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Our study on the national prevalence of self-managed abortion (SMA) is in @JAMANetworkOpen. Congrats to Dr. Lauren Ralph, @Dianagfoster, @seraifman, @BiggsAntonia, @UshmaU, @GoleenSamari, and Dr. Caitlin Gerdts @IbisRH.
Let’s do a deep dive into SMA!
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774320
Let’s do a deep dive into SMA!
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774320
First: What is self-managed abortion?
Basically it’s anything a person does on their own (or with the help of a non-clinician) to end a pregnancy. It may involve taking safe & effective medications, or it may involve taking herbs, or doing something else. https://abortiononourownterms.org/
Basically it’s anything a person does on their own (or with the help of a non-clinician) to end a pregnancy. It may involve taking safe & effective medications, or it may involve taking herbs, or doing something else. https://abortiononourownterms.org/
When most people hear the phrase "self-managed abortion" they often think of the pre-Roe, unsafe abortions throughout history, but today with medication abortions and more skilled support systems, that's usually not the case. We explained on @ACCESSpod: https://www.apodcastaboutabortion.com/episodes/episode-3-what-is-self-managed-abortion
The abortion storytellers at @AbortionStories illustrated this beautifully in their self-managed abortion comics.
If you or someone you know needs legal support when self-managing an abortion, reach out to @ifwhenhow's Repro Legal Helpline at 844-868-2812
https://wetestify.org/sma-comics
If you or someone you know needs legal support when self-managing an abortion, reach out to @ifwhenhow's Repro Legal Helpline at 844-868-2812
https://wetestify.org/sma-comics
Most prior research on SMA came from studies of people seeking care at abortion clinics. While this research is helpful, it's limited because it doesn't capture those who didn't go to a clinic because their SMA was completed or didn't work and they continued their pregnancy.
. @Guttmacher's 2014 national survey of abortion patients by found 1.3% of patients had ever used misoprostol and 0.9% used something else to end a pregnancy or bring back their period. https://www.guttmacher.org/sites/default/files/report_pdf/characteristics-us-abortion-patients-2014.pdf
A @TxPEPresearch study led by @Fuentes_Liza found that SMA was more common in Texas compared to national data. We found that 7% of abortion patients in Texas tried to end their pregnancy on their own before coming into the clinic. https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-019-0877-0
Restrictions on access to clinic-based abortion, as well as proximity to Mexico, where SMA is common, may contribute to the higher rate in Texas. https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-019-0877-0
. @TxPEPresearch did the first study trying to estimate the proportion of people who'd ever tried to SMA via a representative sample of women from the general population in TX. We found at least 1.7% of TX women age 18-49 attempted SMA at some point. https://liberalarts.utexas.edu/txpep/_files/pdf/TxPEP-Research-Brief-KnowledgeOpinionExperience.pdf
Our new study builds on our research in Texas by using a large (over 7,000 survey participants), nationally representative sample of self-identified women age 18-49 to estimate how common SMA was in 2017. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774320
In our survey, 1.4% reported attempting self-managed abortion while in the US. When we correct for people underreporting abortion, which is common when people are asked about stigmatized behaviors in surveys, we estimate that 2% of women have attempted SMA.
Based on these data, we estimate that approximately 900,000 to 1.3 million US women age 18-49 have attempted to self-manage an abortion at some point in their lives. That’s a lot of people.
My brilliant colleagues (shout out to @GoleenSamari 
) used a technique called discrete-time event history models to estimate the lifetime prevalence of self-managed abortion based on our cross-sectional data.
(Nerdy, I know!
)
) used a technique called discrete-time event history models to estimate the lifetime prevalence of self-managed abortion based on our cross-sectional data.(Nerdy, I know!
)
Based on our data, we estimate that 7% of women will attempt to self-manage an abortion at some point in their lives. That’s about 1 in 14 women.
Of course, if the situation changes—for example, if abortion becomes harder to access at clinics—that number may change.
Of course, if the situation changes—for example, if abortion becomes harder to access at clinics—that number may change.
We wanted to understand who is more likely to attempt self-managed abortion. We found non-Hispanic Black women and Hispanic women who completed the survey in English (but not those who completed it in Spanish) were more likely than white women to have attempted SMA in the US.
More research is needed to understand the racial and ethnic differences in use of self-managed abortion. Racist policies and practices are likely at play, creating obstacles to clinic-based abortion care, as well as influencing some people’s preferences to avoid clinics.
Our guess is the same systems that prevent Black and Hispanic people from accessing health care and may contribute to disparities in unintended pregnancy rates (structural racism, discrimination, stigma, cost) might also foster a preference for SMA or prevent access to a clinic.
We also need more research to understand how commonly trans people self-manage their abortions. I imagine many do because because of the worries about being misgendered at a clinic in addition to the many barriers most abortion patients face. https://www.allure.com/story/abortion-trans-man-nonbinary-experience
We also found that people living below 100% of the federal poverty level and those experiencing more barriers accessing reproductive health services in the past 3 years were also more likely to have attempted self-managed abortion. Barriers to care push folks toward SMA.
In addition, we found that people living in the West South Central region (AR, LA, OK, TX) and Pacific region (AK, CA, HI, OR, WA) were more likely to report a history of attempting self-managed abortion. Those born outside the US were also more likely to have attempted SMA.
We also report on the details of the people who attempted SMA. The most commonly reported SMA method was herbs, followed by drugs/medications other than misoprostol, and misoprostol. About 20% reported using something physical, like getting hit in the abdomen.
28% of people reported having a complete abortion after their SMA attempt, while 34% said it was unsuccessful and they ended up going to a clinic or hospital to have an abortion. That means that SMA research on patients at abortion clinics may only capture 1/3 of cases.
13% said the SMA attempt was unsuccessful and they continued the pregnancy. 11% reported having a miscarriage and 13% were unsure. Patients seeking any care during pregnancy may have previously attempted to self-manage abortion as other research has shown. https://link.springer.com/article/10.1007/s13178-018-0359-4
11% of people who said they had attempted to self-manage their abortion said they had a complication that required them to seek care from a doctor or nurse. One participant said they went to a hospital, but most people did not give details of the complications they experienced.
Research from other countries suggests that complications after self-managed abortion with pills are rare. For example, a study from Peru of women using misoprostol from a pharmacy found that 8% had a complication, & most were minor. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0189195
All that to say, more data are needed about the safety of SMA in the US.
The most common reason people gave for attempting SMA was because it seemed easier or faster than going to a clinic. Other common reasons were:
— too expensive
— too far away
— required parental consent.
This suggests increasing abortion restrictions will lead to a SMA increase.
— too expensive
— too far away
— required parental consent.
This suggests increasing abortion restrictions will lead to a SMA increase.
Our findings are similar to a recent study based on interviews with 32 people seeking abortion meds online. SMA can be a response to clinic access barriers (in states with & without restrictive laws), or may reflect a preference over facility-based care. https://onlinelibrary.wiley.com/doi/full/10.1363/psrh.12073
Our study provides the most complete picture of self-managed abortion in the US. We estimate that as of 2017, about 1 in 14 women will attempt SMA in their lifetime. This serves as a useful baseline measure to track the phenomenon moving forward.
We’re planning to repeat the survey to look for changes over time. Stay tuned!
If you have questions about self-managed abortion, let me know, read the study at @JAMANetworkOpen or follow @ANSIRH for more! https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774320
If you have questions about self-managed abortion, let me know, read the study at @JAMANetworkOpen or follow @ANSIRH for more! https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774320
A few more thoughts on the limitations of our study:
Unfortunately the survey panel we worked with in 2017 did not include many transgender or gender non-conforming people, so we can’t say anything about their experiences with self-managed abortion.
Unfortunately the survey panel we worked with in 2017 did not include many transgender or gender non-conforming people, so we can’t say anything about their experiences with self-managed abortion.
People also underreport abortion. We tried to correct for that assuming that they underreport SMA at the same rate they underreport clinic-based abortions. As noted above there were so few trans & GNC folks in the sample that we could not draw conclusions about their experiences.
People living in poverty were underrepresented in our sample which may lead to an underestimation of SMA. We did not specifically ask about mifepristone use for SMA. We didn't ask how folks confirmed pregnancies which limits what we can say about the effectiveness of SMA methods.
