By Dr. Serina Floyd, Medical Director, Planned Parenthood of Metropolitan Washington, D.C.
April 11th marks International Day for Maternal Health and Rights, an opportunity to elevate the challenges faced by women and girls around the globe in their efforts to obtain respectful, safe, and quality comprehensive reproductive health care. This call-to-action focuses on the experiences of individuals accessing maternal health care, but it is also an opportunity to highlight the difficulties faced by those who seek abortion care.
In too many places around the world, including in the U.S., access to abortion care is severely limited, or nonexistent. The barriers are many and include legal restrictions, financial barriers, lack of clinics or providers, distance to facilities, and lack of knowledge about how and where to access services. For these reasons, as well as women's desires for increased autonomy, greater convenience and more privacy, self-managed abortion is gaining acceptance as an option. Self-managed abortion is the managing of one's own abortion, outside of a medical setting, and is also known as "DIY" abortion. Evidence supports that this preference is becoming more widespread in practice. In 2015 there were 700,000 google searches for information on self-managed abortion. A national survey of U.S. abortion patients revealed that 2% of patients reported attempting to self-manage their abortion, and a study of abortion patients in Texas found 7% had taken or done something to try to end their current pregnancy. Another survey of Texas women estimated that 100,000 had attempted to self-manage abortion at some point in their lives.
Self-managed abortion occurs in countries where abortion is legal, like many North American and European countries, as well as in countries where it is illegal, like many South American and African countries. For millions of women around the world, self-management may be their only option for abortion care.
Despite the frequency of utilization of self-managed abortion the practice can have legal consequences. An analysis of 196 countries’ laws using the World Health Organization’s (WHO) Global Abortion Policies Database, reveals that all but Canada and China criminalize abortion performed outside of a clinical context. In countries including Bolivia, Rwanda, South Africa, and Nepal, women are arrested for ending their pregnancies with medications while outside of medical care, even when abortion may be deemed legal. In the U.S., where abortion is legal through the second trimester, more than 40 different types of laws have been or could be used to prosecute individuals attempting to self-manage abortion. A number of women have been arrested and prosecuted under various state statutes including those that explicitly criminalize self-induced abortion, laws that regulate tissue disposal, laws against obtaining or helping someone to obtain abortion-inducing medication, laws on child endangerment, feticide, and even homicide.
Cases of women who have been arrested while attempting to end their pregnancies, such as the 19-year-old in Florida who shot herself in the abdomen or the 17-year-old in Utah who paid a man $150 to beat her, illustrate the extent to which a woman will go when safe abortion is not available or accessible. Even those attempting self-managed abortion with medication have risked their freedom to exercise choice, like the Georgia woman charged with murder for taking abortion pills she ordered online, or the mother sentenced to 18 months in jail because she helped her daughter procure abortion-inducing drugs.
Criminalizing self-managed abortion has many negative consequences, including those that directly threaten healthcare utilization. Fear of prosecution, and in the case of immigrant women deportation, deter women from seeking much needed care, including care for miscarriages, substance use disorders, or complications from abortion. Legal and administrative policies that require providers to report women suspected of self-managed abortion compromise patient-physician relationships and run counter to the legal and ethical obligations a provider has to protect patient confidentiality.
Laws that criminalize self-managed abortion infringe upon the dignity, agency, autonomy, and self-determination of women. They are direct efforts to remove control over women’s bodies from women themselves. Decriminalizing self-managed abortion is an ethical, rational and harm reduction strategy that should be pursued in countries throughout the world in an effort to advance social change towards not just reproductive rights, but also human rights.