More US women have tried to induce their own abortion since fall of Roe – report

Roughly 7% of w​​omen of reproductive age in the US have attempted to induce their own abortions outside the formal healthcare system, a new study has found, up from 5% before Roe v Wade fell in 2022.

The study, published on Tuesday in the Jama medical journal, determined how many people reported ever “self-managing” their own abortion in 2021 and again in 2023 – a timeline that allowed researchers to examine how Dobbs v Jackson Women’s Health Organization, the supreme court case that overturned Roe, has affected self-managed abortions. People of color and LGBTQ+ people were more likely to report having ever attempted to end their own pregnancies.

“We think because it’s getting more difficult to access facility-based abortion, that self-managed abortion will increase,” said Lauren Ralph, the study’s lead author and an epidemiologist at Advancing New Standards in Reproductive Health, a research group at the University of California, San Francisco. “It’s a really important piece of the puzzle, as we try to understand the full impact of the Dobbs decision on people’s reproductive lives.”

Since Dobbs, 14 states have enacted near-total abortion bans. On Monday, Iowa became the fourth state to ban the procedure past about six weeks of pregnancy, before many women even know they are pregnant.

Of the women who reported in 2023 attempting to induce their own abortion, 11% said in 2023 they had used mifepristone, one of the abortion pills typically used in a two-pill protocol, and 13.7% said they used misoprostol, the other pill, on its own. Another study, published in March, estimated roughly 26,000 more people in the US used pills to induce their own at-home abortions than would have done so if Roe had not fallen.

Medical experts widely agree that these pills can be used to safely self-manage an abortion during the first trimester of pregnancy, and the World Health Organization even offers a protocol on how to do it. Misoprostol can safely be used on its own – but often comes with more side-effects than the two-pill regimen – while using mifepristone alone can result in more complications and is not typically recommended when ending a pregnancy .

Far more people tried to end their pregnancies in potentially unsafe ways. In 2023, about 25% of those who attempted to self-manage their abortions used herbs, 22% hit themselves in the stomach and 19% used alcohol or other drugs. Another 15% said that, after their attempted self-managed abortion, they experienced a complication – such as bleeding or pain – that led them to see a doctor or nurse.

Asked why they tried to self-manage an abortion, people said they wanted privacy, that going to an abortion clinic was too expensive or they preferred trying on their own first. Nearly 13% said they were concerned about clinic protesters.

Four in 10 people who have ever self-managed an abortion were younger than 20 when they did it, and 9% of people who had tried to self-manage an abortion were concerned about needing parental consent. Many abortion-tolerant states still have parental involvement laws on the books, which require minors to tell their parents about their plans to get an abortion or to get their consent for the procedure. If a minor cannot or will not do so, they have to go to court and convince a judge to let them get an abortion without parental knowledge or consent – which can be a tall ask.

Ralph was not surprised to find that so many people who try to end their own pregnancies are so young.

“Given things like parental-involvement requirements, given things like difficulty accessing transportation, given things like not having your own bank accounts or having a consistent source of income in the same way that a young adult might, I do think that young people might be more likely to turn to self-managed abortion than their older counterparts,” Ralph said. Young people’s experiences of abortion, she added, had long been understudied.

Because people who self-manage abortions can face criminal consequences, Ralph and her fellow researchers used statistical analyses to account for people who may not be accurately reporting their experiences with the phenomenon. Just one state – Nevada – bans self-managed abortion, but legal experts have long warned that if a prosecutor wants to punish someone for attempting one, they will find a statute pliable enough to do it. Earlier this year, an Ohio grand jury considered whether to indict a woman accused of abusing a corpse after she miscarried into a toilet. (It ultimately declined to charge her.)

Ralph found that about a third of people in both 2021 and 2023 said that their self-managed abortion succeeded, while a fifth said that they later underwent an abortion at a clinic. Another quarter of people said that nothing happened and that they may never have been pregnant in the first place. Fourteen per cent continued their pregnancies.