New Methods in a Millennia-Old Practice: Self-Managed Abortion

photo of a white pill that looks similar to Mifepristone

photo of a white pill that looks similar to Mifepristone

Self-managing abortion is a millennia-old practice, and newer, FDA-approved medications have increased its safety and efficacy. In CORE’s latest brief on Self-Managed Abortion, we consider the methods, legality, and implications of this approach. Given the leaked Supreme Court draft decision that suggests the likely overturn of nearly 50 years of legal precedent with Roe v. Wade, people’s use of self-managed abortion is likely to grow. CORE’s brief examines what the pattern of increasingly self-managed abortions means for people in need of abortion services and the landscape of reproductive healthcare in the U.S. 

People who self-manage their abortions use either medications approved by the FDA for abortion—misoprostol, also known as Cytotec, and mifepristone, also known as Mifeprex—or non-FDA-approved methods. Medical and public health organizations, including the American College of Obstetricians and Gynecologists and the World Health Organization, recommend the following regimens: mifepristone and misoprostol used together, and misoprostol used alone.  

Misoprostol works by causing the cervix to soften and the uterus to contract, which expels the pregnancy tissue. While misoprostol can cause an abortion, it can be more effective in combination with mifepristone, which blocks progesterone and prevents the pregnancy from progressing.  

Research finds that these methods are highly effective for most people, and the medications can be safely taken without an ultrasound or pelvic exam. Taking mifepristone and misoprostol as directed entails less risk of serious complication than taking Tylenol or having one’s wisdom teeth or tonsils removed. 

Methods that are not approved by the FDA include the use of plants and herbs, ingestion of toxic substances, intrauterine and physical trauma, alcohol and drug abuse, and other drugs and substances. In a recent national study, among those people who reported having ever self-managed an abortion, 38% used herbs and 20% used physical methods, such as being hit in the abdomen. These other methods are not currently used in formal healthcare settings, and are considered less safe and less effective than pill abortion. 

Medication abortion can be administered in a clinic setting or at home, but with self-managed abortion, a person who wants to end their pregnancy obtains and takes the medication outside of the formal healthcare system. 

Because self-managed abortion occurs outside of the medical system, it is difficult to measure how many people self-manage abortion care. Based on a recent study of people with the capacity to get pregnant, researchers estimated that approximately 7% of people who can get pregnant in the U.S. have attempted to self-manage an abortion at some point in their lives. In recent years, Aid Access has received about 50,000 requests annually for abortion medications from people living in the United States, and this nonprofit organization is only one of several mail-order services for medication abortion. Use of self-managed abortion is expected to increase as abortion becomes criminalized or increasingly restricted in many US states. 

The FDA has decided that certified providers may dispense medication abortion through the mail, but this approach is not legal in some states — including Wisconsin, where prior to Roe’s overturn, medication abortion must be given in the physical presence of a physician. However, the wording of Wisconsin’s 1849 statute also suggests that people who self-manage their abortions will not be criminalized. In the context of potential legal risks for abortion seekers and providers, it is important to consider online privacy in regard to self-managed abortion.  

Just as people ended pregnancies with herbs and other interventions for centuries, today, people are taking their healthcare into their own hands by self-managing abortions. Given the hostile climate of abortion access in many US states, including Wisconsin, the use of this method will likely increase- and it is critical that people are aware that safer methods now exist in the form of medication abortion.  


For more context and information on how health equity relates to self-managed abortion, read the new brief from CORE on our website. 

The Collaborative for Reproductive Equity (CORE) is an initiative at the University of Wisconsin-Madison School of Medicine and Public Health. CORE supports and translates rigorous, policy-relevant research on reproductive health, equity, and autonomy in Wisconsin and beyond. 

Learn more about CORE at our About page 

CORE Brief: Self Managed Abortion

CORE BRIEF: Self-Managed Abortion
June 2022
core@obgyn.wisc.edu
core.wisc.edu
@WiscCORE
Increased abortion restrictions in Wisconsin and other parts of the U.S. will very likely result in increases in
self-managed abortion, some of which will effectively and safely help people obtain desired abortions, but
some of which put people at risk for a variety of negative outcomes.

What is Self-Managed Abortion?
Self-managed abortion refers to when a person obtains an abortion outside the formal healthcare system. Historical
record suggests that people have self-managed abortions for millennia and continue to do so to this day.

File: CORE-Self-Managed-Abortion-Brief.pdf Self Managed Abortion

Current Laws Impacting Abortion In Wisconsin

A map of Wisconsin showing abortion clinic locations in Dane County, Sheboygan County, and Milwaukee County. There are four clinics as of May 2022.

There’s a lot going on in the abortion policy landscape. Here at UW CORE, Collaborative for Reproductive Equity, we are keeping track of the current policies, and will continue to provide updates should these policies change.

In this CORE Brief, we explore Wisconsin State Laws Impacting Abortion Access. This includes data on current abortion clinics in Wisconsin, abortions by race and by age, and the overall number of abortions from 2009 to 2019.

In Wisconsin, only four health clinics currently provide abortion services. These clinics are located in three counties (Dane, Sheboygan, and two in Milwaukee), meaning that 96% of the state’s counties do not have an abortion provider. Nearly 70% of Wisconsin women of reproductive age (between 15 and 44 years) live in a county that lacks an abortion care clinic. Further, an analysis of state data from 2009-2017 showed that due to recent clinic closures, residents of some counties experienced great increases in driving distances to obtain abortion care. Increases in driving distance make obtaining an abortion more costly in terms of both time and money.

A map of Wisconsin showing abortion clinic locations in Dane County, Sheboygan County, and Milwaukee County. There are four clinics as of May 2022.
A map of Wisconsin showing abortion clinic locations in Dane County, Sheboygan County, and Milwaukee County. There are four active clinics as of May 2022.
Number of abortions that occurred in Wisconsin, 2009-2019. A line graph shows data points ranging from 8542 abortions in WI in 2009, to 6511 abortions in WI in 2019.
Number of abortions that occurred in Wisconsin, 2009-2019. Data comes from the Wisconsin Department of Health Services.
Abortions that occurred in Wisconsin, percentage by race, 2019. Pie chart showing that 51% of abortions in 2019 were among white people, 14% were of people of unknown racial identity, 1% were among American Indian people, 28% were among Black people, 2% were among people of multiple racial backgrounds, and 4% were among people of Asian and/or Pacific Islander backgrounds.
Abortions that occurred in Wisconsin, percentage by race, 2019. Data from the Wisconsin Department of Health Services.
Wisconsin Abortions by age, 2019. A bar chart shows that in 2019, 17 people under 15 years of age received abortion care, 184 people ages 15-17 received abortion care, 506 people ages 18-19 received abortion care, 1,917 people ages 20-24 received abortion care, 1,806 people ages 25-29 received abortion care, 1,202 people ages 30-34 received abortion care, 637 people ages 35-39 received abortion care, 224 people ages 40-44 received abortion care, and 18 people ages 45 or older received abortion care.
Wisconsin Abortions by age, 2019.

 

Learn more in CORE’s Brief, Wisconsin State Laws Impacting Abortion Access.

 

What Will Happen In Wisconsin If Roe Falls?

CORE has paid close attention to the leaked draft opinion in the Supreme Court’s Dobbs v Jackson Women’s Health Organization case that suggests Roe v Wade will be overturned. The opinion is not final; abortion remains legal, and clinics are still open. However, pending changes to abortion access in Wisconsin are extremely likely.

CORE has prepared a brief that reviews the potential legal scenarios and consequences of the Supreme Court’s forthcoming final decision. If Roe is officially overturned by the Court, abortion services in Wisconsin will almost certainly be unavailable. Research suggests that the denial of desired abortion services will have serious repercussions for the lives, families, and communities of Wisconsinites forced to carry unwanted pregnancies to term.

Here at CORE, we document the determinants of reproductive equity, including the impact of abortion access (or lack thereof) on Wisconsinites’ heath and wellbeing across the life course. We will continue to conduct policy-relevant research and produce evidence-based materials—both for this moment and for the long haul. We are also committed to listening to and collaborating with organizations who work to advance reproductive equity on multiple levels.

Learn more at our latest CORE brief, “What Would Happen In Wisconsin if Roe v. Wade Falls? Consequences of the Upcoming Dobbs v. Jackson Women’s Health Organization Supreme Court Decision.”

Gender-Affirming Hormone Therapy in Wisconsin: Opportunity to Expand Access by Enabling Family Planning Providers to Bill Medicaid

a blue, pink, and white trans flag

There is an opportunity in Wisconsin to expand access to gender-affirming care for low-income, transgender people in our state. Rachel Dyer, a CORE researcher and a PhD student in the UW-Madison Department of Counseling Psychology, prepared a brief on this subject with support from CORE staff. In it, Dyer dives into the process and potential outcomes of updating Wisconsin’s Medicaid policy to expand specific family planning coverage.

Dyer compiles extensive research showing that gender-affirming hormone therapy, or GAHT, can improve the health and wellbeing of transgender people. GAHT is a safe and effective form of medical care that may be sought by transgender, nonbinary, two-spirit, gender nonconforming, and other gender diverse people. Like other forms of gender-affirming care, the purpose of GAHT is to support transgender people in feeling more aligned with their gender identity, namely by reducing sex characteristics that they were born with and inducing sex characteristics that align with their gender identity.

Wisconsin could efficiently expand access to GAHT by permitting family planning clinics to bill state Medicaid for GAHT services provided in their clinics. Because each state determines for itself what constitutes family planning and what services can be covered, Wisconsin has the ability to expand the interpretation of family planning to include important healthcare services that fall under the umbrella of GAHT. As a major form of regular and preventative healthcare, family planning providers have a unique capacity to provide gender-affirming services.

The reach of family planning clinics in Wisconsin also make them a useful choice for a site to provide GAHT; there are approximately 150 clinical sites in rural and urban communities across the state that already provide publicly-funded family planning services. Further, expanding Medicaid coverage to include GAHT services provided at these clinics would be of minimal cost to the state of Wisconsin.

To learn more about the importance of clinical provision of gender-affirming hormone therapy, and the opportunity to expand access via Medicaid coverage, check out our CORE Brief.

 

New Brief: Wisconsin’s Proposed Changes to Reproductive Health Funding

several patients wait in a clinic lobby

several patients wait in a clinic lobby

NEW CORE BRIEF: What would happen if reproductive healthcare providers were unable to participate in the Wisconsin Medicaid program?

Members of the Wisconsin state legislature recently passed new legislation that would prohibit healthcare organizations that perform abortions from being certified under the state’s Medical Assistance program.  This prohibition would mean that these clinics could not be reimbursed for other healthcare services provided to Wisconsinites as part of the state’s Medicaid program. Evidence suggests that this policy would have a negative impact on thousands of residents.

The bill is currently on the Governor’s desk.

What is the policy?
Existing Wisconsin state law already prohibits the use of any state, local, or federal funding to cover abortion care services except in limited circumstances. The proposed bill would add a major new level of restriction: it would prevent any healthcare organization that performs abortions from participating in the Medicaid program altogether. Most centrally, this ban would impact family planning clinics that provide abortion care, preventing them from seeking reimbursement from the Medicaid program for any of the reproductive health services they provide, not only abortion. Such vital services include contraception, sexually transmitted infection testing and treatment, and breast and cervical cancer screening.

Implications for Wisconsin
Research indicates that if Wisconsin state law were to prohibit healthcare providers that perform abortions from participating in the state Medicaid program, tens of thousands of Wisconsinites would lose access to essential reproductive healthcare services.

Read the full brief here, and check out our visual explainer on Instagram or Twitter.