Exploring self-managed medication abortion post-Dobbs: A qualitative study on experiences in the United States with Mexico-based accompaniment

Abstract

In response to mounting abortion restrictions and criminalization in the United States, more people are having medication abortions outside of clinical settings. Since 2021, Mexico-based accompaniment collectives have provided support for self-managed abortion in the U.S. Through a collaborative research-activist partnership with three accompaniment collectives, we conducted a qualitative study to understand the care-seeking journeys and abortion experiences of people who contacted Mexico-based accompaniment collectives. We completed 21 interviews including six in-depth interviews via Zoom and 15 asynchronous text interviews through secure phone messaging. Our thematic coding and analysis elucidated factors that contributed to seeking accompaniment support including restrictive laws, preference to avoid clinical care, and financial considerations. Participants described concerns about legal risks such as criminalization and surveillance, and fears around the abortion process. They often felt initial skepticism toward the accompaniment model of care, and many explained how they developed trust through referrals from trusted sources, successful receipt of the pills, and timely, person-centered communication with the accompaniment collective. Participants identified ways they felt prepared for the abortion process through information provision and emotional support, from both the accompaniment collectives and other sources. The Mexico-based accompaniment collectives offered acceptable, person-centered care especially when other options were financially or geographically inaccessible. Evidence-based information and support from these and other allied groups can increase safe, effective abortion care and contribute to reducing the risk of criminalization.