'Self-managed' abortions up 40 percent since Dobbs decision, study finds

Significantly more women chose to end pregnancies themselves — using unsupervised and potentially dangerous at-home methods — in the year following the Supreme Court’s abolition of federal protections for abortion, a new study has found.

An estimated 3.4 percent of all women of reproductive age reported having tried some form of at-home abortion in the year following the 2022 Dobbs v. Jackson Women’s Health Organization decision, according to findings published on Tuesday in the Journal of the American Medical Association (JAMA) Network Open.

That’s up from 2.4 percent of all women the year before — a trend that researchers projected would keep growing. 

“As barriers to facility-based abortion grow, [self managed abortion] may increasingly become an individual’s only or preferred option to end a pregnancy,” the study authors wrote.

In a worrying trend, about three-quarters of women who tried to perform at-home abortions didn’t use the World Health Organization-recommended pills misoprostol or mifepristone.

Instead they opted for “ineffective” methods like herbs, Plan B emergency contraception or punching themselves in the stomach, the study found.

The finding comes out amid a historic national crackdown on abortion. Since the Dobbs decision, 22 states have banned or significantly restricted the procedure, with 14 passing full bans. 

A 2023 estimate by the Society of Family Planning found that if the Supreme Court had not struck down federal protections, there would have been about 150,000 additional abortions in those 14 states alone — even with the strict anti-abortion laws already on the books in the states prior to the Dobbs decision.

Some of those abortions instead took place in states without a total ban, which saw an average of 11 percent more abortions after the 2022 decision, according to the Guttmacher Institute. 

New Mexico, for example, more than doubled its number of abortions since 2020, with nearly twice as many out-of-state women — like Texas mother Kate Cox, whose state bans abortion in almost all circumstances 5 to 6 weeks into pregnancy — traveling in to access the procedure. 

But out-of-state abortions are expensive, and many women also reported concerns with encountering protesters or needing parental consent. Those unable to access in-clinic abortions are “increasingly relying on self-sourced methods to end a pregnancy,” the JAMA Network Open authors wrote.

About a quarter of those who did so in 2023 used misoprostol or mifepristone, while the rest attempted less safe or effective methods.

About a quarter turned to herbal remedies. About 30 percent turned to “physical methods” like punching themselves in the stomach, lifting heavy objects or “inserting an object into the body.” And about a third used alcohol or other drugs or medications.

In about two-thirds of cases, the attempted abortion didn’t work. That proportion was just a bit higher than for those who tried misoprostol or mifepristone. 

A number of the women who turned to ineffective at-home means were relatively young and lacked access to health care. 

About 40 percent of women who attempted an abortion at home were under the age of 20, and a majority — 55 percent — hadn’t taken a pregnancy test before attempting to terminate what they believed was a pregnancy, researchers found.

In total, about one in five women ended up in clinics afterward to deal with complications caused by the attempt, primarily pain and bleeding. About one in twenty ended up in emergency care. 

Of the women whose self-managed abortions failed, about 20 percent got abortions in a clinic, and about 13 percent continued the pregnancy.

Researchers noted that their numbers likely represented an undercount, given the well-documented underreporting of abortion in self-administered surveys. 

If people undercount self-managed abortions on the same level as facility-based ones, the percentage of reproductive aged women who attempted them might have increased “from approximately 5 percent before Dobbs to 7 percent after Dobbs,” the study authors wrote.

As self-managed are likely to increase with access to abortion increasingly being restricted across the U.S., doctors and nurses need to be aware of the trend, they argued.

And, they wrote, it’s a public health imperative “to connect people who are pregnant with safe and effective methods of [self-managed abortion] with medication abortion pills.”

Doing so, they wrote, “may help mitigate some of the legal and health risks people who attempt [self-managed abortions] may face.”

GOP state and federal lawmakers have sought to ban access to the abortion pills, which now account for more than 60 percent of U.S. abortion.

In June, the Supreme Court unanimously threw out a challenge to a post-Dobbs Food and Drug Administration policy that made the pills easier to access — though Justice Brett Kavanaugh’s opinion for the court also included language that could protect  doctors who refuse to provide the care, even in a “healthcare desert.”

The growing use of abortion pills is reflected in the JAMA Network Open data, which found that the number of women who had turned to misoprostol or mifepristone between 2021 and 2023 had increased by about a third, from 18 percent to 24 percent.