As policies continue to limit abortion access, demand for and attitudes about self-managed abortion (SMA)—the act of ending one’s pregnancy without the help of a medical provider—are likely changing. While several states criminalize or punish people suspected of having SMA, the public’s attitudes towards SMA criminalization and people’s personal experiences with SMA is largely missing from research literature. We are currently conducting a three-phase, mixed-methods study that will examine national changes in SMA prevalence, attitudes towards SMA criminalization, and people’s interest in four alternative models of medication abortion provision (in advance from a clinician, over-the-counter from a pharmacy, online, and in the form of a missed period pill).
In the first phase of the SMAASh study, we conducted in-depth qualitative telephone interviews with men and women living in states that criminalize SMA with the goal of assessing their attitudes about SMA criminalization, elucidating ways in which men and women’s views may differ, and developing questions to include in a national survey.
In phase two, we will conduct a probability-based, nationally-representative panel survey of 250 men and 7,000 women about their attempts to self-manage an abortion, their attitudes towards SMA criminalization, and their attitudes towards alternative models of medication abortion provision.
In the final study phase, we will conduct in-depth interviews with specific subgroups with high or unexpectedly low interest in alternative models of medication abortion provision. These qualitative interviews will explore reasons why, how, and when alternative models of medication abortion provision are acceptable.
This survey builds upon a national probability survey that was fielded in 2017 (Principal Investigator: Dan Grossman). We found that 7% of people in the U.S. who identify as women will self-manage an abortion in their lifetime. This survey also explored, for the first time nationally, women’s interest in and support for alternative models of medication abortion provision, as well as their attitudes towards laws that criminalize and punish people involved in SMA. Most women believed SMA should not be illegal, including 55% who lived in states with a law criminalizing SMA, and close to half supported one or more alternative models of medication abortion provision. The current study expands on this previous work by repeating the 2017 survey to assess changes in SMA attempts, interest in alternative models of medication abortion provision, and attitudes towards SMA criminalization, particularly as access to abortion becomes increasingly restricted. The current study also expands the participant population to include people ages 15-17, men, and gender minority groups.
These data will provide evidence in support of policies to protect and expand access to medication abortion, to decriminalize self-managed abortion, support efforts to normalize the de-medicalization of medication abortion and support long-term goals to move medication abortion over the counter. They will also help us understand trends over time in people’s experience with self-managed abortion, and how the COVID-19 pandemic and an increasingly restrictive landscape toward abortion access may have changed people’s attitudes and experiences.