Access to abortion facilities has become more restricted since the Supreme Court revoked the federal right to abortion in the United States, and new research suggests that self-managed abortions – often with unsafe and ineffective methods – have increased in the wake of those restrictions.
The share of women who say they have self-managed an abortion has jumped about 40% since the Dobbs decision, according to a study published Tuesday in the medical journal JAMA Network Open – up from 2.4% at the end of 2021, a few months before court decision, to 3.4% in the summer of 2023, about year after the decision.
The findings are based on surveys of more than 14,000 women under the age of 50 who reported on their own experiences, including hundreds of teenagers.
Survey data likely underestimates how common self-managed abortion is; the study authors say underreporting is expected when asking about “sensitive, stigmatized, and now, in some settings, criminalized behavior.” It’s unclear, however, whether women may have become less likely to disclose their experiences due to the increased criminalization of pregnancy and abortion or more emboldened to share due to increased public attention on the subject, they wrote.
Overall, when accounting for underreporting, the researchers estimate that more than 1 in 10 women will attempt to self-manage an abortion at some point in their life.
Self-managed abortions happen outside of the formal health-care system and without the formal supervision of a doctor or nurse. For this research, women were asked whether they had “ever taken or done something on their own, without medical assistance, to try to end a pregnancy.”
Earlier research has found that requests for abortion pills through sources outside of the formal health-care system surged after the Dobbs decision. Many of the sources that provide pills for self-managed medication abortion also provide information and support through online help desks or peer-to-peer networks. The safety and effectiveness of medication abortion is well-established, and recent research has shown it’s just as safe through telehealth as through in-person clinics and similarly so when self-managed.
The new study suggests that self-managing an abortion with abortion pills has become more common, rising from about 18% of attempts pre-Dobbs to 24% post-Dobbs.
However, many other ineffective, and sometimes unsafe, methods were also common. More than a quarter of women who attempted to self-manage an abortion said they took herbs, more than 1 in 5 said that they hit themselves in the stomach and nearly 1 in 5 said they used alcohol or other substances.
Other research has found that abortions within the formal health care system have increased in the US post-Dobbs, driven by a spike in medication abortions, especially those provided through telehealth.
But privacy is one of the most common reasons for women to self-manage their abortions, according to the new survey data. Nearly a third of women cited this as a reason in 2023, a small tick up from the share in 2021. About 1 in 5 women reported that the clinic would be too expensive, and about 13% said they were concerned about encountering protestors at a clinic.
Despite these concerns, about 15% of women who self-managed an abortion said they had complications such as bleeding or pain that required them to seek medical care. About 5% went to a hospital, emergency room or urgent care.
Black women and those who grew up poor were more likely than others to say that they had self-managed an abortion.
“As barriers to facility-based abortion grow, (self-managed abortion) may increasingly become an individual’s only or preferred option to end a pregnancy,” the researchers wrote. “These findings suggest the need to expand access to alternative models of safe and effective abortion care and ensure those seeking health care post-(self-managed abortion) do not face legal risks.”