With the changing legal landscape around abortion access, you may be hearing more in the news and from those you work with about “self-managed” abortion (SMA). For context, SMA broadly refers to non-clinical abortion, or abortion that happens outside of the formal healthcare system and without the involvement of a medical professional. SMA is not a back-alley abortion or a DIY abortion. It is an abortion that happens most commonly in someone’s home, done in privacy and safety, often with the help of a friend, family member or caregiver.
The Guttmacher Institute estimates that medication abortion accounts for more than half of abortions in the U.S. Misoprostol (alone or in combination with mifepristone) is a safe and effective way to end a pregnancy in the first 10 weeks and has been used successfully by people all over the world without a clinician. SMA using abortion pills outside of a clinical setting is an option that enhances reproductive autonomy, while also potentially serving as a workaround to restrictive policies and gaps in access. While there is limited data on how common self-managed abortions are that don’t involve a medical provider at all in the U.S., there are reports that it does happen and abortion providers say that SMA may rise as access to care decreases.
If/When/How recently published findings from a multiyear study around the criminalization of people ending their own pregnancy. One thing they found was that the primary privacy risk for people seeking abortion is other people. 45% of people were reported to police by health care providers or social workers. This is worth reading again—almost half of the reporting is being done by people who work in healthcare or social services, people who in many instances are guided by ethical and professional codes to do no harm and honor people’s autonomy. We don’t believe that most providers making these reports are doing so out of a desire to harm clients, but rather a lack of information about what, if any, mandatory reporting requirement exists.
To address this disturbing problem, Provide and If/When/How teamed up this year to offer training and technical assistance to domestic violence and sexual assault coalitions on how to navigate mandatory reporting requirements to best support survivors who may consider self-managed abortion. We chose to focus our efforts on these organizations first because of the connections between partner violence, reproductive coercion, and the need for safe accessible abortion care—particularly for those most vulnerable to marginalization and oppression, like Black, Indigenous and other People of Color, LGBTQIA people, and low-income communities.
In these trainings, we do some values clarification work, we cover what self-managed abortion is and isn’t, the impact of criminalization of pregnant people and their families, the difference between giving legal advice and information, and most importantly, that there is no requirement presently in any state to report someone who is self-managing their abortion.
“Prior to this training, I thought that facility managed abortion was the best option if available. Now I realize even if it is available, self-managed abortion may be the best option for many clients.”
“The resources that were provided were extremely helpful. I might not have the answers to questions about SMA, but I now know where to refer people or to seek information myself.”
With the ever-changing legal landscape around abortion, and diminishing access to in-clinic abortion services, knowing how to support people who are considering self-managed abortion will become increasingly important. Provide intends to continue bringing this critical information to healthcare and social service providers across the country, particularly those who work in communities most impacted by legal barriers to care.
The following organizations can provide support to people currently facing legal trouble surrounding a pregnancy or information for those who want to know how to protect themselves from being penalized by the government in pregnancy-related situations.
- If/When/How: Lawyering for Reproductive Justice: If/When/How’s mission is to transform the law and policy landscape through advocacy, support, and organizing so all people have the power to determine if, when, and how to define, create, and sustain families with dignity and to actualize sexual and reproductive wellbeing on their own terms.
- Repro Legal Helpline: A free, confidential source that has information about the law and self-managed abortion, and also connects pregnant people to lawyers if they have been investigated or arrested for having an abortion, or think they may be. Visit org or call (844) 868-2812.
- FAQs on Self-Managed Abortion
- Patient Confidentiality and Self-Managed Abortion: A Guide to Protecting Your Patients and Yourself
- Real People Have Real Reasons
- National Advocates for Pregnant Women (NAPW): A nonprofit organization that works to secure the human and civil rights, health, and welfare of all people, focusing particularly on pregnant and parenting women, and those who are most likely to be targeted for state control and punishment—people of color, those with low-income, and those who use drugs.
The following resources provide information to people to help them safeguard their health and understand legal risks; the following organizations are well-vetted sources of information for those seeking to end an early pregnancy outside of a clinic setting, either because they lack access to legal abortion or simply want to manage their own abortions independently.
- M+A Hotline: This free, confidential, and secure phone and text hotline staffed by doctors with years of experience caring for miscarriage and abortion. For expert advice on self-managing a miscarriage or abortion, call or text 1-833-246-2632 from 10 a.m. to 10 p.m. in all U.S. continental time zones and they will respond within an hour.
- Self-Managed Abortion; Safe and Supported (SASS): The U.S. project of Women Help Women that provides health information about self-managed abortion with pills. This support service provides information and one-on-one support for those in the U.S. looking to end their own pregnancies. SASS can connect pregnant people with experienced counselors—who are directly advised by OB-GYNs and experts on medication abortion—and can help them decide whether they’re a good candidate for self-managed abortion and other medical referrals. Email [email protected].
- Plan C Pills: In 2017, Plan C ordered abortion pills from 14 websites without a prescription and tested the pills they received. Plan C’s website lists these results in a “report card,” which rates the reliability of the medication purchased on various websites, including information about pricing, shipping times, and amounts of active ingredients in the drugs received.
- Aid Access: Information and consultation for receiving medication abortion by mail.
- Women on Web: Founded in 2005, Women on Web is a team of medical doctors, researchers, activists, and help desk members working to provide safe, accessible, and affordable abortion care to people around the world. Consultations can be made on their website to receive pills through the mail. Email [email protected].
- Reprocare Healthline: Provides emotional support and information for people planning or having an abortion at home. Calling is anonymous, secure, and private. Call 1-833-226-7821 from 12 p.m. to 12 a.m. PST, 7 days a week.