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People who face barriers to abortion care are more likely to attempt self-managed abortion

Growing restrictions to abortion care in the United States have increased interest in self-managed abortion. Using data from the Google Ads Abortion Access Study, researchers developed an innovative approach to measure the incidence of attempted self-managed abortion among pregnant individuals in the U.S. searching Google for abortion care. The results demonstrate a need to remove policy restrictions on abortion: attempted self-managed abortion is higher among people facing barriers to abortion care.

Key Findings

The most commonly reported method used for attempting self-managed abortion was taking herbs, supplements, or vitamins, with over half (52%) of those attempting self-managed abortion reporting using these.
Approximately 19% of those who attempted self-managed abortion took emergency contraception (after confirming their pregnancy) or multiple oral contraceptive pills.
18% reported taking mifepristone and/or misoprostol on their own, which included 8% who ordered abortion pills online.
18% reported hurting themselves in the abdomen or other forms of physical trauma.
10% reported smoking, using alcohol, or other substances to end the pregnancy, and 7% reported taking prescription or over-the-counter medications.
Those who experienced greater travel distance and other barriers to abortion including needing to gather money for travel or for the abortion, having to keep the abortion a secret, and fear of violence that would affect their well-being, were significantly more likely to have attempted self-managed abortion.
At 4 weeks follow-up, people who attempted self-managed abortion were significantly more likely to still be pregnant and seeking abortion compared to those who did not.

Study Design

Researchers used data from the Google Ads Abortion Access Study, which recruited people searching for abortion care on Google from all 50 states and the District of Columbia between August 2017 and April 2018. Participants completed an online baseline survey and follow-up survey 4 weeks later, where they were asked, “Did you take or try to do any of the following to try to end this pregnancy?” with a closed-ended list of methods. Participants also had the option to write in other things they may have tried to self-manage their abortion in free text.


Participants in this study reported a broad range of methods used to self-manage their abortions, some of which have not previously been captured in the literature.

State-level restrictions such as limitations on abortion after a specific gestation and Medicaid bans  increase barriers to abortion including those reported by the participants in this study: needing to gather money for travel or for the abortion, having to keep the abortion a secret, and fear of violence that would affect their well-being. People who experienced these obstacles were more likely to attempt self-managed abortion, which can lead to delays in accessing medical care if it is unsuccessful. Methods to expand equitable access to abortion care are also needed, including increasing the number and types of clinicians who can provide abortion, allowing pharmacy access to abortion pills, and approving telehealth models of abortion care.

As the researchers write:

“The FDA can permanently remove strict and unnecessary regulations on mifepristone so that patients can have clinically supported access to abortion through telehealth and receive the medications by mail. Additionally, the 19 states effectively banning telemedicine for abortion must repeal these laws. Such actions would address barriers to abortion care, potentially reducing self-managed abortion attempts. In addition, research exploring over-the-counter access to abortion pills and other ways to support those wanting to manage their own abortions safely and effectively is needed. New models of care will give people more control over their abortion experience, helping them achieve greater reproductive autonomy.”

The article, Barriers to abortion care and incidence of attempted self-managed abortion among individuals searching Google for abortion care: A national prospective study, is available in Contraception.