Self-managed abortion attempts increased after loss of federal abortion protections
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Key takeaways:
- There was an increase in self-managed abortion attempts after Dobbs decision.
- Data suggest self-managed abortion attempts will continue to rise.
The proportion of U.S. women who reported having a self-managed abortion rose by 1 percentage point after the Dobbs decision removed a federal right to abortion, suggesting people are increasingly relying on self-sourced methods, data show.
The study represents the first population-based estimate of changes in attempts to self-manage abortion before and after the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization in June 2022, which overturned federal protections on abortion, Lauren Ralph, PhD, MPH, associate professor and epidemiologist at the department of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco, and colleagues wrote in JAMA Network Open.
“Our study highlights an increase in attempts to self-manage abortion among the U.S. female population of reproductive age following the Supreme Court’s June 2022 decision overturning federal protections on abortion,” Ralph told Healio. “Specifically, we find that 3.3% of reproductive-age women in the U.S. had ever attempted to self-manage an abortion in 2023, an increase from 2.4% in late 2021.”
Survey data on self-managed abortions
The researchers administered serial cross-sectional surveys to a nationally representative sample of U.S. women in December 2021 and January 2022 (n = 7,016; median age, 33 years; 54% white), and again in June and July 2023 (n = 7,148; median age, 32 years; 54% white), or 1 year before and 1 year after the Dobbs decision. The researchers asked survey participants whether they had “ever taken or done something on their own, without medical assistance, to try to end a pregnancy.” Respondents who replied “yes” were then asked to detail their experience. Researchers compared changes in weighted self-managed abortion prevalence between survey years, as well as factors associated with self-managed abortion experience.
Across both surveys, fewer than 1% of respondents reported a past year abortion.
The weighted adjusted proportion of respondents that ever-attempted self-managed abortion was 2.4% (95% CI, 1.9-3) in 2021-2022 and 3.4% (95% CI, 2.8-4) in 2023 — an increase of 1 percentage point (95% CI, 0.2-1.7; P = .03). The projected lifetime self-managed abortion prevalence accounting for abortion underreporting was 10.7% (95% CI, 8.6-12.8).
In adjusted analyses, self-managed abortion experience was higher among Black women vs. other racial and ethnic groups (4.3% vs. 2.7%; P = .04) and higher among sexual and gender minority participants vs. heterosexual or cisgender participants (5% vs. 2.5%; P < .001).
Approximately four in 10 (45.3% in 2021-2022 and 39% in 2023) self-managed abortion attempts occurred before age 20 years.
Methods used for self-managed abortion included herbs, reported by 29.8% of respondents in 2021-2022 vs. 25.9% in 2023, as well as physical methods (28.6% in 2021-2022 vs. 29.7% in 2023) or alcohol or other substances (17.9% in 2021-2022 vs. 18.6% in 2023). Few participants reported seeking emergency care for a complication after a self-managed abortion.
“In our sample, people used a variety of methods to self-manage abortion, ranging from self-sourced mifepristone and misoprostol to herbs to physical methods like hitting themselves in the abdomen,” Ralph told Healio. “While self-managed medication abortion with mifepristone and/or misoprostol is safe and effective, some of these other methods have the potential for harm and are likely ineffective at ending a pregnancy. Thus, some people will likely interact with the health care system following an self-managed abortion attempt, whether that is to make sure that the methods worked, to get care or reassurance for a complication or side effect or to complete an abortion if the self-sourced methods are ineffective.”
Addressing ‘gaps’ in health care system
Ralph said it is critical that clinicians across multiple specialties, but particularly those in emergency and primary care settings, be aware of the potential complications associated with self-managed abortion as well as its usual clinical course, while also protecting patient privacy.
“This study is an important part of getting a full picture of the impact of the Dobbs decision and demonstrates that people will increasingly self-manage abortions as access is increasingly restricted,” Ralph told Healio. “Measuring the prevalence of self-managed abortion tells us about gaps in our health care system, and how we can most effectively respond to meet the needs of people who will want or need an abortion in the coming months and years. We should continue to track the prevalence of self-managed abortion moving forward and identify effective strategies for connecting people who desire abortion with safe and effective methods.”
For more information:
Lauren Ralph, PhD, MPH, can be reached at lauren.ralph@ucsf.edu.