For more on the future of abortion, check out our special edition.
We all love people who have abortions. We don’t always know the story behind peoples’ abortions; we fall into traps of making assumptions about why they needed this care, how they accessed this care, and how they feel about it now.
Instead of assuming, we should listen and be accepting and understanding of the diverse range of experiences of abortion. This includes self-managed abortion care.
I became a physician and specialized in family medicine because I not only enjoy science and health, but I also enjoy talking with people about their lives. It is so important to listen to the experiences, values, and truths of my patients. When I interact with them, I wonder: “What do they do in their day to day? What does their household look like? What makes them happy? What does their future look like?”
Sex. Abortion. Parenthood. Power.
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The answers to these questions can directly affect their health and well-being, and this includes their sexual and reproductive health. As I continued listening to their stories, it became clear to me that in order to provide comprehensive care to patients, I needed to be an abortion provider, and I needed to talk about abortions as a normal part of health care.
When most people I talk to think about abortion care, they imagine a person going to a clinic to receive that care. When the conversation turns to abortion care at home, even well-meaning “pro-choice” supporters talk about not wanting to “return to the days of coat hangers,” referencing experiences in the 1950s and ’60s before Roe v. Wade. There is rarely an open conversation, especially among “pro-choice” supporters and medical professionals, about the realities of accessing abortion care at home without formally engaging in the medical system, or self-managing abortion care.
Accessing abortion care at home without contacting a health-care provider often looks like buying mifepristone and/or misoprostol, the two medications that safely and effectively end a pregnancy, from local sources or ordering these pills online. The ability to self-manage abortion care in this manner is just as necessary as care in a clinic, and should be a part of the abortion-care conversation when talking about achieving equity in reproductive health, rights, justice.
You might assume that someone would only self-manage their abortion if their state has a lot of abortion restrictions, or if they live too far from a clinic, but that is not always the case. Some people in the liberal meccas of New York City and Los Angeles self-manage their abortions, and they don’t always choose this type of care as a last resort or out of desperation—this is the care they want and need, in the way they want and need it.
I know this because I talk with people, and their reasons for accessing this care are varied and made based on their current circumstances. We also know that people of color, especially Black people, have undergone—and still undergo—blatant examples of racism in medicine and reproductive health care that need to be fully acknowledged and corrected. That means we need to talk about self-managed abortion as a racial justice issue.
No one should have to justify why they’re ending a pregnancy or which method they’re using to do so. But through conversations, I’ve learned some of the many reasons people choose to self-manage their abortion care, like feeling more comfortable going through the process at home without their doctor knowing, being able to access the medications sooner by obtaining the pills themselves, or believing that self-managing works better for their work, school, or family schedules.
Most people know their own bodies—they know when they had a period, they know when they’re pregnant, they know when they’re no longer pregnant, and they know if they’re experiencing something that might need in-person medical care. Medical professionals and supporters of bodily autonomy need to recognize this reality. Self-managing an abortion with medications deserves to be at the forefront of advocacy and access efforts, along with decriminalization of the ways people access abortion care.
I was recently in a meeting with other medical professionals and advocates, and I shared a conversation I had with someone who self-managed their abortion. This person told me they bought mifepristone and misoprostol several months ago to have on hand “just in case.” Well, the “just in case” happened: They became pregnant and no longer wanted to be pregnant. After they had a positive pregnancy test, they followed the World Health Organization’s protocol to use the mifepristone and misoprostol to safely and effectively end the pregnancy.
I shared this story as an example of how people often can anticipate their own needs, and then, based on their needs, make the best decisions for their bodies and circumstances. I wanted to highlight how we need to refocus our advocacy efforts in a patient-centered manner. One member of the meeting commented that the current Food and Drug Administration rules don’t allow us to prescribe mifepristone and misoprostol under “just in case” circumstances. This comment is exactly why I shared this story—because we, both medical professionals and advocates, shouldn’t be the gatekeepers to the care that people need.
The decision whether or not to parent often rests in the hands of power-holders and decision-makers that don’t look like us and don’t live in our communities. If someone wants to go to a clinic to access abortion care, that’s OK, but if someone wants to self-manage their abortion in the community, that’s OK as well. We should be the decision-makers for our own bodies; we need to shift the dynamic and make that a reality by discussing and advocating for community-centered abortion care. And that includes self-managed abortion care.