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Understanding and Advocating for Self-Managed Abortion
Self-managed abortion occurs when a person chooses to perform their own abortion outside a medical setting. There are many reasons why one may manage their own abortion outside a clinic setting. It may be because abortion care at a clinic is unavailable, inaccessible, or not desired by the individual.
Self-managed abortion is a broad term that includes all methods a person may use to end their own pregnancy, including medication, herbs, and manual aspiration. While no person should ever be shamed for choosing self-managed abortion, some methods may be safer and more effective than others.
At Reproaction, we focus our self-managed abortion education work on abortion with pills. Within the first 12 weeks of pregnancy, misoprostol is safe and approximately 85 percent effective in terminating a pregnancy. The World Health Organization (WHO) has put misoprostol on the list of essential medicines and created a protocol for how women may manage their abortion with misoprostol without direct provider supervision.
About Self-Managed Abortion with Misoprostol
In the first 12 weeks of pregnancy, the World Health Organization (WHO) recommends that people who want to manage their abortion via misoprostol take a total of 12 misoprostol tablets (200 mcg each). These tablets are administered four at a time, under the tongue, and allowed to dissolve for 30 minutes, every three hours. The WHO protocol is summarized in the following steps:
- Place four pills (200 micrograms each) under the tongue for 30 minutes while tablets dissolve. Swallow the remnants of the pills after 30 minutes.
- After three hours, place four pills (200 micrograms each) under the tongue for 30 minutes while tablets dissolve. Swallow the remnants of the pills after 30 minutes.
- After another three hours, place four pills (200 micrograms each) under the tongue for 30 minutes while tablets dissolve. Swallow the remnants of the pills after 30 minutes.
A woman will know the medication is working when she experiences the following side effects: cramps, menstrual bleeding, nausea, vomiting, and diarrhea. Though rare, complications can occur. Signs of complications include:
- Heavy bleeding that lasts for more than two hours and soaks more than two sanitary pads per hour
- Severe pain that does not go away after hours after taking the medications
- A fever of over 102 degrees Fahrenheit
- Vaginal discharge that smells bad
The treatment of any complication of abortion is exactly the same as the treatment for complications of a miscarriage. There are no tests that can detect misoprostol, and there is no reason to tell a medical provider that a women has managed her own abortion with pills. To date, there have been at least 20 arrests of women who have ended their own pregnancy outside a medical setting in the United States. A woman, therefore, should not tell medical personnel that she has taken misoprostol or she may be at legal risk.
Common Misconceptions about Self-Managed Abortion with Medication
Self-managed abortion with medication is not the same as emergency contraceptives (commonly referred to as Plan B). Emergency contraceptives will prevent a pregnancy from occurring, but they will not end a pregnancy.
Self-managed abortion with medication is also not the same as getting abortion medications from a clinic and taking them at home. In a clinical setting, a pregnant person who wants to end their pregnancy is given a drug called mifepristone, which they take in the presence of a medical provider. The pregnant person is also given misoprostol pills which they are instructed to take around 24 hours later at home. These drugs are commonly called the “abortion pill.” When an abortion is self-managed, the women will procure and administer the medications outside a clinical setting.
It is becoming increasingly common for a pregnant person to obtain both mifepristone and misoprostol to end their own abortion. This regimen is more effective (96 percent), but can also be more expensive and more highly regulated. The WHO protocol for administering the combination of those pills is significantly different than the protocol that is described above. For more information on the protocol for the combination of mifepristone and misoprostol as well as misoprostol alone, please see the resources listed below.
Additional Resources on Self-Managed Abortion with Pills
- Women Help Women
- Self-Managed Abortion Safe & Supported (SASS)
- Women on Waves
- World Health Organization Guidelines
- National Advocates for Pregnant Women
- An Open Letter in Support of Self-Managed Abortion with Pills
Why Is Reproaction Engaging with Self-Managed Abortion with Pills?
We envision a world where every person is respected in their right to parent, not to parent, and the right to raise children in safe and healthy communities. We believe that people are capable of determining what is best for their body, future, and health care – which includes the decision to have an abortion. Reproaction staunchly fights for more access to abortion within the medical system. So too, we respect the decision of people to end their pregnancies on their own and outside of a clinical setting.
The goal of Reproaction’s campaign on self-managed abortion is to raise awareness of self-managed abortion with pills in order to reduce stigma and build grassroots support to change unjust laws. We see raising public consciousness of self-managed abortion with pills as the first step in the journey to making misoprostol or a combination of Mifepristone and misoprostol available to any pregnant person legally, affordably, and conveniently.
Reproaction is organizing activities in the DC metro area, Virginia, Missouri, New York, Arkansas, and more. Activities include community forums, strategy sessions, campus presentations, and direct actions – to name a few.
Sign up for the Reproaction listserv to be the first to learn when activities are happening near you. Follow the action on social media with the hashtag #SelfManagedAbortion.
Particularly with the safe and effective protocols for self-managed abortion with pills, we already have many of the tools we need to build a future where all people can access the care they need.
Pamela Merritt, Reproaction’s co-director and co-founder, and Dr. Colleen McNicholas, OB-GYN and the Chief Medical Officer of Planned Parenthood of the St. Louis Region and Southwest Missouri shared their insights on self-managed abortion and abortion access.
Reproaction co-founder/co-director Pamela Merritt hosted speakers Sara Baker, Legislative and Policy Director, ACLU of Missouri, Mallory Schwarz, Executive Director, NARAL Pro-Choice Missouri, and Indra Woods Lusero, Staff Attorney, National Advocates for Pregnant Women on a call-in press conference to discuss the alarming consequences of criminalizing abortion and prosecuting women for pregnancy outcomes - especially as the St. Louis region has emerged as the front line in the battle to maintain and expand access to abortion.
Abortion pills, including mifepristone and misoprostol, have been used to end pregnancies in the United States for more than 20 years.
By providing information, legal advice, and emotional support, self-managed abortion activists are paving a way for a new future of reproductive rights, one where information is the most powerful tool for ensuring bodily autonomy.
For centuries, women have found ways to control their fertility, and self-managed abortion is the newest.