7% of US women attempt self-managed abortions, study suggests

Around 7% of women in the US attempt a “self-managed abortion” at some point in their life, research suggests.

“Increasing evidence” has highlighted the extent of pregnant women who try to terminate their pregnancy “outside the formal healthcare system”.

To learn more, scientists from the University of California San Francisco (UCSF) analysed over 7,000 women aged between 18 and 49.

One in 100 (1.4%) “reported a history of attempting” an abortion while living in the US.

When projected over the participant’s lifetime, and taking into account “under-reporting of abortion”, the UCSF team calculated 7% of US women try to terminate a pregnancy themselves at some point.

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A self-managed abortion was defined as “doing something on your own to try to end a pregnancy without medical assistance”.

This may include “getting information from the internet, a friend or family member about pills, medicine or herbs”, as well as the “insertion of foreign objects into the uterus”.

Worldwide, 25 million “less safe abortions” are thought to occur every year, of which nearly all (97%) take place in less-developed countries, the UCSF scientists wrote in the journal JAMA Network Open.

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Nevertheless, medics in the US have reported an increase in women presenting with complications after an unsuccessful self-managed abortion attempt.

Feeling the issue was under-reported, the scientists analysed more than 7,000 English or Spanish-speaking women who took part in a survey in August 2017.

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The results revealed 1.4% of the women reported attempting a self abortion while in the US.

When extrapolated over the participants’ lifetime, and “adjusting for under-reporting of abortion”, the prevalence was found to be 7%.

Black and Hispanic women were around three times more likely to have attempted a self abortion than their white counterparts, the results show.

During the women’s most recent attempt, one in five (20%) used the World Health Organization-recommended abortion drug misoprostol, but without medical supervision.

Just under a third (29%) took another medication, while two in five (38%) used herbs.

One in five (19%) made the attempt via “physical methods”.

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Around half (47%) of the women who tried to induce a self abortion cited “it seemed faster or easier”.

Some pregnant women may struggle to access abortion care, or have “a preference for a more private or natural abortion experience”, wrote the UCSF scientists.

“Abortion deserts”— US regions where women have to travel more than 100 miles to a clinic—are “common”, particularly in the Southern and Midwestern states, they added.

The team also blamed “unprecedented levels of new state-level abortion restrictions, the Trump administration’s domestic gag rule restricting primary and reproductive health care clinicians’ ability to discuss or refer patients to abortion, and the potential for a supreme court decision that could reshape federal constitutional protections on abortion”.

One in four (25%) of the study’s participants who attempted a self abortion said “the clinic was too expensive”.

Overall, around one in 10 (11%) of the women endured a complication as a result of their attempt.

What an abortion involves and the support available

Legal abortions in the UK are induced via medication or surgery.

These can only be carried out by an NHS hospital or licensed clinic.

Women can self-refer themselves for the procedure by contacting an abortion provider directly.

The British Pregnancy Advisory Service (BPAS), Marie Stopes UK, the National Unplanned Pregnancy Advisory Service (NUPAS) and local NHS sexual health websites provide information about eligibility and services in your area.

GPs and sexual health clinics can also refer women for the procedure.

Women can usually choose whether to have a surgical termination or take two pills, around 24 to 48 hours apart.

Ordinarily, women who opt to take the pills are required to go to a registered clinic where they have the first drug and are given the second to take at home.

Campaigners have long argued there is no logical reason why both pills cannot be taken at home, with many women enduring side effects on public transport after leaving the clinic.

Amid the coronavirus outbreak, England, Wales and Scotland are allowing medics to supervise the use of both pills from home via videoconferencing or telephone consultations.

Pandemic aside, women should not have to wait more than two weeks from when they or a medic contacts an abortion provider, to the procedure being carried out.

Most abortions in England, Wales and Scotland are conducted before 24 weeks of pregnancy.

After this time, the procedure may be carried out under “very limited circumstances”, like if the mother’s life is at risk or the child would have a severe disability.

Most abortion services ask to perform an ultrasound scan to determine how many weeks pregnant the woman is.

Abortions are safer the earlier they are carried out, however, there is always the risk of womb infections, excessive bleeding, damage to the entrance of the womb and some of the pregnancy remaining.

This may require further treatment, like surgery.

All women requesting an abortion can discuss their options, and receive support, from a trained pregnancy counsellor. Details are always kept confidential.

Women may also benefit from speaking to their GP, a counsellor at the abortion clinic or loved ones.

Discomfort and vaginal bleeding are common for up to two weeks after the procedure.

An abortion should not affect a woman’s chances of becoming pregnant again.

Pregnant women considering an abortion can learn more and get support from BPAS, Marie Stopes UK, NUPAS and Brook, for those under 25.

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