Overview:

Self-managed abortion (SMA) in the United States refers to the practice of ending one’s own pregnancy outside of a medical setting. When someone decides to end a pregnancy, whether they go to a health care provider or manage their own abortion, it is important that they are able to do so safely and with dignity.

We don’t always know a person’s circumstances or why they may seek to end their own pregnancy. For some people, ending their own pregnancy in the privacy of their homes fits with the reality of their lives. There are many reasons why a person might prefer to end a pregnancy at home. It may feel more natural to them, like having a miscarriage. It allows the individual to choose who they want to have with them for support and lets them control the location and timing. Some people want to maintain privacy because of cultural or religious stigma in their community around abortion. Others avoid clinics because of previous negative experiences, mistrust of the medical system or fear of being deported, outed, or shamed. Additionally, those experiencing intimate partner violence may find SMA to be a safer option because it can be more discreet.

Incidence of Self-Managed Abortion:

Very limited data exist about how many people have tried or considered self-managed abortion in the U.S. What we do know suggests that self-managed abortion does occur. For example, a 2008 nationally representative survey by the Guttmacher Institute estimated that about 2.6% of abortion patients seeking clinical abortion care had reported “ever taking something to self-induce abortion.”(i) A 2015 study by the Texas Policy Evaluation Project estimated that 1.7% of Texas women of reproductive age had ever attempted to end a pregnancy on their own without medical assistance.(ii) A recent study showed hundreds of thousands of internet searches per year in recent years for phrases related to self-managed abortions.(ii)

Restrictions on Abortion Care:

Although abortion is legal, it has been over-regulated, made unaffordable, and pushed out of reach for many people. Restrictions on abortion affect people of all backgrounds yet fall hardest on those who are most marginalized and likely to face financial and logistical barriers to care, particularly communities of color, queer and transgender people, immigrant communities and people in rural areas. Some people must drive hundreds of miles or even out of state to get the care they need. Others can’t afford the cost of an unexpected medical procedure that many insurance policies don’t cover. People are looking for options to end a pregnancy that are safe and fit their circumstances.

Safety & Effectiveness:

Medication abortion is an FDA-approved method to end a pregnancy. After more than 15 years of use in the U.S., it is known to be extremely safe and effective, as documented in the 2018 NASEM report “The Safety and Quality of Abortion Care in the United States.”

Research shows that when people have accurate information about what to expect and a way to get their questions answered, they can use medication abortion safely and effectively on their own. Health care providers are essential resources to ensure that their patients feel comfortable seeking follow-up care if they need it, whatever their individual circumstances. The World Health Organization (WHO) recommends that women can manage use of the mifepristone and misoprostol combination without direct supervision of a health care provider when they have accurate information and access to a health care provider should they need or want it at any stage of the process. WHO also recommends that where mifepristone is not available, misoprostol used alone is a safe and effective method to end a pregnancy.

Criminalization of SMA:

People who end their own pregnancies and those who assist them risk arrest, jail time or investigation. In the past few years, several women in the U.S. have been charged with crimes and sent to prison after trying to end their own pregnancies, or for seeking medical help after miscarriage or stillbirth. Instead of sending a person to jail for ending their own pregnancy or for seeking medical care afterwards, it is important to ensure that however a person decides to end a pregnancy, they can do so safely, effectively, and with dignity and respect.

Health care provider associations have taken strong positions against criminalizing self- managed abortion, noting health risks by deterring women from seeking needed care. The American Medical Association (AMA) passed a resolution in 2018 opposing the criminalization of self-induced abortion and the American College of Obstetricians and Gynecologists (ACOG) issued a Position Statement on the Decriminalization of Self- Induced Abortion.

Health care providers have taken strong positions against criminalization of pregnancy outcomes, including self- managed abortion, noting health risks by deterring patients from seeking needed medical care. The American Medical Association (AMA) passed a resolution in 2018 opposing the criminalization of self-induced abortion(iv) and the American College of Obstetricians and Gynecologists (ACOG) issued a Position Statement on the Decriminalization of Self-Induced Abortion.(v)

The laws that can be used to charge people with a crime for self-managed abortion are complex and vary from state to state. These include laws directly criminalizing self-managed abortion (7 states); fetal harm laws that don’t exempt people who self-manage (11); and criminal abortion laws misapplied to people who end their own pregnancies (15 states). In several of the known cases, these and other laws were misused by prosecutors in ways far beyond the intention of lawmakers. There have been at least 21 arrests and even more criminal investigations in 20 states related to allegations of self-managed abortions since 1973. These include the following cases in recent years:

Case Outcome
In 2011, a New York woman was charged with self-abortion. She was interrogated by police and reported having drunk an herbal tea to induce an abortion. The charge was dropped when the District Attorney acknowledged the difficulty of proving the source of a miscarriage.
In 2011, an Idaho woman was charged under Idaho’s law criminalizing self-induced abortions when she safely ended a pregnancy with pills she obtained online. The charges were dropped due to insufficient evidence. Later, in a civil suit brought by the woman against the state of Idaho, the Ninth Circuit affirmed that the use of the state’s criminal abortion law against a person who takes medication ordered online is unconstitutional.
In 2013, an Indiana woman was convicted and sentenced to more than a decade in prison for allegedly ending a pregnancy with abortion pills obtained from the internet. The Court of Appeals of Indiana ruled that neither Indiana’s feticide law nor its criminal abortion laws were intended to punish people for self-inducing abortions. She was released after three years of incarceration.
In 2015, a Tennessee woman was arrested for trying to end her pregnancy using a coat hanger. When she sought emergency medical care, she was turned over to law enforcement and was arrested for attempted homicide. She pleaded guilty to procurement of a miscarriage and was released after more than a year of incarceration.
In 2015, a Georgia woman was jailed and charged with murder after she took an abortion-inducing pill. The murder charge against her was later dropped because the law was not permitted to be used against a woman for the termination of her own pregnancy.
In 2016, an Arkansas woman was accused by a prosecutor of trying to prompt an abortion after she took misoprostol to induce labor. She was found guilty and sentenced to six years in prison for “concealing a birth.”
In 2016, a Virginia woman sought emergency medical care following her stillbirth. The treating physician called the police, triggering a criminal investigation, prosecution and jail time. She was charged with concealing a dead body, a felony carrying a five-year sentence. She was later pardoned by Virginia Governor Ralph Northam.
In 2017, a Virginia woman was accused of self- aborting her pregnancy. She was arrested on felony charges of "producing abortion or miscarriage." In 2018, the prosecution voluntarily dismissed the case.