As facility-based abortion care becomes increasingly difficult or impossible to access post-Roe, more people will turn to self-induced or self-managed abortion (SMA). In a Viewpoint for JAMA, Nisha Verma, MD, MPH, and ANSIRH Director Daniel Grossman, MD, outline what physicians and other health professionals should prepare for as more patients present before, during, or after their self-managed abortion.
Since the constitutional right to abortion was overturned in Dobbs v. Jackson Women’s Health Organization, 13 states have already banned the practice, with additional states imposing restrictions. Due to these circumstances, the prevalence of self-managed abortion will likely increase, and health care professionals will need to respond with a harm-reduction approach to their care.
First, it is critical that physicians and other clinicians know that medication abortion—a regimen of mifepristone and misoprostol—is safe and effective. Recent studies show that self-managed abortion is safe and effective with outcomes similar to in-person provision of medication abortion. Rather than medical complications, patients are more at risk for legal difficulties.
For patients who plan to self-manage their abortion, health care professionals can provide information on the safety of medication abortion, expected effects, potential legal risks, and possible complications. The authors encourage health care professionals to create a safe and comfortable space for follow-up care if patients have questions or concerns after self-managed abortion. If patients present for care after a self-managed abortion attempt, they should be provided with the best available care, informed by knowledge of the normal course of medication abortion to avoid unnecessary interventions. Health care professionals can also take steps to protect patients from legal risk.
Verma and Grossman conclude:
“With the loss of clinicians and centers that provide specialized abortion care in states with bans, it becomes the role of all health care professionals to support patients needing this care, including supporting those who choose to self-manage their abortion by minimizing the medical and legal risks they may encounter.”
Read the full article, Self-managed Abortion in the US, in JAMA.