The American College of Obstetricians and Gynecologists released its first-ever guidance on self-managed abortion, emphasizing that while the majority are completed safely with misoprostol (either alone or with mifepristone), criminalization poses greater risks than medical complications for most patients.
ACOG recommends physicians know reporting requirements in their jurisdiction; inform patients of relevant restrictions; and commit to providing safe care or appropriate referrals regardless of circumstances.
ACOG strongly opposes criminalizing self-managed abortion (SMA), citing an investigation that identified 61 criminal investigations or arrests between 2000-2020. More than 50% of these cases were prosecuted under laws not directly related to abortion. The report found Black, Hispanic, and Asian individuals were disproportionately reported for SMA.
The guidance advocates for a harm-reduction approach, citing the nongovernmental organization Inciativas Sanitarias in Uruguay, whose program reduced abortion-related maternal mortality from 37.5% to 8.1% over a decade. ACOG recommends treating any complications as spontaneous pregnancy loss while minimizing documentation that could expose patients to legal risk.
The statement directed physicians only to document information necessary for medical care, noting that many criminalization cases stemmed from health care provider reports. ACOG opposes mandatory reporting of pregnancy outcomes unless legally compelled.
A 2020 study estimated that 7% of women in the United States will attempt to self-manage an abortion during their lifetime. Research tracking requests for SMA medications through Aid Access found substantial increases in states that banned abortion following the Dobbs vs. Jackson Women's Health Organization decision.
Among those reporting SMA attempts in a cross-sectional survey of 7,022 individuals, 20% used misoprostol, 29% used other medications or drugs, 38% used herbs, and 20% used physical methods.
Various factors drive SMA decisions, including health care costs, clinic distance, legal restrictions, language barriers, immigration concerns, privacy preferences, and desire for autonomy. Medications were obtained through international NGOs, online pharmacies, and international retail pharmacies near border communities. Documented herbal methods included aloe, rue, sage, black and blue cohosh, savin, myrrh, mug wort, ergot, and parsley.
The authors reported no conflicts of interest; ACOG has neither solicited nor accepted any commercial involvement in developing this guidance.
