SELF-MANAGED ABORTION
Self-managed abortion (SMA) includes any method of self-managing an abortion, such as medications, herbs, substances by mouth or vagina, and deep abdominal massage. Self-managed medication abortion (SMMA) specifically refers to the act of obtaining abortion pills outside of the clinical setting to end a pregnancy (e.g. from online sources, friends/family, or over the counter in some countries).
SMA Prevalence
SMA occurs worldwide, regardless of legal restrictions (Moseson 2020). People turn to SMA for various reasons, including greater bodily autonomy, a need to keep the abortion private from family or an abusive partner, distrust of healthcare institutions, social stigma, cost, distance, or legal barriers to accessing abortion care. While some prefer SMA, for others, it is their only option.
Although SMA is not new, medication abortion and therefore, SMMA are becoming more common. SMMA is recognized as a safe, simple and effective reproductive health option by professional organizations such as ACOG, SFP, and WHO. Evidence shows that individuals can accurately self-assess their eligibility for medication abortion, manage the process, and confirm completion (Johnson 2023, Moseson 2022a, 2022b).
SMA is not only a response to systemic barriers and legal changes (such as the overturn of Roe) but also an autonomous choice reflecting the needs of individuals seeking care (Ralph 2024, van den Dungen 2024). Post-Dobbs, the proportion of people in the U.S. attempting to self-manage abortion increased from 5% to 7%, with the use of mifepristone for SMMA nearly doubling from 6.6% in 2021 to 11% in 2023 (ANSIRH 2024). Efforts to expand access to safe, effective SMA methods can help mitigate legal and health risks for those who pursue this pathway.
SMA Safety
SMMA with accompaniment support has been demonstrated in various countries to be as safe and effective as clinician-provided abortion care < 22 weeks gestation (Moseson 2022b). When individuals have access to accurate information and reliable resources (e.g., hotlines, digital tools, or accompaniment programs), SMMA is both simple and remarkably safe (Moseson 2022b) and a critical component of reproductive healthcare.
Supporting SMA means addressing the structural inequities that limit access to clinical abortion care, particularly for marginalized populations. Communities most affected by systemic oppression are often at the forefront of seeking SMA due to intersecting barriers such as transportation challenges, restrictive laws, limited health center availability, and stigma. SMA provides a pathway to care that respects personal agency.
SMA is not limited to medication abortion alone; some people turn to herbal methods or herbal support practices deeply rooted in cultural and historical knowledge passed down through generations (Planned Parenthood 2023, RHAP 2023). Across different cultures, herbal practices have long been used, and for many, it remains a meaningful option. Some use herbs as their primary method, while others incorporate them alongside other approaches for cervical softening, hormonal regulation, or symptom management (Dutton-Kennedy 2024, RHAP 2023).
As clinicians, our role is to approach people choosing SMA with respect and validation rather than judgment. While research is limited, acknowledging herbal practices and providing non-judgmental, evidence-based support ensures that people feel safe when seeking care for follow-up, reassurance, or complications.
People may present at different stages of their SMA journey. A simple statement such as, “I’m so glad you were able to take charge of your reproductive health,” can foster trust and affirm a person’s agency.
The primary risk associated with SMA is not a medical complication but potential legal consequences, underscoring the importance of clinician support and advocacy for systemic protections (ACOG 2024).
Helpful Resources for Supporting SMA:
- Confidential Legal Support:
- Repro Legal Helpline
- Guttmacher Institute – state-specific SMA legal information.
- HIPAA & Patient Privacy Protections:
- Poison Control Hotline: 1-800-222-1222
- For concerns about SMA allergic reactions, toxicity, or rare poisoning.
- Guidance from Professional Organizations:
Grounded in an RJ framework, this curriculum encourages providers to meet people where they are, affirm their choices, and ensure they receive the care and respect they deserve.
Additional Resources:
Additional Provider Resources: