Self-managed Abortion in the US

Abortion pills on TV: An exploratory study of the associations between abortion plotline viewership and beliefs regarding in-clinic and self-managed medication abortion

OBJECTIVES

Entertainment television is an influential source of health information, including about reproductive health. We investigated the association between exposure to television plotlines about medication abortion on audience awareness and beliefs about medication abortion.

STUDY DESIGN

We administered a national cross-sectional online survey from December 2021 to January 2022 with a probability-based sample of people assigned female at birth. We asked respondents to select plotlines they had seen from a list of seven that portrayed medication abortion. Among the 3425 people who responded to plotline items, 3340 responded to our outcome measures. Using weighed multivariable analyses, we examined adjusted relationships between exposure to specific types of abortion plotlines and awareness of and beliefs about medication abortion medical safety.

RESULTS

We found that audience exposure to medication abortion plotlines in which the medication abortion was obtained from a clinic and portrayed as safe was associated with greater awareness of medication abortion compared to nonexposure (RR: 1.68; 95% CI: 1.17, 2.40). Exposure to plotlines that portrayed MA or self-managed MA as safe was associated with audience beliefs that medication abortion is safe.

CONCLUSIONS

This study demonstrates that the content of abortion plotlines and exposure to accurate information may be connected to audience awareness of and beliefs about abortion.

IMPLICATIONS

In a climate of misinformation about abortion, audience exposure to medically accurate television plotlines about medication abortion may be an effective way to increase awareness of medication abortion and influence beliefs about medication abortion safety.

Health care use and health consequences of geographic lack of access to abortion and maternity care

BACKGROUND

Recent years have brought substantial declines in geographic access to abortion facilities and maternity care across the US. The purpose of this study was to identify the reproductive health consequences of living in a county without access to comprehensive reproductive health care services.

METHODS

We analyzed National Center for Health Statistics data on all live births occurring in the US in 2020. We used data on locations of abortion facilities and availability of maternity care in order to classify counties by level of access to comprehensive reproductive health care services and defined comprehensive reproductive health care deserts as counties that did not have an abortion facility in the county or in any neighboring county and did not have any maternity care practitioners. We fit modified Poisson regression models with generalized estimating equations to estimate the degree to which living in a comprehensive reproductive health care desert was associated with receipt of timely and adequate prenatal care and risk of preterm birth, controlling for individual-level and county-level characteristics.

RESULTS

In 2020, one third of counties in the US were comprehensive reproductive health care deserts (n = 1082), and 136,272 births occurred in these counties. In adjusted models, there was no difference in prenatal health care use (timeliness or adequacy of care) between persons in comprehensive reproductive health care deserts and those with full access to care, but the risk of preterm birth was significantly elevated (aRR =1.09, 95% CI = 1.06, 1.13).

CONCLUSIONS

Lack of access to comprehensive reproductive health care services may increase the incidence of preterm birth.

Provision of Medications for Self-Managed Abortion Before and After the Dobbs v Jackson Women's Health Organization Decision

Importance

The Supreme Court decision in Dobbs v Jackson Women's Health Organization overturned the right to choose abortion in the US, with at least 16 states subsequently implementing abortion bans or 6-week gestational limits. Prior research indicates that in the 6 months following Dobbs, approximately 32 360 fewer abortions were provided within the US formal health care setting. However, trends in the provision of medications for self-managed abortion outside the formal health care setting have not been studied.

Objective

To determine whether the provision of medications for self-managed abortion outside the formal health care setting increased in the 6 months after Dobbs.

Design, Setting, and Participants

Cross-sectional study using data from sources that provided abortion medications outside the formal health care setting to people in the US between March 1 and December 31, 2022, including online telemedicine organizations, community networks, and online vendors. Using a hierarchical bayesian model, we imputed missing values from sources not providing data. We estimated the change in provision of medications for self-managed abortion after the Dobbs decision. We then estimated actual use of these medications by accounting for the possibility that not all provided medications are used by recipients.

Exposure

Abortion restrictions following the Dobbs decision.

Main Outcomes and Measures

Provision and use of medications for a self-managed abortion.

Results

In the 6-month post-Dobbs period (July 1 to December 31, 2022), the total number of provisions of medications for self-managed abortion increased by 27 838 (95% credible interval [CrI], 26 374-29 175) vs what would have been expected based on pre-Dobbs levels. Excluding imputed data changes the results only slightly (27 145; 95% CrI, 25 747-28 246). Accounting for nonuse of medications, actual self-managed medication abortions increased by an estimated 26 055 (95% CrI, 24 739-27 245) vs what would have been expected had the Dobbs decision not occurred.

Conclusions and Relevance

Provision of medications for self-managed abortions increased in the 6 months following the Dobbs decision. Results suggest that a substantial number of abortion seekers accessed services despite the implementation of state-level bans and restrictions.

Automating untruths: ChatGPT, self-managed medication abortion, and the threat of misinformation in a post-Roe world

Background

ChatGPT is a generative artificial intelligence chatbot that uses natural language processing to understand and execute prompts in a human-like manner. While the chatbot has become popular as a source of information among the public, experts have expressed concerns about the number of false and misleading statements made by ChatGPT. Many people search online for information about self-managed medication abortion, which has become even more common following the overturning of Roe v. Wade. It is likely that ChatGPT is also being used as a source of this information; however, little is known about its accuracy.

Objective

To assess the accuracy of ChatGPT responses to common questions regarding self-managed abortion safety and the process of using abortion pills.

Methods

We prompted ChatGPT with 65 questions about self-managed medication abortion, which produced approximately 11,000 words of text. We qualitatively coded all data in MAXQDA and performed thematic analysis.

Results

ChatGPT responses correctly described clinician-managed medication abortion as both safe and effective. In contrast, self-managed medication abortion was inaccurately described as dangerous and associated with an increase in the risk of complications, which was attributed to the lack of clinician supervision.

Conclusion

ChatGPT repeatedly provided responses that overstated the risk of complications associated with self-managed medication abortion in ways that directly contradict the expansive body of evidence demonstrating that self-managed medication abortion is both safe and effective. The chatbot's tendency to perpetuate health misinformation and associated stigma regarding self-managed medication abortions poses a threat to public health and reproductive autonomy.

Self-managed Medication Abortion in the United States

Self-managed abortion (SMA) is ending a pregnancy without medical supervision, either by obtaining medications (known as self-managed medication abortion) or through other means. Many factors influence a person's decision to pursue self-managed abortion, such as time constraints, financial considerations, and local availability of abortion services. We present on the prevalence, methods and best practices for clinicians in the United States who may interface with individuals undergoing self-managed medication abortion at any point in the process through a harm reduction approach.

Makeshift medicine is a response to US health system failures

The ‘makeshift medicine’ framework describes how individuals address healthcare needs when they are unable to access the US healthcare system. The framework is applied to gender-affirming care, the health of people who inject drugs and abortion access. Recommendations for future research, advocacy and policy are made.

Self-Managed Abortion in the United States

Purpose of Review

This review aims to provide up-to-date information about self-managed abortion in the USA.

Recent Findings

Evidence indicates that there is growing demand for self-managed abortion in the USA as obstacles to facility-based care increase, especially since the Supreme Court overturned Roe v. Wade. Self-managed abortion with medications is safe and effective.

Summary

Based on a nationally representative survey, the lifetime prevalence of self-managed abortion in the USA in 2017 was estimated to be 7%. People experiencing barriers to abortion care, including people of color, people with lower incomes, people in states that have restrictive abortion laws, and those living farther from facilities providing abortion care are more likely to attempt self-managed abortion. While people may use a range of methods to self-manage abortion, there is growing use of safe and effective medications, including mifepristone used together with misoprostol and misoprostol used alone; use of traumatic and dangerous methods is rare. While many people attempt to self-manage their abortion because of barriers to facility-based care, others have a preference for self-care because it is convenient, accessible, and private. While the medical risks of self-managed abortion may be few, the legal risks may be significant. Sixty-one people have been criminally investigated or arrested between 2000 and 2020 for allegedly self-managing their abortion or helping someone else do so. Clinicians play an important role in providing evidence-based information and care to patients considering or attempting self-managed abortion, as well as minimizing legal risks.