The politics of abortion in the US make people’s experiences of getting abortion highly variable, heavily depending on where a person lives. States have the power to set their own abortion laws, leading to policies that conflict with science and medicine. This has led to a doubling of the number of people who must travel out of their home state for abortion services. It has also increased the demand for mifepristone and misoprostol for medication abortion without getting the drugs from a clinician, often known as self-sourced and managed abortion (SSMA).  

The standards of care for medication abortion have changed in response to growing scientific evidence showing that most people need minimal testing and in-person assessments. With the increase in restrictions, more people are safely terminating their own pregnancies without medical oversight. This raises questions about the role of medical expertise in this care, and the extent to which this experience should be medicalized, if at all. 

In a new paper, Jennifer Karlin, MD, PhD, and colleagues interviewed physicians about their attitudes toward SSMA. Several themes emerged: 

• Physicians (who specialize in reproductive and sexual health) consider medication abortion without clinical oversight as safe and effective.
• Physicians’ professional values, which are sometimes competing, shape their perceptions about SSMA.
• Exposure to medical evidence is not enough to change physicians' assessment of SSMA.
• Exposure to alternative ethical frameworks to medicalization aids in resolving conflicts between physicians' values.

This research is important for informing how to inform other physicians who might care for pregnant people about best practices for those who have previously self-sourced and managed their abortions. Particularly now that abortion is illegal or limited in many states, these views are critical to ensuring the safety of pregnant people in the US. As these injustices become increasingly obvious, clinicians are called upon to address them.