Study of Online Searches for Abortion Revealed High Rate of Self-Managed Abortion
People who face barriers to abortion care are more likely to attempt self-managed abortion, including taking actions that may be harmful physically, according to the results of a recent study.1
The findings are particularly relevant as an increasing number of American women have little or no access to safe and legal abortions in their communities or states.
“It seems very clear that more states will ban abortion at earlier gestations, and I have no doubt that many more people will try to end their pregnancies on their own,” says Ushma D. Upadhyay, PhD, MPH, lead study author and associate professor in Advancing New Standards in Reproductive Health at the University of California, San Francisco. “They’ll be left with limited clinical support when doing this, and it will have dire complications. It won’t be the like the pre-Roe time because we have mifepristone. But if we have these safe methods, we know people will resort to ending their pregnancy on their own.”
Investigators recruited people who were searching online for abortion care between August 2017 and April 2018. Everyone who searched using the words “an abortion near me” received a study recruitment Google ad next to their search results.
In a follow-up survey, participants were asked if they were pregnant right now. If they answered “No,” they were asked what happened with their most recent pregnancy. The survey gave them these five options for answering the question:
- “I had an abortion procedure done by a clinician in a clinic or doctor’s office”;
- “I took abortion pills that I got from a clinic, doctor, or nurse”;
- “I took abortion pills that I got from the internet or another source”;
- Other (please explain).
Participants also reported barriers they experienced while seeking abortion care. Among these were fear of violence or threats; keeping the abortion a secret; protestors at the clinic; arranging for transportation or child care; distance of travel to a clinic; getting time off from work; and financial barriers.
“We know that when abortion is limited, and there are barriers to care, people with means will have an easier time traveling and getting to states where it is legal,” Upadhyay says.
Twenty-eight percent of respondents attempted self-managed abortions. Among the people who attempted a self-managed abortion, a little more than half used herbs, vitamins, or supplements. These included vitamin C, vitamin D, niacin, turmeric, celery seed, vinegar, olive oil and honey, and others.
Seven percent reported attempting an abortion by taking prescription or over-the-counter medications, such as Lexapro, Celexa, Xanax, steroids, codeine, muscle relaxers, aspirin, laxatives, and painkillers. Also, nearly one in five people said they took many oral contraceptive pills or emergency contraception to try to end their pregnancy. One in four people had attempted more than one method.
About 10% said they tried to end the pregnancy through use of alcohol, cigarettes, marijuana, or street drugs. Nearly 18% reported trying to hurt themselves in the abdomen, trying to starve themselves, or letting a kidney infection go untreated. A few even tried to penetrate or dilate their cervix.
“There were some people who had ordered pills online, and 18% of those who attempted a self-managed abortion used mifepristone on their own — they didn’t go into a clinic,” Upadhyay says. “This was at a time when it wasn’t as easily available to order pills from overseas.”
The findings suggest that women will attempt a self-managed abortion when there are too many barriers to obtaining a safe and legal abortion through a clinician. The high rates of people attempting a self-managed abortion show that more education and information are needed to prevent people from trying to end their pregnancies through dangerous and/or useless methods.
“People can be very desperate and resort to desperate means,” Upadhyay says. “Many people live in areas where they cannot easily access abortion care right now, but that number will grow exponentially once the Supreme Court allows states to ban abortion.”
There is no doubt that people will attempt self-managed abortion in much greater numbers when that happens, Upadhyay adds.
- Upadhyay UD, Cartwright AF, Grossman D. Barriers to abortion care and incidence of attempted self-managed abortion among individuals searching Google for abortion care: A national prospective study. Contraception 2022;106:49-56.
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