Supporting Patients through Self-managed Abortion

May 25, 2024


Supporting Patients through Self-managed Abortion

Written by Aliye Runyan, MD, AMSA Reproductive Health Strategist

As attacks on abortion access continue across the country, there has been an increase in use of  medication abortion (63% of all abortions in 2023) – it is private, in many cases does not require a visit to a physical location, and has become more accessible through telehealth services. Self -managed abortion (SMA) is any attempt to end a pregnancy outside of the formal healthcare system, which can include taking  mifepristone and/or misoprostol. While there are unsafe ways to self-manage an abortion, with wider availability of these medications, SMA is a low risk option for patients to maintain confidentiality, autonomy, and avoid criminalization. The Society of Family Planning supports SMA and provides clinical recommendations for healthcare professionals. Unfortunately, most individuals who have faced criminal charges for SMA were reported by a healthcare provider. In many cases, there is bias towards patients attempting to manage their care outside the medical system, and often these patients are of lower socioeconomic status or already face structural barriers to medical care.

It is important as physicians to examine our own personal biases,
and recognize that SMA does not fall under mandatory reporting.

Our first duty is to protect a person’s right to maintain bodily autonomy in the face of criminalization of basic medical care. For the foreseeable future, abortion restrictions are likely to increase, and SMA will continue to be targeted by restrictive statesAllies at Pregnancy Justice, formerly the National Advocates for Pregnant Women, report alarming findings in their updated report, The Rise of Pregnancy Criminalization: A Pregnancy Justice Report, clearly tying the rise in criminalization of pregnancy with growing calls to recognize “fetal personhood” stating “without the protections of Roe, pregnant people across the country are more vulnerable than ever.” Deepening cause for concern are actions leading to this week’s headline in Politico: Louisiana is set to make possessing abortion pills without a prescription punishable by up to 10 years in prisonThese realities coupled with the pending U.S. Supreme Court decision expected in June in FDA v. The Alliance for Hippocratic Medicine could further reduce access to abortion medication through formal medical systems leading to more self-managed abortions and driving them underground. 

These challenges could leave one wondering if there is reason for hope — do we see a path to the future where legal, safe, voluntary abortions should be available to all who need them, regardless of how much they earn, who they work for, or what state they live in? The answer is an unequivocal YES!

In May, 17 state attorneys general came together under the leadership of Massachusetts AG Andrea Campbell to form the new Reproductive Rights Working Group.  Their hope is “to use their authority to introduce reproductive rights hotlines for residents seeking legal support, advocate for legislation that safeguards patients’ reproductive health data and create dedicated ‘reproductive justice’ units within their offices,” as exclusively reported in  The 19th. The article went on to report “New York Attorney General Letitia James announced that her office would prosecute a collection of New York-based anti-abortion centers — non-medical facilities that work to dissuade people from seeking abortions, and are also known as ‘crisis pregnancy centers’ — because they allegedly advertised a treatment purported to reverse medication abortions. (There is no evidence suggesting such “abortion pill reversal” actually works.)”

The growing support from policy-makers like them, along with amazing allies who generously develop resources like those below, and future physicians like you, stokes our hope!

We Invite You to Ignite Some Hope in Your Community! 

Explore & share this post, the resources below, and plan to attend & invite your friends and classmates to join us online for 

Two Years Post-Roe: Uniting to Turn the Tide as Patients,
Providers & Medical Education Face Growing Risks

Friday, June 21, 6:30pm – 8:30pm ET 

Co-hosted by the AMSA Reproductive Health Project and Medical Students for Choice (MSFC),
this online teach-in event will feature a 90-minute expert panel discussion with Q/A followed by optional 30-minute advocacy skills-building breakouts.

Learn More & Register Here
See you there!

Resources to Explore & Share

Resources for healthcare providers to learn more about SMA and to act as a support system to people who choose to self manage their abortion or miscarriage are available. Here is a good place to start: Clinical Recommendations on Self-managed abortion endorsed by the Society of Family Planning and supported by the American College of Obstetricians and Gynecologists (ACOG)

Plan C provides reliable up-to-date information on how to obtain abortion pills online for those in the U.S. They list groups that provide medications and clinical services outside of the formal healthcare system, as well as online pharmacies without clinical support –  https://www.plancpills.org/

Aid Access is a global service that aims to support all people seeking safe and effective medication management of an abortion or miscarriage. Aid Access consists of a team of doctors, activists, and advocates working outside of the formal healthcare system – https://aidaccess.org/en/

Exhale is a peer-based phone/text hotline for emotional support around abortion. Call 617-749-2948 https://exhaleprovoice.org/

Reprocare Healthline an anonymous healthline providing peer-based emotional support, medical information, and referrals to those having an abortion at home with pills. Call 833-266-7821https://abortionhotline.org

M + A Hotline a team of clinicians with years of experience in caring for Miscarriage and Abortion – https://mahotline.org/

The Abortion Coalition for Telemedicine (ACT) is the only nationwide advocacy organization working to proactively advance telemedicine abortion in all 50 states. By providing clinicians with the direct legal and technical support needed to operate an interstate telemedicine practice, we can close the abortion accessibility gap for all patients – regardless of their zip codes – https://www.theactgroup.org/

*Note: an excerpt of this Spotlight is included in AMSA Reproductive Health Project eNews #17: 
Supporting Patients & SMA, May 25, 2024
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