Insights: Self-Managed Abortion: What Clinicians Need to Know
Self-managed/self-sourced medication abortion (SMA) with mifepristone and misoprostol or misoprostol alone is safe and effective. It can be empowering and life-saving.1,2 As abortion restrictions and bans spread across the US, primary care clinicians and other health professionals will encounter more patients who are interested in using or have used these medications on their own. Most people simply need information and reassurance.
With the risks of criminalization in an ever-changing legal landscape, clinicians have the responsibility to care for their patients with compassion and to uphold their bodily autonomy, safety, and health care needs. Key ways clinicians can do this include:3
- Provide patients with information about their health and pregnancy with options counseling, pregnancy dating, assessing history/eligibility to use abortion pills, information about how to use the pills, what to expect when taking the pills, and offering follow-up if desired.
- Clinicians working in a state where abortion is illegal may want to frame suggestions as general information, rather than specific advice for ending a pregnancy.
- Document judiciously: only document what you need to know for current and future care.
- Do not report. Legal experts are unaware of any laws requiring a clinician to report SMA or a patient’s intention to self-manage an abortion to law enforcement.
- Only ask questions necessary to provide care. You don’t usually need to know if a patient self-managed.
- Be familiar with the laws in your state and consult an in-state attorney with specific legal questions.
Our new resource, “Approach to Patients Undergoing Self-managed Medication Abortion” shares common questions and concerns clinicians may hear about SMA and how you can answer patient questions and share important information. Some highlights include:
- “How do I know the pills are real?” – Plan C offers information about authentic pills for medication abortion.
- “What’s the best way to use the pills?” – Providing instructions to patients carries very little legal risk for clinicians. Vaginal insertion of misoprostol may leave pill fragments that can be detected on a clinician’s exam. Buccal and sublingual insertion of pills do not leave pill fragments and may be less likely to trigger criminalization.
- “Can anyone tell that I used these pills?” – Assure patients that there is no blood test or exam that proves they attempted to end a pregnancy with pills. Patients who need in-person care may want to express concern about a miscarriage.
RHAP Resources:
Approach to Patients Undergoing Self-Managed Medication Abortion
Self-Managed Abortion Resource Page
How to Use Abortion Pills: Misoprostol Alone
Non-RHAP Resources:
Talking to Health Care Providers After an Abortion or Miscarriage
Know Your State’s Abortion Laws: Guides for Medical Providers
Sources:
1. Abortion care guideline. Geneva: World Health Organization; 2022. License: CC BY-NC-SA 3.0 IGO
Pharma-free
The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or products. The information in Insights is unbiased, based on science alone.
