Abortion with Pills without a Clinician: The NWHN’s Position on Self-managed Abortion Using FDA-approved Medication

December 5, 2016, updated February 27, 2018

The concept of abortion is as old as pregnancy itself; women have desired to control their fertility for as long as they have been able to get pregnant. The National Women’s Health Network defends women’s sexual and reproductive health and autonomy against anti-choice threats that seek to undermine access to contraception and abortion care. As an organization, we place great value on women having the autonomy, information, and resources necessary to make the decision that is best for them and their family—in fact, we were founded on it. We trust women and support them to make decisions that make sense for them in the lives they are living and to reject narratives that don’t place their autonomy in the highest regard.

In the United States, people seeking medication abortion (a combination of mifepristone + misoprostol or misoprostol-alone) and surgical abortion face politically motivated barriers to access from anti-choice politicians. These barriers prevent people from accessing safe and effective abortion care. In many other countries, however, people are able to walk into a local pharmacy and purchase abortion kits (containing both mifepristone and misoprostol) and Cytotec (misoprostol) over the counter to end their pregnancy. Online services, such as Women on Web, have also been shipping pills to those who need them for more than 10 years. (Cytotec is an inexpensive medication that, in addition to being an abortifacient, is commonly prescribed to treat stomach ulcers and post-partum hemorrhage.) In these countries, women are able to make this decision for themselves without involving a health care provider.

People should have access to safe, affordable abortion care with the assistance of a medical provider if and when they so choose. We recognize that in some situations, it is appropriate for doctors and providers to serve as a “gatekeeper” to health care, e.g. when it takes specialized training to diagnose a condition and safely use a prescription medication. In these cases, the provider protects the patient from harm by serving in this capacity. Our values lead us to a different conclusion when a person has decided to terminate a pregnancy, however. Even if they have access to a provider, some people may choose to self-manage. We acknowledge and support that choice.

Since 2011, there has been a large upswing in the number of anti-choice bills introduced and passed at the local, state, and national levels. Barriers to provider-led abortion access have contributed to an increasing number of women seeking ways to end their pregnancies without involving a provider. When women who want provider-led care are blocked from receiving it and are forced into alternatives they would not otherwise choose, the system is broken.

But, just as some women prefer to give birth at home, so too do some women prefer to have an abortion without a provider’s involvement—and their choice should be respected. Both mifepristone used with misoprostol and misoprostol (Cytotec) used alone are safe and effective medications for terminating an unwanted pregnancy. Women should not have to see a doctor, or “get permission” from the medical community, before ending their pregnancy with an FDA-approved medication.* Certainly, women who choose to self-manage should not face criminal charges for doing so. But even more broadly, medication abortion without the involvement of a provider is not a failure of the system, but rather one option of many that women ought to be able to choose for themselves.

The NWHN seeks to eliminate the full range of barriers to abortion access, from insurance coverage and cost to geography to stigma, that block women who would prefer provider-led abortion care from receiving it. But we also acknowledge and support the right of women to end pregnancies on their own, safely, with FDA-approved medicine*, and without fear of persecution.

As a society, we must trust that people will make the best decisions for themselves and their families, even if it is not the method preferred by their provider. Reproductive health care needs are as unique as the people who have them, and we must trust people’s decisions are right for them.

Pregnant individuals seeking to end a pregnancy on their own may have access to mifepristone and misoprostol pills, which are used following the same dose and schedule provided in clinics, or may take only misoprostol, following a different dose and schedule. (Misoprostol alone is up to 80% effective.) Two trusted websites AbortionPillInfo.org and PlanC provide information on how to access and use abortion pills in the US without a clinician. You can learn more about medication abortion from our health information fact sheet. Learn more about the role of politics in shaping access to medication abortion and what the NWHN is doing to help.

* This paper addresses the use of FDA approved medications for self-managed abortion.  It is not intended to address the use of unregulated products or techniques, such as herbs or uterine massage, where the safety and effectiveness may be unknown. We do not consider menstrual extraction as practiced by self-help groups to be self-managed abortion.

 





 

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