Factors influencing self-managed abortion

Factors influencing self-managed abortion | Image Credit: © Talia Dinwiddie - © Talia Dinwiddie - stock.adobe.com.

This is part 1 of our 3 part series on abortion. Click here for part 2. Click here for part 3.

Patients commonly consider self-managed abortion before seeking in-clinic care, according to a recent study published in JAMA Network Open.

The right to choose abortion was overturned by the Supreme Court in Dobbs v. Jackson Women’s Health Organization. Since this decision, total or near-total bans have been implemented in some states, making access to an abortion clinic unavailable in many areas.

Self-managed abortions take place outside of formal health care environments, and can be accomplished through abortion medications, herbs and botanicals, or self-harm. While it is commonly considered exclusive to in-clinic care, it could be considered or attempted by individuals with access to a clinic.

A need for understanding self-managed abortion factors has arisen as states implement abortion bans. However, there is little data on differences in considering or attempting self-managed abortion by state, local, or individual factors.

To understand the consideration of self-managed abortion based on environmental and individual factors, investigators conducted a survey of abortion patients from January 2019 to May 2020. Patients were gathered from 46 independent clinics associated with Planned Parenthood across 28 states. An additional 3 clinics from a Texas pilot study were also included.

Sample diversity was achieved through 4 clinic-level variables: geographic region, state abortion policy context, distance from an international border, and racial and ethnic diversity. Of the clinics, 12% were in the Northeast, 22% in the Midwest, 29% in the West, and 37% in the South.

A hostile or extremely hostile state abortion policy was seen for 55% of clinics, and a neutral or supportive state policy for 45%. Sixty-one percent predominantly served racial and ethnic minority groups, and 43% were within 200 miles of the Canadian or Mexican border.

Participants included patients presenting for abortion care at one of the participating clinics. In states with parental consent laws for minors, patients were aged 18 years and older. Participants were informed of the survey and received an iPad with further study information. Survey completion was accomplished through REDCap software.

Questions in the survey were about patients’ knowledge of self-managed abortion, if they had considered self-managed abortion prior to visiting the clinic, and if they had attempted self-managed abortion.

Questions about attempted self-managed abortion included abortion pills and nonmedication methods, with knowledgeable participants providing pill names and sources for self-managed abortion. Patients who considered self-managed abortion were asked to provide their reasons.

All patients were asked about their preferred abortion care method, in-clinic abortion care experience, prior abortion experiences, and if they knew anyone who completed a self-managed abortion. Demographic questions were also provided.

There were 19,830 participants in the survey, 99.6% of which were female, 60.9% aged 20 to 29 years, 43.6% with prior college attendance, and 27.6% with only high school graduation. Of patients, 29.6% were Black, 19.3% Hispanic, 36% non-Hispanic White, and 15.2% other.

Barriers to clinic access were reported by 32.3% of patients, with finding money to pay for care being the most common barrier, followed by taking time off work or school.A previous abortion experience was reported by 40.1% of patients, and 7.7% reported knowing someone who had self-managed using pills.

A preference for abortion care without in-person clinic attendance was seen in 18.4% of patients. About 1 in 3 patients knew about pills for self-sourcing and self-managing abortion, of which misoprostol was the more commonly known. When including all names for the pill, misoprostol was known by 59.3% of patients aware of pills for self-managed abortion, compared to 23.9% knowing about mifepristone. 

Of patients who knew about pills for self-managed abortion, 16.1% considered using one of these pills before their in-clinic visit. The cost of in-clinic care was the most common reason for considering self-managed abortion, reported by 48% of patients, while a preference for the privacy of taking pills at home was reported by 37.2% of patients.

Self-managed abortion was considered by 11.7% of the full study population, 46.3% of which considered abortion pills, 34.7% vitamin C, and 30.7% herbs or botanicals. Nearly one-third of patients considering self-managed abortion attempted to do so.

Knowledge of self-managed abortion methods were more commonly seen in Black patients, while attempts were more common in Hispanic patients. Knowledge and consideration were more common in patients who received any form of social services, while parents were less likely to consider or attempt self-managed abortion.

A slight positive association for knowledge of self-managed abortion and attending a clinic close to the Mexican or Canadian border was also found. However, this factor was also associated with decreased chances of having attempted self-managed abortion.

Overall, knowledge of self-managed abortion was commonly seen in patients, with consideration common prior to accessing in-clinic abortion care. Investigators concluded these results show a need for expanded access to telemedicine and other models of decentralized abortion care.

Reference

Aiken ARA, Tello-Pérez LA, Madera M, et al. Factors associated with knowledge and experience of self-managed abortion among patients seeking care at 49 US abortion clinics. JAMA Netw Open. 2023;6(4):e238701. doi:10.1001/jamanetworkopen.2023.8701