In spite of abortion bans, self-managed abortions are safer than ever

As the U.S. Supreme Court overturned Roe v. Wade in the 2022 Dobbs decision, abortion rights protesters held signs adorned with wire coat hangers. The symbol evoked memories from a pre-Roe era, when the only option to terminate an unwanted pregnancy was unsafe and potentially deadly.

As detailed by one retired gynecologist in the New York Times in 2008, the symbol of a wire coat hanger was “in no way a myth.” He recalled a period between 1948 and 1953 when women would frequently arrive in his office with a coat hanger still trapped in the cervix — and it wasn’t just coat hangers. Crochet hooks, soda bottles, and darning needles were also used in attempts to end pregnancies. 

When Roe overturned in 2022, many thought the post-Roe world would look similar to those dark pre-Roe times. But as Dr. Carole Joffe, a professor in Advancing New Standards in Reproductive Health (ANSIRH) at the University of California–San Francisco, told Salon in 2022, a post-Roe landscape would likely have “less injuries” but "more surveillance" — in part because of medical advancements like the abortion pills.

“It is important to understand that self-managed abortion (SMA) looks very different now compared to the period before Roe v. Wade, largely due to the availability of medications, specifically misoprostol and mifepristone,” researchers confirmed in 2023. In an ever-shrinking landscape, experts want the public to know that medication is still an option. And that thanks to telehealth and medications like mifepristone and misoprostol, self-managed abortions, if done with medications, are safer than ever. 

“We have very safe and effective technologies in the form of abortion pills,” Elisa Wells, co-founder and co-director of Plan C, a non-profit abortion access group, told Salon in a phone interview. “We know that people are still using older methods of self-managing abortions, but by and large, it is much much safer now when people use abortion pills.”

Wells said the non-profit she co-founded, which provides educational resources and information to increase access to medication abortion in the United States, has seen a surge in interest in receiving abortion pills by mail. She cited the pandemic as a real turning point, when the the United States Food and Drug Administration (FDA) removed the in-person requirement to obtain abortion pills. 

“Then with the Dobbs decision overturning Roe v. Wade, we saw a huge surge in interest to our website — just an unbelievable spike in the days following people looking for information and specifically, information about how to get pills if they live in a state that unjustly restricts their access to abortion care,” she said. “And then, with each new egregious action of courts or legislators, we do see spikes in people coming to our website.” 

Medication abortions typically occur by taking the brand name drug Mifeprex, which contains mifepristone and misoprostol. In the two-step process, a pregnant person first takes a mifepristone pill, then 24 to 48 hours later, a second pill containing another drug known as misoprostol. The two-step process works up to 70 days after the first day of a person's last period. 

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By definition, a self-managed abortion “involves any action that is taken to end a pregnancy outside of the formal healthcare system.” It could include “self-sourcing” medications or using herbs, plants, vitamins or supplements — or using physical objects.

Lauren Ralph, an associate professor in the department of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco, told Salon that in her research a self-managed abortion is “anything that a person does on their own without the supervision of a clinician to try to end a pregnancy.” In 2017, Ralph co-led research that found that 7 percent of U.S. self-identified women said they had done something on their own to try to end the pregnancy. 

“We know that it's something that was happening before Dobbs, but what's different now is that there's really been the increased availability of medication abortion for self-managed abortion,” Ralph said. “And we have a good deal of evidence that shows us that self-managed abortion with medications, with mifepristone and misoprostol or misoprostol only, is quite safe and effective, and as effective as medication abortion provided through the formal healthcare system.”

Earlier this year, researchers analyzed data between April 2021 and January 2022 from 6,000 patients who obtained abortion pills from telehealth clinics. They found there were no serious adverse effects 99.8 percent of the time and that 98 percent of the time no follow-up care was required. The data was similar to those who received medication abortion at a doctor’s office or abortion clinic. 

Before the Supreme Court overturned Roe v. Wade, an estimated 4 percent of abortions were done via telehealth. In data from April 2022 to September 2023, 16 percent of abortions in the U.S. were done via telehealth, according to data by the Society of Family Planning With those who had a telehealth medication abortion, 43 percent said that telehealth made it possible for them to have a timely abortion.

“That increased availability and increased awareness is mitigating some of the loss of access to clinic-based abortion or facility-based abortion post-Dobbs,” Ralph said. 

As more states like Florida implement near-total abortions bans, self-managed abortions are an important piece of maintaining some sort of access and options, especially as abortion funds and clinics in surge states become overwhelmed by the influx in patients. Megan Jeyifo, executive director of Chicago Abortion Fund, said self-managed abortions are a “critical” piece in this landscape. 

“People have self-managed abortions since the beginning of time. People have always had abortions,” Jeyifo told Salon. “People need to understand these medications are extremely safe, and these are options that were not available 60 years ago when we were thinking about back-alley abortions, those experiences were terrible, but that's not what modern abortion looks like now.”

And yet, accessibility to mifepristone is on the line as the U.S. Supreme Court weighs restricting access or not — a decision that’s expected to be made by late June. Until a decision is made, Wells from Plan C said it’s critical for people to know that abortion pills are available by mail in all 50 states right now.

“Even states with bans. The pills are very safe and very effective for early self-managed abortion,” Wells said. “And that there are resources available to help people understand where to get the pills, how to use the pills, to answer medical questions and also to answer any legal questions that people might have about using them in a restrictive state.”