What is Self-Managed Abortion?
Any conversation we have about reproductive health, reproductive freedom, bodily autonomy, or abortion should include detailed discussions of all of the available options on how abortion care can be accessed-- and that includes self-managed abortion. Self-managed abortion is not a new concept, but it has been historically accessed in unsafe and secretive ways. With the current administration’s constant attacks on reproductive health and rights, as well as the shifting of the Supreme Court with the confirmation of Brett Kavanaugh, abortion rights are being undermined and many fear the return of unsafe, self-managed abortion methods. Megan Donovan with the Guttmacher Institute talks to us about the evolving ways in which self-managed abortion is becoming a more easily accessible, safe, and effective option.
Safe and legal abortion in the United States doesn’t solely take place under the ceilings of medical centers and reproductive health clinics. In fact, there are a variety of ways in which people may self-manage their own abortion. Medication abortion, first approved by the FDA in 2000, consists of the medications mifepristone and misoprostol. Taking these medications while not under the direct supervision of a medical provider is considered self-managed abortion.
There are many, currently-existing barriers to a fully supported, self-managed model of care. Barriers to medication abortion generally include risk evaluation and mitigation strategies, (REMS) which are a set of restrictions imposed on mifepristone by the FDA. REMS are a tool used by the FDA to ensure that the benefits of taking a drug outweigh the risks. Given its extensive safety profile, mifepristone don’t belong alongside drugs typically subject to REMS. There are also state-level restrictions on medication abortion, as well. 34 states limit the provision of medication abortion to physicians, despite recommendations from WHO and NAF that other practitioners can safely administer medication abortion. 19 states require those providing the medication abortion to be physically present.
There are also a number of barriers to achieving the environment in which self-managed abortion is fully supported, accessible, and available to everyone. Stigma and fear often prevent people from accessing medication abortion. Providing education and information on medication abortion can de-mystify and create new options for those seeking care. Going one step farther and making medication abortion available over-the-counter would allow people to access the medication they need directly, rather than needing a provider to write a prescription. Over-the-counter status wouldn’t come without its own barriers, though, including affordability and the possibility of religious refusals.
No one should be punished for seeking to terminate a pregnancy, but there are a variety of state laws that have been used to punish people who have been suspected of seeking to self-manage their own abortion. Seeking to education legislators and defy harmful state laws could help lower trends of criminalization.
Facilitating access to self-managed medication abortion is really about ensuring that people have access to a full range of safe and effective methods of abortion care. Self-managed abortion provides another option for people as we increasingly face restrictions against abortion care.
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