A roadmap for research on self-managed abortion in the United States

Media coverage and research data show a growing awareness of the option to self-manage (or self-induce or self-source) abortion outside of the formal health care system; we are learning more about people’s experiences with self-managed abortion, and how often people choose this option in the United States. Recent evidence indicates between one and seven percent of abortion patients (see below) have taken or done something to try to end their current pregnancy. In addition, in 2015, there were more than 700,000 Google searches using terms related to self-induced abortion in the United States. The reasons women attempt to self-manage an abortion are varied, but they are often related to barriers accessing clinic-based care, as well as a preference for self-care.

At the same time, many in our field recognize that facility-based provision of medication abortion in the United States is overly medicalized, although it has certainly become less medicalized over the 17 years since mifepristone was approved by the US Food and Drug Administration (FDA). For example, protocols now allow for women to take both mifepristone and misoprostol at home. But medication abortion could be even further demedicalized through pharmacy dispensing and expansion of telemedicine models—or even making it available over the counter (OTC)—which have the potential to expand access greatly.

We are now seeing a groundswell of interest among advocates and clinicians in efforts to make progress on two different but complementary goals. The first is to understand better what women and all people who need access to abortion care in the United States are actually doing as they access medication abortion on their own, ensure that they are doing so safely, and explore ways to support people who self-manage their abortions. Evidence is needed to understand how best to get people the information and resources they need, as well as to help clinics adapt to this changing landscape. The second goal is to work toward demedicalizing care and expanding access to medication abortion within facility-based, legal medical services. Research is necessary to understand and document alternative models of medication abortion provision, as well as to develop and test technologies that support demedicalized care models. Progress on these two goals would significantly improve the quality of abortion care in the United States.

Clearly many similarities exist between self-managed abortion and formal demedicalized care. Critics often have the same concerns about both—especially fears about the safety of abortion with less clinical supervision. Evidence that helps to allay those fears, including research to document experiences with self-managed abortion from a range of contexts in the United States and in other countries, will serve both to improve quality of care for people who choose to self-manage abortion now and to lay the foundation for future simplified medication abortion service delivery models.

Together, Advancing New Standards in Reproductive Health (ANSIRH), Gynuity Health Projects, and Ibis Reproductive Health have collaborated to develop this forward-looking research agenda around self-managed and demedicalized abortion in the United States. Below we describe four research priorities that we believe will significantly advance our goals to support people who self-manage abortion to do so safely and to generate critical evidence to remove unnecessary restrictions and provide medication abortion in user-friendly and accessible ways across the United States.