A new report from the Guttmacher Institute providing data for 2017 found that 18 percent of nonhospital facilities reported having seen at least one patient who had attempted to end a pregnancy on her own, an increase from 12 percent in 2014 (the first year that question was included in the survey). The biggest reason? The only drugs approved by the FDA to be used in a medication abortion (misoprostol and mifepristone) are becoming increasingly available online, as are resources about how to safely and effectively self-manage an abortion outside of a clinical setting.
According to research by the Guttmacher Institute, during a month-long period in May and June 2017, individuals in the United States conducted more than 200,000 Google searches for information related to self-abortion. Another piece of data comes from Aid Access, an online telemedicine service based in Europe, which reported that 21,000 U.S. residents requested mifepristone and misoprostol from them in their first year of operation.
"Taken together, all of this evidence suggests that self-managed abortion may be on the rise in the U.S.," says Daniel Grossman, an OB-GYN and reproductive health researcher at the University of California, San Francisco.
Increased access to safe methods for ending an unwanted pregnancy in itself is not a cause for concern. However, attempting a self-induced abortion outside of clinical care and FDA-approved medication can put women at risk not only health-wise but also legally. Here are the facts.
Why Are More Women Self-Managing Abortion?
There are a plethora of reasons why women may seek to end a pregnancy on their own.
"In our research, people report a variety of reasons for attempting to self-manage their abortion. Many people say they did this because of barriers accessing clinic-based abortion care. Some of those barriers include the cost of care, distance to clinics, not knowing where a clinic was, and for adolescents a concern (true or not) that parental consent was required," says Dr. Grossman. "Another group of people express a preference for self-managed care—because they see it as more natural or less invasive. Some say they use herbs or supplements to manage all their healthcare, and they see self-managed abortion as a natural extension of that."
Another cause is decreased access to abortion clinics. In 2017, 808 clinic facilities provided abortions, a two percent increase from 2014. However, regional and state disparities in clinic availability grew more pronounced; the number of clinics increased in the Northeast and the West, by 16 percent and four percent respectively, and decreased in the Midwest and the South, by six percent and nine percent, respectively.
Health Risks of DIY Abortion Methods
A 2019 study published in the journal Contraception of 650 abortion providers found that two-thirds of respondents had experiences with women attempting to self-manage abortion, and about one-third witnessed complications related to self-managed medication abortion.
"People report a variety of methods, including vitamins, herbs, medications, and physical methods like getting hit in the abdomen," says Dr. Grossman.
While some methods are obviously alarming and unsafe, others have become increasingly common due to the belief that they are a "natural" solution. A 2011 study published in the American Journal of Obstetrics & Gynecology found that 1.4 percent of 9,493 women surveyed, reported using vitamin C or herbal products to attempt to end a pregnancy. But there is no scientific or clinical evidence these methods work. Here's what you need to know:
Vitamin C Abortion
A vitamin C abortion is a self-induced abortion method that requires taking large amounts of vitamin C, also known as ascorbic acid, for several days in a row. But can taking too much vitamin C really cause a miscarriage?
"There is not good data about the effectiveness of herbs or vitamin C, and we have interviewed some women who reported using these methods, which were not effective and delayed them in the process of obtaining a clinic-based abortion," says Dr. Grossman.
A 2016 review of vitamin supplementation used to prevent miscarriage found that there was no difference in the risk of total fetal loss by taking vitamin C. Not only that, taking vitamin C during pregnancy has been studied to help reduce the risk of pregnancy complications such as pre-eclampsia, intrauterine growth restriction, and maternal anemia.
An herbal abortion is a self-induced abortion method that requires taking excessive amounts of certain herbs to induce bleeding and uterine contractions. The herbs involved in herbal abortions are often referred to as emmenagogues, herbs capable of stimulating the menstrual flow even when it is not due. These herbs include:
Coleus; Coleus forskohlii
Cotton root bark; Gossypium spp.
Eucalyptus; Eucalyptus spp.
Goldenseal; Hydrastis canadensis
Motherwort; Leonurus cardiaca
Mugwort; Artemisia spp.
Pennyroyal; Mentha pulegium
Tansy; Tanacetum vulgare
Yarrow; Achillea millefolium
Others may include tansy, thuja, safflower, scotch broom, rue, angelica, wormwood, and parsley oil/parsley apiole. These herbs also may pose toxicity risks for women taking them, including kidney and liver damage, tissue damage, internal bleeding, and even death.
Data for herbal abortions is difficult to obtain, partly because of the legal implications of patients admitting to illegal abortion.
"My biggest concern with these methods is that they are often not effective, and people may not recognize they didn't work until it is too late to get a clinic-based abortion," says Dr. Grossman.
Legal Risks of DIY Abortion Methods
Some states have laws that criminalize self-induced abortions. According to the Guttmacher Institute, in 2018 there were seven states with laws directly criminalizing self-induced abortions, 10 states with laws criminalizing harm to fetuses that lack adequate exemptions for the pregnant person, and 15 states with criminal abortion laws that have been and could be misapplied to people who self-induce.
"I don't have any medical concerns about self-managed abortion, particularly when effective medications are used early in pregnancy," says Dr. Grossman. "But I do have concerns about the legal risks people take by doing this. At least 21 women have been prosecuted for allegedly attempting to end a pregnancy on their own or helping someone else."
The American College of Obstetricians and Gynecologists released its position on decriminalizing self-induced abortions in a statement in December 2017: "The threat of prosecution may result in negative health outcomes by deterring women from seeking needed care, including care related to complications after abortion."
ACOG also opposes administrative policies that interfere with the legal and ethical requirement to protect private medical information by mandating obstetrician-gynecologists and other clinicians to report to law enforcement women they suspect have attempted self-induced abortion. Such actions compromise the integrity of the patient-physician relationship.
Visit a Health Clinic to Safely Manage an Abortion
The FDA only has two approved drugs for medical-induced abortions: mifepristone used together with misoprostol. It was approved in 2000. Mifepristone works to block pregnancy-enabling hormones, while misoprostol causes uterine contractions. The two-drug method is most effective, at 98 percent, while misoprostol taken alone is 80 percent effective.
Visit a health clinic or an OB-GYN office to access an FDA-approved abortion pill. Since laws vary from state to state regarding your rights to terminate a pregnancy, the best place to start is by contacting your local Planned Parenthood for more information about where to get the abortion pill or visit websites like the Safe Place Project.