Research and story by Pro-Choice Washington staff Clareta Tsang
Self-managed abortions are a reality for many people.
With the changing legal landscape for abortion access and reproductive freedom in many states, self-managing your care is often the only option available.
People self-manage their abortions for a variety of reasons: not wanting their abortion to be traced; not wanting law enforcement or partners to know; or not having the resources to get care at a clinic.
For others, a self-managed abortion is an affirmative, positive choice, based on wanting more privacy, more flexibility, and more control over the process.
Pro-Choice Washington’s recently released Abortion Access Guide is a comprehensive resource for patients who want to learn more about abortion care and access in Washington. The guide focuses on the ways you can get care through the formal health care system, including telehealth, clinic care, medication abortion, and other alternatives.
What is a Self-Managed Abortion?
Self-managed abortion is when a person gets an abortion outside of the formal health care system, meaning they don’t see or get help from a medical provider.
This can mean using medication abortion pills obtained online without a prescription or through abortion networks in one’s community. It is not the same as telehealth.
Why Do People Get Self-Managed Abortions?
There are many reasons why people choose to self-manage their abortions. Some people don’t feel comfortable with or don’t trust the health care system. Others may not have clinics in their communities. Sometimes it can be an issue of cost and another barrier to accessing care.
There may also be legal restrictions around abortion that make it difficult for a person to get care from a provider. Lastly, some people simply feel better about being able to self-manage their abortion in the convenience of their own home and in their own time.
Self-Managed Abortion and Legal Risk
Self-managed abortion is legal in Washington state, but your legal risks may be different depending on your situation. People who help others get self-managed abortions have also sometimes faced legal risks as well.
If you have legal questions or concerns about getting a self-managed abortion, you can contact Repro Legal Helpline at 844-868-2812. Repro Legal Helpline is a free, confidential legal helpline that serves people in every state in the U.S., including Washington state.
Self-Managed Abortion with Abortion Pills is Safe and Effective
Medication abortion, or medical abortion, is very safe and effective, especially when used to end pregnancies of 11 weeks or less. According to Planned Parenthood, you can have a medication abortion after 12 weeks, but this will change the number of pills you will need to take, and it can be less effective.
Before you decide to self-manage your abortion, it is important to confirm how many weeks your pregnancy is. You should also make sure that you don’t have an IUD (or intrauterine device) in place, have an ectopic pregnancy (when the pregnancy forms outside of your uterus), have a bleeding problem or are taking certain long-term steroid treatments.
After a medication abortion, you can expect to have side effects such as:
- Vaginal bleeding
- Abdominal cramping and pain
- Nausea, fever, chills, headache, dizziness, vomiting, and diarrhea
Complications are very rare but include hemorrhage (heavy vaginal bleeding), infection or persistent pain. If you have heavy vaginal bleeding that soaks through more than 2 full-size maxi pads per hour for 2 hours in a row, you should contact a provider immediately.
While also very rare, one potential risk of using medication abortion for a self-managed abortion is if you have an incomplete abortion and the pregnancy continues. It’s a good idea to take a pregnancy test around 4-5 weeks after (earlier can give you a false positive) your self-managed abortion to make sure you aren’t still pregnant. If you find out that you are still pregnant, you should contact a provider immediately.
Having a self-managed abortion using medication abortion doesn’t put you at a higher risk of having health problems in the future like breast cancer, infertility or depression.
Where Can I Get Medication Abortion Pills?
You can get medication abortion pills for a self-managed abortion by ordering from online sources and receiving them in the mail. These sites don’t need you to see a doctor or have a prescription. In turn, they don’t offer medical support.
Plan C is a website you can use to get more information about getting abortion pills online. People who self-manage their abortions sometimes get pills from friends or through abortion activist groups in their community.
How Do I Use Medication Abortion Pills?
If you decide to self-manage your abortion using medication abortion pills, here’s what you will need:
- Pregnancy test(s)
- Medication abortion pills (mifepristone and/or misoprostol)
- Over-the-counter pain medication
- Maxi pads
- Access to a bathroom
It may also be a good idea to make sure that you are within 1 hour of a hospital and to have a trusted person available in case you need help.
There are two ways that people typically will take medication abortion to end their pregnancy. The number of pills you need will also differ depending on how far along your pregnancy is. Plan C has a guide for how to take the pills depending on how many weeks it has been from your last period.
A common way to use medication abortion is to use both mifepristone and misoprostol. This method is approved by the Food and Drug Administration (FDA). Learn how to use Mifepristone and Misoprostol for your self-managed abortion here.
Sometimes when mifepristone is unavailable, misoprostol can be used alone to end a pregnancy. This method is approved by the World Health Organization (WHO). Learn how to use Misoprostol only for your self-managed abortion here.
If you need medical support during your self-managed abortion, you can get free help by calling or texting the M+A Hotline at 1-833-246-2632. The hotline is available from 5 AM PST (8 AM EST) to 10 PM PST (1 AM EST).
In the event you have a medical emergency, the Emergency Medical Treatment & Labor Act or EMTALA guarantees your right to go to any hospital to get care. If the hospital cannot provide care, they must provide you with a referral to one that can.
If you are denied care in a medical emergency related to a pregnancy outcome, call Repro Legal Helpline.
You do not need to tell medical providers that you have taken medication abortion pills or are trying to have an abortion. Ending a pregnancy with a medication abortion looks the same as a miscarriage, and providers generally cannot tell the difference.
Self-Managed Abortions in Our Current Moment
Abortion and self-managed abortion are legal in Washington state. To keep this access and improve health care for everyone, here’s what you can do during this legislative session:
- Support the Shield Law (SB 5632)
- Support Amending the Parent Rights Initiative to Bring it into Alignment with Existing Law (SB 5181)
- Support Safe and Inclusive Schools (HB 1296)
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