What is self-managed abortion? Doctor explains.

As abortion rights are threatened in light of the leaked draft Supreme Court opinion that voted to overturn Roe v. Wade, organizations, doctors and others are sharing information online about self-administered abortions, particularly abortifacients.

Google searches for “abortion pills” are reportedly “skyrocketing,” and inquiries from other organizations about prescription abortion pills have spiked after the Supreme Court’s draft opinion was made public.

But what exactly is a self-administered abortion? How safe is it?

What is self-administered abortion?
Dr. Mitchell Creinin, professor of obstetrics and gynecology and director of family planning at UC Davis Health, told Yahoo Lifestyle that there is a “spectrum” when it comes to self-administered abortion. Dr. Emily Godfrey, associate professor of obstetrics and gynecology at the University of Washington Medical Center, told Yahoo Life they range from safe medication abortions using approved prescription drugs to treatment options and procedures – including “devices” and “herbal remedies” – that can be ineffective, dangerous and even deadly.

But when doctors talk about self-administered abortions, they are usually referring to medication abortions outside of the formal medical setting.

What is a medication abortion?
More than half of all abortions in the United States are now medication abortions, surpassing surgical abortions for the first time this year. For traditional medication abortions, patients follow an FDA-approved drug regimen of mifepristone and misoprostol, which can be taken during the first 10 weeks of pregnancy, with the support of a clinician.

Mifepristone blocks the hormone progesterone, which is necessary to continue the pregnancy. According to the Kaiser Family Foundation (KFF), misoprostol taken 24 to 48 hours after mifepristone can cause cramping and bleeding to terminate a pregnancy.

According to KFF, the medication regimen is a “safe and efficient method of terminating pregnancy” – more specifically, they are effective 99.6 percent of the time, with a 0.4 percent risk of major complications.

What is self-administered medication abortion?
With self-administered medication abortion, people can only get mifepristone and misoprostol or misoprostol outside of a regular medical facility.

“Self-harm should not be considered the only or primary option for ending a pregnancy after ovulation,” Dr. Andrea Henkel, a complex family planning specialist in obstetrics and gynecology at Stanford University, told Yahoo Life. “The medications used to self-manage abortion are identical to those a person might obtain from a clinician and can be purchased online.”

However, “some people can only use misoprostol,” Creinin says. While he notes that misoprostol alone may not work as well as when paired with mifepristone, Creinin says, “but it’s not very harmful.”

In fact, a 2019 study found that misoprostol alone is “effective and safe, and a reasonable option for women seeking an abortion in early pregnancy.”

According to the Guttmacher Institute, “even the use of misoprostol by untrained individuals is still safer than traditional clandestine abortion methods, which are considered the least safe, such as inserting sharp objects into the uterus or ingesting toxic substances.”

Dr. Deyang Nyandak, a fellow with the Society of Reproductive Health Physicians, told Yahoo Lifestyle, “Many pregnant women may choose to self-administer abortions.” She explained that these types of abortions “look very different in the modern world than they did in the pre-Roe era. There are data describing the effectiveness and safety of self-administered abortions through pharmaceutical methods.”

However, she added, “Self-administered abortions can be criminalized in many states in this country. Therefore, it needs to be decriminalized so that people are not prosecuted by the state for accessing these services outside of the health care system.”

The Role of Telemedicine in Self-Managed Abortion
Telemedicine also makes it easier for people to perform medication abortions at home, but requires the support of an online clinician. In addition, in December 2021, the FDA expanded access to abortion drugs by permanently allowing abortion drugs to be sent through the mail.

A study published in The Lancet in 2022 found that “self-administered medication abortion using online telemedicine was highly effective with a low incidence of serious adverse events,” which the study authors called “a safe and effective option for those without access to clinical care. concern.” Nyandak said that in states where medication abortion is legal and available via telemedicine, “patients do not need to make an in-person appointment for a medication abortion. “Therefore, patients can choose medication abortion because they can have the medication delivered directly to their preferred address without having to see their provider in person.”

However, according to KFF, six states – Arizona, Arkansas, Missouri, Louisiana, Texas and West Virginia – “have passed laws that specifically prohibit telemedicine from providing abortion services.” KFF also notes that 14 other states have “enacted laws requiring clinicians providing medication abortions to be physically present during the procedure, effectively prohibiting the use of telemedicine to remotely dispense abortion drugs.”

How Abortion Restrictions Lead to Unsafe Self-Managed Abortions
If Roe v. Wade is overturned, Creinin said, “we’ll be back to [unsafe] self-administered abortions where people feel extremely out of control and will do anything” to end a pregnancy. “How safe is it? It depends on what people do. If they feel trapped and have to go to extremes, it can be very dangerous.”

As several experts and organizations have already pointed out, abortion restrictions don’t stop abortions. “These laws don’t reduce the number of abortions – they just increase the number of unsafe abortions,” Godfrey said. “You’re harming the health and well-being of women and others who need these services.”

Creinin agreed, adding, “We know from decades of research and abortion rates that when you make abortion illegal, abortion doesn’t become any rarer. People end up dying or doing something that could be harmful.”

According to the Guttmacher Institute, abortion rates “are similar in countries where abortion is highly restricted and widely legal: In countries where abortion is banned or allowed only to save the life of the pregnant woman, the abortion rate is 37 per 1,000 women. In countries where the reason for abortion is not restricted, the rate is 34 per 1,000 women.”

The Institute notes that “legal restrictions do not eliminate abortion. Rather, they increase the likelihood that abortions will be performed unsafely because they force women to seek clandestine procedures. In fact, abortion is widely legal in countries where it is legal and in countries with high gross national income.”

Creinin also noted that “those who can afford it always have access to abortion,” while those who are “economically disadvantaged are at a greater disadvantage.

Those who live in states where abortion is restricted and/or criminalized and cannot afford to go to another state – including taking time off work and finding child care (60 percent of women seeking abortions are already mothers) – are put in a difficult position. “If we put people in the corner, they will do things that are dangerous to themselves,” Creinin said.

How can people access abortion pills online?
Several organizations, such as Just the Pill, offer confidential online counseling in some states and mail abortion pills directly to a person’s home.

If your state may restrict and/or criminalize abortion after Roe v. Wade is overturned, experts recommend that you get the necessary medication ahead of time and stick with it just in case. According to FIGO (International Federation of Gynecology and Obstetrics), mifepristone and misoprostol usually have a shelf life of two years.

For people living in states that have implemented abortion restrictions, including telemedicine bans, some have solved the problem by ordering abortifacients from online pharmacies outside the United States.

“In states that restrict telemedicine, [one] way to get the medication is through Aid Access,” Godfrey said. Aid Access, based in Austria, offers online counseling and sends abortion pills by mail to the United States. It also provides instructions on how to use the abortion pill.

Plan C researched and reviewed online pharmacies that sell abortion pills without a prescription, allowing people to check which pharmacies will mail the pills to their state.

Other organizations, such as the M+A Hotline, provide confidential advice and support for self-administered abortions by phone or text message. “They don’t ask for any information about the caller, and it’s staffed by licensed clinicians who can provide answers to any questions patients may have when having a self-administered abortion,” Godfrey said.