A recent study revealed that nearly 7% of women seeking abortion services at Texas facilities in 2012 and 2014 reported they had attempted to self-manage their abortion before visiting the clinic.1

“The study is part of a program run by the Texas Policy Evaluation Project, looking at the impact of a variety of laws and policies in Texas, including the restrictive abortion law that went into effect in 2013,” says Daniel Grossman, MD, FACOG, professor, department of obstetrics, gynecology, and reproductive sciences, and director, Advancing New Standards in Reproductive Health, at the University of California, San Francisco. “As part of that work, we were surveying patients who were seeking abortion care in clinics in Texas. We heard reports about patients who were trying to self-manage their abortions. We wanted to see just how common this was.”

Nationally, the overall prevalence of self-managed abortion among patients seeking abortion services at a clinic is about 2%. The study revealed that the Texas rate is 6.9%.1

“These are abortion patients in Texas who had tried to end their current pregnancy by taking something on their own, so it does appear it’s more common in Texas,” Grossman says.

Seven percent could be the tip of the iceberg, he notes. “These are only the women who failed at an abortion and then went to an abortion clinic,” he explains. “It’s possible there are other people who did something on their own and had a successful abortion, or they did something that didn’t work, and they had a baby.”

The women who attempted a self-managed abortion were between the ages of 20 and 42 years. They reported being between four and seven weeks pregnant when they attempted the abortion. Twenty percent of the women were African American, 28% were white, 42% Latina, and 10% other. More than 40% reported they had previously undergone an abortion.

The women reported these reasons for attempting a self-managed abortion:

  • They could not afford to get to a clinic or pay for the abortion procedure;
  • Their local clinic had closed;
  • A close friend or family member recommended self-induction;
  • They wanted to avoid the stigma or shame of abortion.

The most common self-managed abortion method was herbs, which 43% of women attempted. Another 12% tried using a drug or medication. Nearly 8% used misoprostol, and an identical percentage of women had hit themselves in the stomach. The remainder said they had attempted an abortion induction through the use of acupressure, heating pads, and papaya preparation, as well as other methods.1

“There are not great data about the efficacy of herbs to end a pregnancy, but some traditions have a long history of using herbs to produce abortion,” Grossman says. “Some people said they used herbs, but it didn’t work, which is why they came to the clinic. A few people reported doing things that are more dangerous, like hitting themselves in the abdomen, but no one reported inserting something in the uterus.”

A number of women reported going to Mexico to buy drugs, like misoprostol, or herbs to end their pregnancies. Obtaining misoprostol in the United States requires a prescription, and women must visit an abortion clinic to receive it. In states like Texas, where most abortion clinics closed because of restrictive state laws, accessing an abortion clinic is challenging, Grossman says.

“There is a clinic in New Mexico, across the border from El Paso, where people can get a medication abortion, but that only helps people in that area,” Grossman says.

“There is so much stigma about abortion. Any provider who does 50 abortions has to be registered as an abortion provider in Texas, so it’s hard to get medication other than going to an abortion clinic,” he explains.

Although it is against the rules of the Food and Drug Administration (FDA), some people might order misoprostol through mail-order pharmacies. “The FDA says medications can’t be prescribed and dispensed by mail-order pharmacies,” Grossman says. “They view the sale of these medications online as illegal.”

Barriers to safe and legal abortions appeared to be associated with women attempting self-management of abortion. “We found from interviews that the reason people reported trying to do this was related to the access barriers they faced,” Grossman says. “Some people talked about how their local abortion clinic closed, and it was too hard to get to the next nearest clinic.”

Some people said they were trying to figure out how to obtain an abortion when a close friend told them to get it on their own, he adds. “Some women talked about the stigma and shame of going to an abortion clinic. They thought they could avoid that by doing it on their own,” he says.

“Maybe the reason why self-managed abortion is more common in Texas is related to the access barriers women face in the state, where half the abortion clinics closed after a 2013 state law,” Grossman continues. “As restrictions on abortion access increase, it is likely that self-managed abortion also will become more common.”

REFERENCE

  1. Fuentes L, Baum S, Keefe-Oates B, et al. Texas women’s decisions and experiences regarding self-managed abortion. BMC Women’s Health 2020;20:6.