Self-Managed Abortion
Recommendations and Conclusions
- Obstetrician–gynecologists and other health care professionals should educate themselves on self-managed abortion (SMA), including its history in the United States and globally, the reasons people may use SMA and the methods that can be involved, the safety of SMA, and the ways the medical field can better support patients who need and choose abortion care.
- Obstetrician–gynecologists and other health care professionals should apply a harm-reduction approach to reduce potential negative consequences associated with SMA while creating an open and nonjudgmental patient–clinician relationship.
- Obstetrician–gynecologists and other health care professionals should recognize that the greatest risk of harm related to SMA often is the harm resulting from potential criminalization.
- The American College of Obstetricians and Gynecologists (ACOG) strongly opposes the prosecution of pregnant people for conduct alleged to have harmed the fetus, including the criminalization of SMA.
- The American College of Obstetricians and Gynecologists strongly opposes legislation requiring obstetrician–gynecologists to report pregnancy outcomes to law enforcement or other governmental agencies. Obstetrician-gynecologists should not report pregnancy outcomes unless legally compelled to do so and should seek confirmation that such reporting is legally required before any reporting occurs under employer policies or procedures.
- Obstetrician–gynecologists and other health care professionals should provide all people with compassionate, nonjudgmental medical care, including those presenting before, during, or after self-managing an abortion. Health care professionals should be aware that, if a patient voluntarily discloses an SMA, documenting and reporting of the information can cause harm to the patient as well as the health care professionals involved in the patient's care.
- Obstetrician–gynecologists and other health care professionals have an obligation to both understand the legal environment in which they practice and how laws in various states affect care and to protect patient autonomy and confidentiality and the integrity of the patient-clinician relationship. Professional and legal advocacy organizations should work to make resources available to health care professionals to help them navigate these complexities.
Recommendation Grading
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Overview
Title
Self-Managed Abortion
Authoring Organization
American College of Obstetricians and Gynecologists
Publication Month/Year
November 14, 2024
Last Updated Month/Year
December 2, 2024
Document Type
Consensus
Country of Publication
US
Document Objectives
Self-managed abortion (SMA) refers to actions people take to end a pregnancy outside the formal health care system. There are a variety of reasons people choose to self-manage their abortions, and these reasons may vary based on regional contexts. For some people, medically delivered abortion care is no longer, or has never been, available in their community. Available options might be inaccessible or unacceptable, or the person might have a preference for self-managed care as a primary choice. The majority of SMAs are completed safely with misoprostol, either alone or with mifepristone. Rare medical complications should be managed as they would be in any case of spontaneous pregnancy loss. For many people, the greatest risk of harm related to SMA comes from the threat of criminalization. Many U.S. states have at least one law in place that could be misused to prosecute people attempting or assisting with SMA. Criminalization makes people less safe and harms the confidential patient–practitioner relationship. Obstetrician–gynecologists and other health care professionals should provide all people with compassionate, nonjudgmental medical care, including those presenting before, during, or after self-managing an abortion.
Inclusion Criteria
Female, Adolescent, Adult, Childbearing
Health Care Settings
Ambulatory
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Counseling, Management
Keywords
abortion, self managed abortion
Source Citation
Self-managed abortion. Committee Statement No. 13. American College of Obstetricians and Gynecologists. Obstet Gynecol 2024;144:e152–e9.