Self-managed abortion (SMA) is a method of abortion care that occurs outside of the formal medical system. While there are many forms of self-managed abortion, one of the most common ways to self-manage is using abortion pills at home, a combination of mifepristone and misoprostol or misoprostol alone. SMA with pills is a safe, effective, and a common option for many abortion seekers [1]. In today’s landscape of increasing state violence and criminalization of abortion and pregnancy loss, folks turn to SMA for a variety of reasons.

Since the overturn of Roe v. Wade, self-managed abortion has become an increasingly common form of abortion care as bans impacting in-clinic care increase [2]. As of 2024, the share of people who have self-managed an abortion has increased to 40%, and likely higher now, jumping from 3.4% in 2023. [3] Surveying a diverse set of participants, reasons for SMA are vast and personal. Post-Dobbs, many people turned to self-managed care for fear of criminalization in restrictive states and a lack of knowledge on the state of legality where they lived. [3] Overall, SMA with pills has become a more accessible option for many, and one that can offer a more private and comfortable abortion experience. With trusted distributors such as Aid Access and Women On Web offering the shipment of pills to anyone in any US state or territory has drastically opened doors for many abortion seekers considering care outside of the medical system – distributors that often offer a sliding scale or low costs for pills.

Even in states where abortion is legal, and/or where abortion clinics remain open, state-wide clinic closures and patient increases have made wait times for appointments longer in many states [4]. Abortion seekers might also face financial or practical barriers to accessing care at a clinic – this especially goes for folks covered under Medicaid, whose insurance is generally not permitted to cover abortion care [5]. For those who pay out of pocket for a procedural abortion, prices can range up from a few hundred to tens of thousands of dollars, depending on the gestational age of the pregnancy [6]. People might also not have the means to physically access a clinic, particularly where they might face reproductive health care deserts and are forced to drive multiple hours, or even an entire day, to get to a clinic. The average cost of out-of-state travel for abortion care, not including the procedure costs itself, can range anywhere from $500-$1000 dollars. [7] Given that 60% of abortion seekers already have one or more children, arranging childcare to access in-clinic care can produce even more financial or logistical burden. [8] Abortion funds and practical support networks often stand in the gap for abortion seekers for in-clinic care, but are increasingly strained in resources as donations fizzle. [9] Even when they can, abortion seekers might be bombarded with logistical hurdles, protesters outside clinics, or legal barriers like waiting periods before accessing the care they need.

Many abortion seekers might be deterred from accessing care within the medical system due to stigma or prior negative experiences. Trans, nonbinary and gender expansive folks, for example, are more likely to rely on telehealth or self-managed care due to concerns of gender discrimination in clinical settings. [10]. Many queer and trans abortion seekers experience incorrect pronoun use, unpleasant gender-related interactions, or general stigma from medical providers in traditional health care settings – Self-managed abortion offers a way to circumvent these possible experiences and manage care in the privacy of a space that is comfortable for them. [10]

Exacerbating these barriers is the complexity of the criminalization landscape we’re seeing today. With ICE terrorizing our communities, abducting and murdering people in our streets, more entry points to pregnancy criminalization and state violence surmount. Abortion seekers and pregnant people are scared to leave their houses, let alone interact with the medical system that is often a gateway to federal law enforcement [11]. Many health care facilities have warned patients of ICE presence in and around their facilities. [11] In light of these surveillance mechanisms, medical centers are already sharing reports of pregnant patients being deterred from accessing care for fear of ICE presence and/or feelings of unsafety. [12] With more deterrence from the medical system comes a greater reliance on community aid for the purposes of at-home or telehealth care, allowing SMA to serve as a safer alternative of care for many.

More recently, the use of telehealth abortion networks has been increasingly criminalized in states where abortion is banned or restricted. Texas, for example, recently implemented a ‘bounty-hunter law’ that incentivizes citizens to sue anyone who prescribes, mails, or provides abortion pills in or to Texas. [13] The state has already begun criminalizing providers who have provided pills to Texas residents either through out-of-state care or via online distribution sites. [14] Having set a legal precedent for other restrictive states to follow suit, it’s imperative that abortion seekers stay up to date on the legal landscape in their state and take necessary security precautions before seeking care for a self-managed abortion.

At the heart of the SMA ecosystem is community. Many abortion seekers rely on abortion doulas or support companions to support their self-managed abortions, many of whom are connected through local doula collectives or mutual aid networks. SMA places a greater emphasis on these networks to get people the care they need — whether it be the pills themselves, information about the protocol, or support during/after the abortion. With these resources at our disposal, it’s critical we uplift SMA as an option for abortion seekers that may not want to seek care within traditional medical pathways. By destigmatizing SMA, we can further close the access gaps that continue to escalate in the face of funding cuts, criminalization points, and barriers that make physical clinics less accessible for folks.

Bottom line, it doesn’t matter why or how someone seeks abortion care. Reproductive justice requires supporting the full spectrum of abortion experiences and allowing people to have their abortions in whatever way is most comfortable for them. Addressing gaps in abortion access requires our knowledge and acceptance of SMA as a safe and effective practice, one that’s been utilized by abortion seekers for generations (centuries, in fact!). As entry points to abortion criminalization escalate, both via state law and federal, no one should have to justify the way they’re accessing care. SMA will continue to be a valid option for abortion seekers across the country, now and forever.

Learn more about the SMA protocol and how to support SMA at reproaction.org/sma.

Sources

1. https://www.ibisreproductivehealth.org/publications/misoprostol-alone-medication-abortion-safe-and-effective
2. https://www.ansirh.org/research/research/new-research-shows-self-managed-abortion-increased-aftermath-dobbs-decision
3. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821654?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jamanetworkopen.2024.24310
4. https://www.kff.org/womens-health-policy/abortion-trends-before-and-after-dobbs/
5. https://abortionfunds.org/need-an-abortion/abortion-and-medicaid/
6. https://www.plannedparenthood.org/blog/how-much-does-an-abortion-cost
7. https://truthout.org/articles/the-anti-migrant-crackdown-is-also-a-reproductive-justice-crisis/
8. https://www.ineedana.com/blog/abortion-facts
9. https://apnews.com/article/abortion-funding-pills-clinic-closures-56694deb186a0339e1fe9fe3e1c1c363
10. https://www.sciencedirect.com/science/article/pii/S0010782425004032
11. https://www.kff.org/quick-take/health-care-providers-warn-of-impacts-of-increased-ice-presence-at-health-care-facilities/
12. https://19thnews.org/2026/01/ice-fears-pregnant-immigrants-minnesota-prenatal-care/
13. https://reproductiverights.org/news/four-things-hb7-texas-new-abortion-law/
14. https://www.texastribune.org/2026/02/02/texas-california-abortion-pill-lawsuit-bounty-hunter-law-hb-7/