Study: Self-Managed Abortions Rise Alongside Abortion Restrictions

mifepristone abortion pill

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Key Takeaways

  • A new study finds 7% of women living in the United States will attempt a self-managed abortion at least once in their life.
  • Women of color or low-income are more likely to report having a self-managed abortion.
  • The Supreme Court reimposed a rule that mandates abortion pills to be picked up in-person.

On January 12, 2021, the Supreme Court granted a request from the Trump administration necessitating in-person visits with a medical professional in order to pick up abortion pills, further limiting abortion access during the COVID-19 pandemic. Previously, people could receive the medication for terminating an early pregnancy, called mifepristone, through the mail after a telehealth visit.

In the United States, the legality and morality of an abortion is a heated topic of debate. While Roe v. Wade gives all women the constitutional right to an abortion, some states only make this good on paper. Since 2011, there have been a total of 401 state laws enacted to restrict access to abortion care. While the barriers to receiving an abortion has undoubtedly contributed to the decline of abortions in clinics, a recent study in JAMA Network Open finds this may not be the case for self-managed abortions.

Lead study author Lauren Ralph, PhD, MPH, an associate professor and epidemiologist with Advancing New Standards in Reproductive Health (ANSIRH) at the University of California, says abortion restrictions could also be creating a greater preference for self-managed abortions.

“As we see access to abortions becoming more difficult in the U.S. as abortion clinics closed due to increased restrictions, we are likely to see self-managed abortions being more common in the U.S.,” Ralph tells Verywell. “This is more prevalent today in the COVID-19 landscape.”

For this reason, Ralph says her team sought to collect data on abortions outside of clinics. “Clinic-based estimates won’t capture people who’ve managed a successful self-managed abortion, or women who didn’t have a successful abortion, but continued on with the pregnancy,” she says.

What Are Self-Managed Abortions?

Self-managed abortions don't require a procedure and don't necessitate a hospital visit. They encompass a range of methods to end a pregnancy, some safer than others. For the study, Ralph says self-managed abortion was defined as taking measures to end an unwanted pregnancy without medical supervision, which can include the abortion pill.

According to the World Health Organization (WHO), medically-managed abortions are the most common type of self-managed abortion, and use a pill containing mifepristone and/or misoprostol. Medication-induced abortions can be done in a clinic or at home, increasing access to abortion care for women.

During the COVID-19 pandemic, access to medication for abortions is paramount, especially since several states have closed clinics, deeming their services non-essential. One study looking at telemedicine found that across the United States, the demand for self-managed abortions increased by 27% during the pandemic. Requests were highest in states with steeper COVID-19 case counts and with greater restrictions for abortion clinics. Of note, there was a 94% increase in requests for self-managed abortions in Texas. As of January 13, Texas Health and Human Services reported a cumulative total of 1,775,619 coronavirus cases.

1 in 14 Women Will Attempt a Self-Managed Abortion of Some Kind

Ralph's study began before COVID-19. But she says its implications are crystal clear as the pandemic and politicians alike make access to abortion harder: “Self-managed abortions will likely become more prevalent in the U.S. like in other countries, and we need to ensure there are models so that people have access to the safest and most effective methods towards self-managed abortions,” she says.

In 2017, the team surveyed 7,022 women ranging from 18 to 49 years old on their experience with self-managed abortions. If they had experience, researchers asked follow-up questions regarding the method, reasons for the termination of pregnancy, and the result of their experience.

Results showed that about 7% of women living in the United States will attempt a self-managed abortion at least once in their life. “That’s about 1 in 14 women or just under a million individuals,” Ralph says.

About 33.6% of women had an unsuccessful self-managed abortion and opted to pursue clinic-based abortions. Thus, the study suggests that data from clinics may only reflect this portion of self-managed abortions.

Who Is More Likely To Self-Manage Abortion?  

In the face of increasing restrictions, results showed low-income women were more likely to undergo self-managed abortions, as well as Black and Hispanic women. The findings coincide with a 2013 review which suggested that women of color or women with financial insecurity had higher abortion rates than White women or women with a higher socioeconomic status. 

One in 5 women said they chose a self-managed abortion because they couldn’t find a provider or would have to travel too far to a clinic. About 25.2% of women said it was too expensive to go to a clinic, and 14% were deterred by the need for parental consent at a clinic.

About 13.2% of women said they preferred a self-managed abortion because it seemed more natural. “We found that many also cited a desire for self-managed abortions because they thought it was easier, faster or that it was more natural,” Ralph says. “So, it was something they preferred rather than going to a clinic.”

Preference for self-managed abortions is consistent with prior research. A separate 2020 study surveyed women in three Texas abortion clinics and found 39% of women were interested in self-managed abortions.

Are Self-Managed Abortions Safe?

Of the abortion methods used, researchers found that 20% of women had a medicinal abortion using misoprostol, 29.2% of women used another medication, 38.4% used herbs, and 19.8% used physical techniques to induce an abortion.

Kim Langdon, MD, an OB-GYN at the telemedicine company Medzino, says that physical methods are not safe and recommends using misoprostol and mifepristone, which offer a higher chance of success if taken in the first trimester.

“Self-managed abortions performed by putting something in your uterus through the vagina are virtually impossible to perform without also putting your own life at risk,” Langdon tells Verywell. “An instrument placed into the uterus can cause an infection, hemorrhage, death, air embolus, infertility, and subsequent hysterectomy if there are complications.”

Without easy access to a pill, experts fear more women will turn to unsafe methods. Improperly managed abortions can lead to complications ranging from hemorrhaging and sepsis to death.

Ralph says her team is looking ahead to repeat the survey to better reflect the impact of COVID-19. They also hope to be able to work with medical professions to create screenings for abortion medications that can be mailed to people in need.

What This Means For You

Abortion restrictions vary by state, and the Supreme Court ruling severely limits the ability to safety access options for self-induced abortions. Talk to a doctor to find out if a self-managed abortion is a viable treatment option before undergoing any course of action.



11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Supreme Court of the United States. Food and Drug Administration, et al. v. American College of Obstetricians and Gynecologists, et al.

  2. Guttmacher Institute. Policy trends in the states.

  3. Guttmacher Institute. The U.S. abortion rate continues to drop: once again, state abortion restrictions are not the main driver.

  4. Ralph L, Foster DG, Raifman S, et al. Prevalence of self-managed abortion among women of reproductive age in the United States. JAMA Netw Open. 2020;3(12):e2029245. doi:10.1001/jamanetworkopen.2020.29245

  5. Herold S & Sisson G. Hangers, potions, and pills: abortion procedures on American television. Women's Health Issues. 2019;29(6):499-505. doi:10.1016/j.whi.2019.06.006

  6. World Health Organization. Self-management of medical abortion.

  7. Kaiser Family Foundation. State action to limit abortion access during the COVID-19 pandemic.

  8. Aiken A, Starling J, Gomperts R, et al. Demand for self-managed online telemedicine abortion in the United States during the coronavirus disease 2019 (COVID-19) pandemic. Obstetrics and Gynecology.

  9. Texas Health & Human Services. Texas COVID-19 data.

  10. Dehlendorf C, Harris LH, Weitz TA. Disparities in abortion rates: a public health approach. American journal of public health. 2013;103(10):1772-1779. doi:10.2105/AJPH.2013.301339

  11. Aiken AR, Broussard K, Johnson, DM, et al. Knowledge, interest, and motivations surrounding self-managed medication abortion among patients at three Texas clinics. American Journal of Obstetrics and Gynecology. doi:10.1016/j.ajog.2020.02.026

By Jocelyn Solis-Moreira
Jocelyn Solis-Moreira is a journalist specializing in health and science news. She holds a Masters in Psychology concentrating on Behavioral Neuroscience.