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Opposition to the Criminalization of Self-Managed Abortion

July 6, 2022

Throughout the United States, individuals have been prosecuted for a variety of actions during pregnancy that allegedly caused harm or risk of harm to fetuses they were carrying. For example, people have been arrested and jailed for crimes such as child endangerment, feticide, or homicide for using substances during pregnancy, attempting suicide, or declining to proceed with a recommended medical procedure, such as a cesarean delivery. ACOG has long opposed efforts to criminalize such actions during pregnancy.1,2,3

In addition, people have been prosecuted and sometimes incarcerated after being accused of self-managing an abortion in the United States.4,5 Self-managed abortion refers to any action taken to end a pregnancy outside of the formal healthcare system (i.e. self-sourcing mifepristone and/or misoprostol, consuming herbs or other drugs, and using physical methods).6,7 In some cases, individuals have been prosecuted under laws that explicitly criminalize self-managed abortion or that criminalize harm to the fetus, while in other cases, people have faced charges related to the disposal of pregnancy tissue or because they obtained, or helped someone else obtain, abortion-inducing medication.

Data suggest that many individuals at least consider self-managed abortion. During a month-long period in 2017, there were more than 200,000 Google searches for information regarding self-managed abortion in the United States.8 A 2014 national study of patients seeking abortion care found that approximately 2% had attempted to self-manage an abortion at some point,9 and a 2017 national population-based study reported that 7% of women around the country attempted self-managed abortion in their lifetimes.10

Rates of attempted self-managed abortion appear to be higher among people facing barriers to abortion care.11 One study of patients seeking abortion care in Texas, where access to abortion is highly restricted, found that 7% had taken or done something to try to end their current pregnancy before coming to a clinic.12 Another study, which looked at over 57,000 requests from U.S. residents for self-managed abortion through an online service between March 2018 and March 2020, found that the majority came from people living in states with restrictive abortion laws.13 Researchers estimated a 27% increase in self-managed abortion requests after the start of the COVID-19 pandemic as compared to before.14 Those receiving health insurance through the federal government are also inequitably precluded from coverage of abortion except for the narrow exceptions of incest, rape, or threat to the pregnant person’s life, creating significant barriers to accessing abortion care.15 In addition, people currently providing active-duty military services experience increased likelihood of unintended pregnancy, financial hardship, and deployment in states or countries where abortion is highly restricted or illegal, creating difficulty in accessing traditional abortion services.15,16

The reasons why people attempt to self-manage an abortion are varied and multifactorial. They include barriers to accessing clinic-based care, such as cost, distance to the facility, and lack of knowledge of where and how to access services. Notably, some individuals attempt self-managed abortion due to personal preference for self-care, with avoidance of abortion clinics and perceived advantages of convenience, privacy, and comfort as motivating factors.17,18,19 Due to the growing restrictions on abortion access and the closure of facilities providing this care, self-managed abortion attempts may become more common.

The American College of Obstetricians and Gynecologists (ACOG) opposes the prosecution of a pregnant person for conduct alleged to have harmed their fetus, including the criminalization of self-managed abortion. The threat of prosecution may result in negative health outcomes by deterring individuals from seeking needed care, including care related to complications after abortion. ACOG also opposes administrative policies that interfere with the legal and ethical requirements to protect private medical information by mandating that clinicians report those they suspect have attempted self-managed abortion to law enforcement, social workers, or other agencies. Such actions compromise the integrity of the patient– clinician relationship and disproportionately harm communities who are historically marginalized from care and are more likely to be reported and criminalized for their pregnancy outcomes due to bias and discrimination.

It is essential that obstetrician–gynecologists and other clinicians protect patient autonomy, confidentiality, and the integrity of the patient–clinician relationship and advocate against mandated reporting related to self-managed abortion. In addition, clinicians should provide compassionate, non-judgmental care to any patient presenting for medical care, including those presenting after self-managing an abortion.

References

  1. Alcohol abuse and other substance use disorders: ethical issues in obstetric and gynecologic practice. Committee Opinion No. 633. American College of Obstetricians and Gynecologists. Obstet Gynecol 2015;125:1529-37.
  2. Substance abuse reporting and pregnancy: the role of the obstetrician–gynecologist. Committee Opinion No. 473. American College of Obstetricians and Gynecologists. Obstet Gynecol 2011;117:200-1.
  3. Refusal of medically recommended treatment during pregnancy. Committee Opinion No. 664. American College of Obstetricians and Gynecologists. Obstet Gynecol 2016;127:e175-82.
  4. If/When/How. Making abortion a crime (again): how extreme prosecutors attempt to punish people for abortions in the U.S. Available at https://www.ifwhenhow.org/resources/making-abortion-a-crime-again/. Retrieved January 11, 2022.
  5. Donovan M. Self-Managed Medication Abortion: Expanding the Available Options for U.S. Abortion Care. New York (NY): Guttmacher Institute; 2018. Available at: https://www.guttmacher.org/gpr/2018/10/self-managed-medication-abortion-expanding-available-options-us-abortion-care. Retrieved January 11, 2022.
  6. Ralph, L., et al., Prevalence of Self-Managed Abortion Among Women of Reproductive Age in the United States. JAMA Netw Open, 2020. 3(12): p. e2029245.
  7. Moseson, H., et al., Self-managed abortion: A systematic scoping review. Best Pract Res Clin Obstet Gynaecol, 2020. 63: p. 87-110.
  8. Jerman J, Onda T, Jones RK. What are people looking for when they Google "self-abortion"? Contraception. 2018 Jun;97(6):510-514.
  9. Jerman J, Jones RK, Onda T. Characteristics of U.S. abortion patients in 2014 and changes since 2008. New York (NY): Guttmacher Institute; 2016. Available at: https://www.guttmacher.org/report/characteristics-us-abortion-patients-2014. Retrieved December 1, 2017.
  10. Ralph L, Foster DG, Raifman S, Biggs MA, Samari G, Upadhyay U, Gerdts C, Grossman D. Prevalence of Self-Managed Abortion Among Women of Reproductive Age in the United States. JAMA Netw Open. 2020 Dec 1;3(12):e2029245. doi: 10.1001/jamanetworkopen.2020.29245. PMID: 33337493; PMCID: PMC7749440.
  11. Upadhyay UD, Cartwright AF, Grossman D. Barriers to abortion care and incidence of attempted self-managed abortion among individuals searching Google for abortion care: A national prospective study. Contraception. 2022 Feb;106:49-56.
  12. Grossman D, White K, Hopkins K, Potter JE. The public health threat of anti-abortion legislation. Contraception 2014;89:73-4.
  13. Aiken ARA, Starling JE, Gomperts R. Factors Associated With Use of an Online Telemedicine Service to Access Self-managed Medical Abortion in the US. JAMA Netw Open. 2021;4(5):e2111852.
  14. Aiken ARA, Starling JE, Gomperts R, Tec M, Scott JG, Aiken CE. Demand for Self-Managed Online Telemedicine Abortion in the United States During the Coronavirus Disease 2019 (COVID-19) Pandemic. Obstet Gynecol. 2020 Oct;136(4):835-837.
  15. Fix L, Seymour JW, Grossman D, Johnson DM, Aiken ARA, Gomperts R, Grindlay K. Abortion Need among U.S. Servicewomen: Evidence from an Internet Service. Womens Health Issues. 2020 May-Jun;30(3):161-166.
  16. Grindlay K, Grossman D. Unintended pregnancy among active-duty women in the United States military, 2011. Contraception. 2015 Dec;92(6):589-95.
  17. Grossman D, Holt K, Peña M, Lara D, Veatch M, Córdova D, et al. Self-induction of abortion among women in the United States. Reprod Health Matters 2010;18:136-46.
  18. Aiken ARA, Broussard K, Johnson DM, Padron E. Motivations and Experiences of People Seeking Medication Abortion Online in the United States. Perspect Sex Reprod Health. 2018 Dec;50(4):157-163.
  19. Moseson H, Fix L, Gerdts C, Ragosta S, Hastings J, Stoeffler A, Goldberg EA, Lunn MR, Flentje A, Capriotti MR, Lubensky ME, Obedin-Maliver J. Abortion attempts without clinical supervision among transgender, nonbinary and gender-expansive people in the United States. BMJ Sex Reprod Health. 2022 Jan;48(e1):e22-e30.
  20. Moseson H, Herold S, Filippa S, Barr-Walker J, Baum SE, Gerdts C. Self-managed abortion: a systematic scoping review. Best Pract Res Clin Obstet Gynaecol 2020;63:87-110. doi: 10.1016/j.bpobgyn.2019.08.002.