, from the province of Neuquén, extends throughout the country, creating a network of community care. An exploratory descriptive study with a qualitative approach was conducted to analyze the experiences of women who facilitate access to permitted abortion in Argentina. Through in-depth interviews with three leaders of the feminist collective La Revuelta and semi-structured interviews with 33 members of the socorrista groups, conducted between November 2019 and December 2020, we describe their history and processes of work and growth; we explore their motivations and feelings and characterize the interactions of these organizations with public and private health systems. The results of this work align with the international conversation and bibliographic production about these organizations and their particularities, and with the need to incorporate these forms of care into institutional health systems.

Seeking abortion accompaniment: experiences and self-managed abortion preferences of hotline callers after abortion legalisation in Argentina

BackgroundUntil the legalisation of abortion in Argentina in 2021, the Socorristas en Red, a network of feminist collectives, provided support and information (‘accompaniment’) to people self-managing their abortion with medications....

Supporting Self-Managed Medication Abortion: Care Needs and Preferences of SMMA Users in Three US States

Supporting Self-Managed Medication Abortion: Care Needs and Preferences of SMMA Users in Three US States

Abortion pill marketing and sourcing on twitter following Dobbs v. Jackson supreme court ruling

Objective This study examines abortion-related discourse on Twitter (X) pre-and post-Dobbs v. Jackson ruling, which eliminated the constitutional right to abortion. Study Design We used a custom data collection tool to collect tweets directly from Twitter using abortion-related keywords. We used the BERTopic language model and examined the top 30 retweeted and top 30 textually similar tweets from relevant topic clusters using an inductive coding approach. We also conducted statistical testing to assess potential associations between abortion themes. Results 166,799 unique tweets were collected from December 2020-December 2022. 464 unique tweets were coded for abortion-related themes with 154 identified as relevant. Of these, 66 tweets marketed abortion pills, 17 tweets were identified as offering consultations, and 91 tweets were relevant to self-managed abortion. All marketing and consultation tweets were posted post-Dobbs decision and 7 (7.69%) of self-managed tweets were posted pre-Dobbs versus 84 (92.30%) posted post-Dobbs. A positive association was found between tweets offering a medical consultation with tweets marketing abortion pills and discussing self-managed abortion. Conclusion This study detected online marketing of abortion pills, consultations and discussions about self-managed abortion following the Dobbs v. Jackson ruling. These results provide more context to the type of abortion-related information that is available online.

Medicalization as a social good? Lay perceptions about self-managed abortion, legality, and criminality

Interest in ending a pregnancy outside the formal healthcare sector, also known as self-managed abortion (SMA), is expected to increase in the wake of the overturning of Roe v Wade. However, there is little social scientific research on public perceptions of SMA, particularly regarding opinions around legality and criminalization. We seek to fill this gap in this paper by drawing on 54 in-depth interviews with a mixed-gender sample (men, women, nonbinary) recruited from eight U.S. states with the most restrictive abortion laws. Our analysis finds that most participants believed that SMA should not be illegal or criminalized largely due to two overarching justifications: (1) due to a belief that people should have a right to their own bodily autonomy even in the case of potential self-harm and (2) the belief that criminalizing SMA would be against public health goals. Further, many are concerned that making SMA illegal will lead to unfair or even cruel punishment. However, an underlying thread connecting both support and opposition to SMA legality and criminalization is the assumption that SMA is inherently harmful or dangerous, indicating a lack of lay awareness about the safety and efficacy of SMA using medication abortion pills. These findings indicate the power of medicalization and a valuing of medicalization as a social good, as many believe that behaviors occurring within the healthcare system are inherently safer, more justified, and more moral.

Provision of Medications for Self-Managed Abortion Before and After the Dobbs v Jackson Women’s Health Organization Decision

The Supreme Court decision in Dobbs v Jackson Women's Health Organization overturned the right to choose abortion in the US, with at least 16 states subsequently implementing abortion bans or 6-week gestational limits. Prior research indicates that in the 6 months following Dobbs, approximately 32 360 fewer abortions were provided within the US formal health care setting. However, trends in the provision of medications for self-managed abortion outside the formal health care setting have not been studied. To determine whether the provision of medications for self-managed abortion outside the formal health care setting increased in the 6 months after Dobbs. Cross-sectional study using data from sources that provided abortion medications outside the formal health care setting to people in the US between March 1 and December 31, 2022, including online telemedicine organizations, community networks, and online vendors. Using a hierarchical bayesian model, we imputed missing values from sources not providing data. We estimated the change in provision of medications for self-managed abortion after the Dobbs decision. We then estimated actual use of these medications by accounting for the possibility that not all provided medications are used by recipients. Abortion restrictions following the Dobbs decision. Provision and use of medications for a self-managed abortion. In the 6-month post-Dobbs period (July 1 to December 31, 2022), the total number of provisions of medications for self-managed abortion increased by 27 838 (95% credible interval [CrI], 26 374-29 175) vs what would have been expected based on pre-Dobbs levels. Excluding imputed data changes the results only slightly (27 145; 95% CrI, 25 747-28 246). Accounting for nonuse of medications, actual self-managed medication abortions increased by an estimated 26 055 (95% CrI, 24 739-27 245) vs what would have been expected had the Dobbs decision not occurred. Provision of medications for self-managed abortions increased in the 6 months following the Dobbs decision. Results suggest that a substantial number of abortion seekers accessed services despite the implementation of state-level bans and restrictions.

The Impact of the Pandemic on Reproductive Autonomy and Gender Equality: Perspectives from the Sustainable Development Agenda

Abstract The COVID-19 pandemic had mixed effects on reproductive autonomy. While some governments excluded reproductive health care from the category of “essential” services that could be provided during shutdown orders, the pandemic also gave researchers an opportunity to study the efficacy and safety of telemedicine abortion and self-managed abortion. Feminist organizations around the world have also organized to provide cross-border services and far more women now know how to obtain abortion medications. This can be empowering, not only during a public emergency but also when legal rights are suddenly taken away. Unfortunately, for those women who require surgical abortion care, overly strict laws can still lead to tragic outcomes. This is why it is important that human rights treaty bodies and courts are gradually recognizing a right to reproductive autonomy under regional and international human rights law. Hopefully, even conservative governments can be persuaded to provide compassionate exceptions in their laws regulating abortion. A more compassionate approach to the subject of abortion would promote both maternal health and gender equality, helping governments to achieve the ambitious targets in the Sustainable Development Goals.

Foregrounding pain in self-managed early medication abortion: a qualitative study

ObjectiveTo explore experiences of pain in the context of early medical abortion (EMA) in the UK and to guide best practice around anticipatory guidance on pain.MethodsFrom late 2020 to early...

Abortion information-seeking experiences among women who obtained abortions in Kinshasa, DRC: Results from a qualitative study.

Little is known about the process of seeking information related to abortion care options among women in the Democratic Republic of Congo (DRC). Understanding how women obtain information can help identify opportunities for intervention to increase awareness and use of safe pregnancy termination options. Using qualitative data collected from women in Kinshasa, DRC who reported having an abortion in the last 10 years, this study aims to determine how women navigate obtaining information about their options for abortion and the role of their social network in their information-seeking processes. Data for this analysis come from a mixed-method study of abortion in Kinshasa conducted from December 2021 to April 2022. Fifty-two qualitative interviews followed a structured interview guide, including open-ended questions and probes, developed by a multidisciplinary team of researchers in Kinshasa and the United States. Inductive thematic analysis was conducted using Atlas.ti, and a thematic analysis matrix was used to describe the major themes and subthemes. Thematic analysis revealed two main themes with nested subthemes. The first and most salient theme highlighted the highly selective and narrow information search process women engaged in, involving no others or very few individuals (e.g., partners, women in one's community, or providers) that the pregnant woman chose strategically. The second theme revealed the heterogeneous and often stigmatizing nature of these interactions, including attempts at deterrence from many sources and information of varying completeness and accuracy. While the recent liberalization of the abortion law in the DRC is essential to improve access to safe abortion, public health gains will not materialize unless they are accompanied by community-level actions to raise awareness about the legality and availability of safe abortions services, including medication abortion pills for safe self-managed abortion.

Automating untruths: ChatGPT, self-managed medication abortion, and the threat of misinformation in a post-Roe world.

ChatGPT is a generative artificial intelligence chatbot that uses natural language processing to understand and execute prompts in a human-like manner. While the chatbot has become popular as a source of information among the public, experts have expressed concerns about the number of false and misleading statements made by ChatGPT. Many people search online for information about self-managed medication abortion, which has become even more common following the overturning of Roe v. Wade. It is likely that ChatGPT is also being used as a source of this information; however, little is known about its accuracy. To assess the accuracy of ChatGPT responses to common questions regarding self-managed abortion safety and the process of using abortion pills. We prompted ChatGPT with 65 questions about self-managed medication abortion, which produced approximately 11,000 words of text. We qualitatively coded all data in MAXQDA and performed thematic analysis. ChatGPT responses correctly described clinician-managed medication abortion as both safe and effective. In contrast, self-managed medication abortion was inaccurately described as dangerous and associated with an increase in the risk of complications, which was attributed to the lack of clinician supervision. ChatGPT repeatedly provided responses that overstated the risk of complications associated with self-managed medication abortion in ways that directly contradict the expansive body of evidence demonstrating that self-managed medication abortion is both safe and effective. The chatbot's tendency to perpetuate health misinformation and associated stigma regarding self-managed medication abortions poses a threat to public health and reproductive autonomy.

Triumphs and trials with the UK abortion law: The power of collaboration in abortion reform.

The UK is usually viewed as having liberal abortion regulations, providing good access to abortion care within a publicly funded health service. However, the underlying laws are authoritarian, dating from an era when public executions drew large crowds and 67 years before women were able to vote. Abortion is only legal when two doctors certify it meets the permitted grounds, and the penalty for self-managed abortion is up to life imprisonment for both the woman and any accomplice. These laws had prevented the use of mifepristone and misoprostol at home. Changes to the regulations for misoprostol in 2018 and mifepristone in 2020 permitted home use, but the government announced they were rescinding the approval for mifepristone in 2022. This article discusses how, despite the opposition of government, significant progressive changes to the abortion laws were achieved. Early medical abortion at home is now protected in law, and safe access zones protect patients and staff from harassment and intimidation from protesters. Despite this progress, increasing numbers of women are facing criminal investigation and face long prison sentences if convicted. The need for decriminalization and for abortion care to be regulated like all other health care is the next pressing issue.

Strategic (Non)Disclosure: Activation and Avoidance of Social Ties among Women Seeking Abortion.

The increased politicization of sexual and reproductive health has created barriers to medically necessary care. In absence of formal health care, social ties become critical sources of information and resources, yet the disclosure of stigmatized health needs carries significant risk. How do people navigate the risks and benefits of disclosure when seeking care for stigmatized needs? Drawing on original survey data (N = 153) and in-depth interviews (N = 55) with women who attempted a self-managed abortion, I first describe the distinct roles of weak and strong ties in women's health-seeking experiences. I then demonstrate how both partial disclosure and nondisclosure are critical tools for obtaining information, resources, and emotional support during periods of health-seeking. Findings advance understanding of disclosure as a continuum that can be strategically wielded by people with stigmatized needs to confront and evade stigma and surveillance from their networks, the state, and the formal health care system.

Aya Contigo: evaluation of a digital intervention to support self-managed medication abortion in Venezuela.

Venezuela continues to face a humanitarian crisis, where healthcare is difficult to access and abortion is legally restricted. In response to a growing need for life-saving abortion and sexual and reproductive health (SRH) services, a digital application called Aya Contigo was co-developed with local partners to support self-managed medication abortion. We sought to evaluate this digital health tool among pregnant people seeking abortion in Venezuela. This is a mixed-methods pilot evaluation of Aya Contigo, a digital tool for pregnant people seeking abortion in Venezuela. From April to June of 2021, people in the first trimester of pregnancy were recruited via passive sampling. Once enrolled, participants accessed information and resources on the application and were supported by study team members over an encrypted chat. Following medication abortion, participants completed an online survey and a semi-structured interview. Descriptive statistics were used to evaluate the survey responses. Interviews were coded thematically and analyzed qualitatively with NVivo. Forty participants seeking medication abortion in Venezuela were recruited to the study and given access to Aya Contigo. Seventeen completed the online survey (42.5%), with all participants identifying as women and a mean age of 28 (range 19-38; SD 5.55). Participants expressed confidence in Aya Contigo; 53% (9/17) felt "very supported" and the remaining 47% (8/17) felt "somewhat supported" by the app throughout the self-managed abortion process. The app was rated as highly usable, with an overall System Usability Scale score of 83.4/100. Thirteen respondents participated in a semi-structured phone interview, and qualitative analysis identified key themes relating to the experience of seeking abortion in Venezuela, the user experience with Aya Contigo, and the app's role in the existing ecosystem of abortion and contraceptive care in Venezuela. This mixed-methods pilot study demonstrates that the Aya Contigo mobile application may support pregnant people seeking medication abortion and post-abortion contraceptive services in Venezuela. Participants valued the provision of evidence-based information, virtual accompaniment services, and locally-available sexual and reproductive health resources via the digital tool. Further research and interventions are needed to ensure that all pregnant people in Venezuela can access safe abortion and contraceptive resources.