Self-Managed Abortions Are on the Rise But Not All Methods Are Safe

In June of 2022, the United States Supreme Court ruling on Dobbs v. Jackson Women's Health Organization overturned the landmark Roe v. Wade decision, the landmark case that recognized a person's right to abortion care. Subsequently, the Dobbs decision removed federal protections for people seeking abortion care. Almost immediately, there was a confusing patchwork of state laws across the country where, in some places, abortion care was outright banned. In other areas, the legality of abortions began to see sharp debate. Despite this, self-managed abortions have continued to rise.

Researchers followed and documented trends in online telemedicine requests for medications to self-manage abortions before and after the Dobbs ruling, and, perhaps unsurprisingly, they found that requests for the medication increased immediately after the Supreme Court's Dobbs decision, particularly in states that had a total ban on abortion care.

But even before the US Supreme Court decided on Dobbs, self-managed abortions had been steadily climbing. This was partly due to the availability of abortion medication online. Additionally, there has been an increase in public awareness about the two FDA-approved medications for abortion, mifepristone and misoprostol, both of which are very safe and highly effective.

Self-managed abortion in itself is not a cause for concern. However, attempting to self-induce an abortion outside of clinical care and with tools or ingredients other than FDA-approved medication can put people at risk health-wise and legally. Here are the facts.

Why Are More People Self-Managing Abortion?

There are many reasons why a person may seek to end a pregnancy on their own.

"In our research, people report a variety of reasons for attempting to self-manage their abortion. Many people say they did this because of barriers accessing clinic-based abortion care. Some of those barriers include the cost of care, distance to clinics, not knowing where a clinic was, and for adolescents a concern (true or not) that parental consent was required," says Daniel Grossman, MD, and OB-GYN and reproductive health researcher at the University of California, San Francisco.

"Another group of people express a preference for self-managed care—because they see it as more natural or less invasive. Some say they use herbs or supplements to manage all their health care, and they see self-managed abortion as a natural extension of that," he adds.

Another cause is decreased access to abortion care providers. In 2017, 808 clinic facilities provided abortions, a 2% increase from 2014. However, regional and state disparities in clinic availability grew more pronounced; the number of clinics increased in the Northeast and the West by 16% and 4%, respectively, and decreased in the Midwest and the South by 6% and 9%, respectively. And that was before the aftermath of the Dobbs decision.

The changing legality and potential consequences of abortion post-Dobbs may be another reason why people are choosing to self-manage an abortion. For example, in Texas, Senate Bill 8 (SB8), which was signed into law in 2021, bans nearly all abortion care and allows private citizens to file a civil lawsuit against anyone who knowingly "aids or abets" an abortion. For some Texans, self-managing abortion at home may feel less risky than traveling to an out-of-state clinic for abortion care.

According to the Association of American Medical Colleges, anti-abortion laws are impacting not just individuals seeking abortions but also where new doctors are choosing to practice—new doctors are avoiding residencies in states with anti-abortion laws.

Health Risks of DIY Abortion Methods

A 2019 study published in the journal Contraception of 650 abortion providers found that two-thirds of respondents had experiences with people attempting to self-manage abortion, and about one-third witnessed complications related to self-managed medication abortion.

"People report a variety of methods, including vitamins, herbs, medications, and physical methods like getting hit in the abdomen," says Dr. Grossman.

While some methods are obviously alarming and unsafe, others have become increasingly common due to the belief that they are a "natural" solution. A 2011 study published in the American Journal of Obstetrics & Gynecology found that 1.4% of 9,493 people surveyed reported using vitamin C or herbal products to attempt to end a pregnancy. However, there is no scientific or clinical evidence these methods work.

Vitamin C abortion

The term "vitamin C abortion" refers to a questionable method of ending a pregnancy that requires taking large amounts of vitamin C, also known as ascorbic acid, for several days. But can taking too much vitamin C really cause a miscarriage?

"There is not good data about the effectiveness of herbs or vitamin C, and we have interviewed some women who reported using these methods, which were not effective and delayed them in the process of obtaining a clinic-based abortion," says Dr. Grossman.

In fact, a 2016 review of vitamin supplementation used to prevent miscarriage found that there was no difference in the risk of total fetal loss by taking vitamin C. Not only that, taking vitamin C during pregnancy has been studied to help reduce the risk of pregnancy complications such as pre-eclampsia, intrauterine growth restriction, and perinatal anemia.

Vitamin C is safe to take and unlikely to cause harm during pregnancy, even at high doses of more than 2,000 milligrams; however, doses higher than 2,000 milligrams can cause nausea, vomiting, and diarrhea. The more likely consequence of attempting a "vitamin C abortion" is the time lost while waiting to see if it works.

Herbal abortion

An herbal abortion is a self-induced abortion method that requires taking excessive amounts of certain herbs to induce bleeding and uterine contractions. The herbs involved in herbal abortion methods are often referred to as emmenagogues, which are herbs that are capable of stimulating the menstrual flow even when it is not due. These herbs include:

• Coleus (Coleus forskohlii)
• Cotton root bark (Gossypium spp.)
• Eucalyptus (Eucalyptus spp.)
• Goldenseal (Hydrastis canadensis)
• Motherwort (Leonurus cardiac)
• Mugwort (Artemisia spp.)
• Pennyroyal (Mentha pulegium)
• Tansy (Tanacetum vulgare)
• Yarrow (Achillea millefolium)

Other herbs used may include tansy, thuja, safflower, scotch broom, rue, angelica, wormwood, and parsley oil/parsley apiole. These herbs pose toxicity risks for people taking them, including kidney and liver damage, tissue damage, internal bleeding, and even death.

Legal Risks of DIY Abortion Methods

"I don't have any medical concerns about self-managed abortion, particularly when effective medications are used early in pregnancy," says Dr. Grossman. "But I do have concerns about the legal risks people take."

The American College of Obstetricians and Gynecologists (ACOG) released its position on decriminalizing self-induced abortions in a statement in December 2017: "The threat of prosecution may result in negative health outcomes by deterring women from seeking needed care, including care related to complications after abortion."

ACOG also opposes administrative policies that interfere with the legal and ethical requirement to protect private medical information by mandating OB-GYNs and other clinicians to report to law enforcement people they suspect have attempted self-induced abortion. Such actions compromise the integrity of the patient-physician relationship.

But that hasn't stopped lawmakers from attempting to—and in some cases succeeding in—passing laws to restrict abortion care, including self-managed abortions.

How To Manage an Abortion Safely

The FDA only has two approved drugs for medication abortion: mifepristone and misoprostol. It was approved in 2000. Mifepristone works to block pregnancy-enabling hormones, while misoprostol causes uterine contractions. The two-drug method is most effective, at 98%, while misoprostol taken alone is 80% effective. The legality of access to mifepristone has been challenged in the courts in 2023 and may soon change.

Rather than attempting to end a pregnancy through potentially unsafe and ineffective DIY methods like an herbal or vitamin C abortion, experts advise people to visit a health clinic or an OB-GYN office to access FDA-approved medications under medical supervision. Given the political landscape, however, not everyone has access to in-person abortion care, and some may need to seek abortion medication online. A few safe and reputable sources include:

• Planned Parenthood: You can search their database of services based on in-person or telehealth care.
• Abortion Finder: Abortion Finder provides information on nationwide verified abortion care and support.
• Plan C: Search by state to view options for at-home access.
• Hey Jane: Hey Jane offers services in 19 states and the District of Columbia. If you can physically get to one of those states, then you are eligible for the services. The company has partnerships with local abortion organizations to offer financial support for those who need help facilitating travel.
• AidAccess: This organization offers medication through the mail, including "advanced provisions" to keep on hand in case you need access in the future.

Since laws vary from state to state regarding your rights to terminate a pregnancy, the best place to start is by contacting your local Planned Parenthood for more information about where to get abortion medication.