Apr 18, 2023
JAMA Network

Factors Associated With Knowledge and Experience of Self-managed Abortion Among Patients Seeking Care at 49 US Abortion Clinics

Access to in-clinic abortion care in the US has changed profoundly following the Dobbs v. Jackson Women’s Health Organization Supreme Court decision, which overturned the constitutional right to choose abortion established in Roe v. Wade.1 In many states, access to clinical abortion care was already limited before the Dobbs decision. However, now state-level total or near-total bans have created large areas of the country where abortion in a clinic is unavailable.2 In this new policy climate, self-managed abortion has become an increasingly important component of access.3 A self-managed abortion is one that occurs outside the formal health care setting and comprises a spectrum of methods, including abortion medications (mifepristone and/or misoprostol), herbs and botanicals, and self-harm.4 Although people have self-managed their abortions throughout history, increased access to abortion medications via online pharmacies and telemedicine services such Aid Access means that more people may now self-manage using pills.5

Although self-managed abortion is often viewed solely as a mutually exclusive alternative to in-clinic care, research suggests that it may be considered or attempted by those who ultimately do access a clinic as part of the path to securing an accessible and acceptable option. A 2014 study showed that 1.2% of US abortion clinic patients had ever attempted to self-manage using misoprostol,6 while a 2019 study showed that abortion clinic patients in Texas considered or attempted self-management before attending the clinic because they were unsure whether they would be able to overcome access barriers or because they would have preferred to self-manage but were ultimately unable to find an acceptable method.7