Doctors and healthcare facilities need to prepare as self-managed abortion increases under restrictive laws

Many states across the U.S. have passed laws restricting access to abortion and several states are considering new legislation to further limit access.

Emergency clinic
Using COVID-19 as a cover, several states are locked in court battles over near absolute bans on abortion care by claiming it is not an essential service. Researchers anticipate that as more restrictions mount, more people will attempt to self-manage their abortions. Some will use safe and effective methods, like mifepristone and misoprostol pills purchased online. Others may use ineffective methods, such as herbs, and some may use unsafe methods, such as getting hit in the abdomen or inserting objects into the uterus.

In ANSIRH’s recent review, Dr. Daniel Grossman and Dr. Lisa Harris outline ways clinicians and facilities can prepare for a future where even more people turn to self-managed abortion. They assert that appropriate care should be patient-centered while also addressing the patient’s legal safety, which may pose a bigger threat than medical risks in restrictive states where patients may be prosecuted for managing their own abortion. In 2018, If/When/How, a national network of law students and legal professionals that advocates for reproductive justice, reported that 25 states had laws on the books that could be used to prosecute people for managing their own abortions, with 7 states criminalizing it directly.

Because medication abortion is extremely safe, patients presenting for care may only need confirmation that the abortion is complete. However, in cases where patients attempt to self-induce abortion using unsafe methods, life-saving care may be necessary. As abortion restrictions increase, self-managed abortion will surely increase as well; thus, healthcare providers must be prepared to treat these patients. In order to prepare for this reality, healthcare providers must become comfortable with providing care without knowing whether or not it is for a miscarriage or self-induced abortion and be prepared to manage life-threatening complications of abortion caused by unsafe means. Since patients may be legally vulnerable if they have self-induced an abortion, providers should focus on only gathering information that is relevant to provide to best care. The authors also urge doctors and healthcare institutions to develop strategies in favor of effective and patient-centered clinical care over legal investigations of their patients.

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