Self-managed abortions increase since Dobbs decision, study indicates

NEW YORK, July 30 (UPI) -- Ending a pregnancy without medical supervision is becoming a more common practice since the Supreme Court reversed federal protections on abortion two years ago, a new study suggests.

The study, conducted at the University of California-San Francisco, was published Tuesday in JAMA Network Open.

In light of the findings, researchers recommended that "self-managed abortion should continue to be monitored carefully as barriers to facility-based care broaden."

Self-managed abortion methods have entailed taking the oral medications mifepristone and misoprostol, as well as ingesting herbs, alcohol or other substances, or even "punching oneself in the stomach," the authors wrote.

They noted that "with the Supreme Court's decision in Dobbs vs. Jackson Women's Health Organization in June 2022 overturning federal protections on abortion, the landscape of abortion access in the [United States] has changed substantially."

Access to abortion is banned or severely restricted in 21 states. Meanwhile, there has been an uptick in travel for abortion to states in which legal protections still exist.

"Making abortion more difficult to access does not mean that people want or need an abortion less frequently," the study's lead author, Lauren Ralph, an associate professor of obstetrics, gynecology and reproductive sciences at the University of California-San Francisco, told UPI.

"In fact, in our study, we see that since the Dobbs decision, there has been an increase in attempts to self-manage abortion outside of the formal health care system."

Ralph, who holds a doctorate in epidemiology, added that other studies also have found increases in requests for abortion pills virtually or by mail over the same time period.

"The onus is on the health care system and policymakers to make sure that we can connect people with safe and effective abortion methods," she said.

So far, researchers noted, no other studies have looked at changes in the prevalence of self-managed abortion amid the evolving policy climate.

To examine changes in prevalence, they administered surveys throughout the country from December 10, 2021, to January 11, 2022, and June 14 to July 7, 2023.

Participants were female at birth and spoke English or Spanish. They were between 15 and 49 years old. Those between 15 and 17 years old were recruited through adult participants.

Researchers inquired if the participants had "ever taken or done something on their own, without medical assistance, to try to end a pregnancy." If they answered affirmatively, researchers requested details of their experiences.

The proportion of participants who ever attempted self-managed abortion was 2.4% in 2021 to 2022 and 3.4% in 2023.

Adjusting for under-reporting of abortion, the lifetime rate of self-managed abortion was 10.1%, the researchers said.

Self-managed abortions were higher among non-Hispanic Blacks than other racial and ethnic groups. And about 4 in 10 self-managed abortion attempts occurred before age 20.

"Our data reflect the experiences of nationally representative sample of U.S women of reproductive age. People of all ages, races and ethnicities, socioeconomic statuses, geographies, and sexual and gender identities report experience with self-managed abortion," Ralph said.

"However, we observe increased prevalence of self-managed abortion attempts among people of color, LGBTQ and gender non-conforming people, and those born outside the U.S."

In the study, few participants sought emergency care for a complication. Yet, Ralph said, some methods of self-managed abortion may cause harm or be ineffective at ending a pregnancy.

"It is therefore 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," she said.

"It's also imperative that clinicians protect patients' privacy and ensure that they are not criminalized for their actions."

The study's findings indicate that more American women are attempting to end their pregnancies through self-managed abortion, said Patty Skuster, associate director in the master of public health program at the University of Pennsylvania Perelman School of Medicine in Philadelphia. She was not involved in the study.

"This is a groundbreaking and important study that helps us understand -- for the first time -- changes in self-managed abortion prevalence following the 2022 Supreme Court decision that eviscerated the right to abortion in the U.S."

Skuster, a lawyer who has researched legal issues surrounding self-managed abortion globally and in the United States, said "self-managed abortion can be a safe and effective option to end a pregnancy."

She added that "supportive clinicians will be key to helping people who need follow-up care without incurring risk of legal repercussions."

A profound stigma toward abortion compels some women to resort to unsafe practices, said Jenny Higgins, a professor of obstetrics and gynecology at the University of Wisconsin School of Medicine and Public Health in Madison.

"Someone may drink heavily, use illicit substances, or engage in certain physical activities such as over-exercising or lifting heavy boxes, hoping that will cause a miscarriage," Higgins said.

Confusion abounds about what is legally permissible in any particular state, said Dr. Jamila Perritt, president and chief executive officer of Physicians for Reproductive Health and an obstetrician-gynecologist in Washington, D.C.

"The best thing for folks to do is to educate themselves about what laws and policies are in place in their own communities that are putting their access to safe and essential care at risk," Perritt said, adding that the number of self-managed abortions "is likely grossly under-reported."

While people choose self-managed abortion for various reasons, Tara Shochet, director of programs and grants at the Family Planning Council of Iowa in West Des Moines, said "all individuals should have access to the full range of contraceptive methods, as well as to abortion methods that are safe and effective."