Commentary Abortion

Self-Managed Abortion and Embodying the Principles of Reproductive Justice

Marlene G. Fried & Susan Yanow

Legal and policy barriers too often render the legal right to abortion meaningless, especially for those individuals and communities who are already the most vulnerable.

Worldwide, there is an enormous gap between having the legal right to abortion and being able to access one. This is painfully obvious in the United States. While abortion is legal, its opponents have successfully decreased access to services through restrictive laws; bans on Medicare, Medicaid, and private insurance coverage; and violence directed at clinics and providers.

These strategies have successfully put abortion clinic services out of reach for many people. Their long-range goal is to overturn Roe v. Wade and re-criminalize abortion. In the meantime, legal and policy barriers too often render the legal right to abortion meaningless, especially for those individuals and communities who are already the most vulnerable.

The option of self-managing one’s abortion has in response become more salient. Abortion pills are a very safe option for ending an unwanted pregnancy, as long as people have accurate information about how to use them and reliable sources for obtaining the medicine. It is critically important that a person who is unable or unwilling to go to an abortion clinic knows the correct dosage of medication, how to recognize the signs of a complication, and how to get medical care if needed without risking legal prosecution.

While there are numerous websites with information about how to use abortion pills, there have been few, if any, for those who have questions while managing their own abortion. To help fill this gap and provide necessary information to support those using abortion pills, Women Help Women, an international organization, has launched Self-managed Abortion, Safe and Supported (SASS) in the United States. In addition to having a user-friendly website, SASS is staffed by counselors who are available 14 to 16 hours a day to answer questions via a secure email portal in English and Spanish.

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SASS is committed to reaching as many people as possible with information about how to safely obtain and use abortion pills. Ironically, the largest risk to those using abortion pills is legal, not medical, and information about minimizing this risk is therefore critical. Those in disempowered communities are at most at risk for criminal prosecution when choosing to self-manage their abortion. In the United States, between 2007 and 2016, 17 people who have attempted to self-induce their own abortions have been arrested and prosecuted; all have been low-income women and most have been women of color. SASS provides critical information about how to determine when medical attention is needed and what to say to medical professionals to minimize legal risk. This information is provided through a secure portal so that there is no electronic “trail” of communication, further protecting users of the SASS counseling service.

SASS also provides information to help people who want the support of the medical system to find clinics and funding. By offering information about all options, including how to safely use abortion pills on one’s own, SASS works to ensure that every person gets the support, information, and care needed to decide their own reproductive futures.

SASS is a direct response to the reality that people are determined to have abortions no matter what its legal status, and that safe methods of abortion exist that can be managed by people outside the formal medical system. Access to self-managed abortion is a solution to a single individual’s problem of having a pregnancy they feel they cannot support or continue at a particular time.

But it is much more than that. Applying the holistic reproductive justice framework to abortion makes clear that such care is part of a person’s entire life and not an isolated event. The term “reproductive justice” was coined by a group of Black women who were attending a pro-choice conference in 1994 advocating for health-care reform. They saw that the needs of women in communities of color were being ignored by the proposed policies. While they believed that abortion was one critical resource for Black women, they were also focused on other essential needs, including jobs, education, housing, and the right to motherhood. They argued against pro-choice advocacy that isolated abortion and reproductive health care from all these other social justice issues, because it missed that larger context. Since that time, reproductive justice has become a powerful, dynamic movement led by women of color.

Looking at self-managed abortion through a reproductive justice lens highlights the ways in which the practice lies at the intersection of human rights, public health, empowerment and access. This lens informs SASS’ approach to outreach and messaging as we work to remove language that stigmatizes people’s abortion choices and create messages and materials that frame self-managed abortion in communities as a legitimate and, in some cases, preferred option for ending an unwanted pregnancy.

Supporting the use of pills on one’s own and putting the tools for safe abortion directly in the hands of those who want and need them is an empowerment strategy. This is a challenge to the prevailing narrative that stigmatizes abortion and frames it as safe only when supervised by a trained medical professional. By claiming this knowledge for ourselves, self-managed abortion is an expression of the fundamental feminist principle and basic human right to bodily autonomy, and to our right to control our own health care: core tenets of reproductive justice.

The reproductive justice framework also reminds us that individuals do not exist in isolation from communities. Supporting a culture of self-help at the community level emphasizes this connection and builds collective power, while simultaneously giving individuals immediate relief and support. When people are supported and empowered in their choices and are linked to support in their own communities, the stigma and silence surrounding abortion are challenged.

Advocates for self-managed abortion are part of the broad coalition seeking to change law and policy to ensure abortion access. Our allies in the reproductive rights, health, and justice movement are dedicated to these important efforts. For example, the All* Above All campaign is dedicated to restoring public funding for abortion. In addition to advancing change at the federal level, many groups, such as the National Network of Abortion Funds, SisterSong, and URGE, organize and provide resources at the grassroots level. The Center for Reproductive Rights, the American Civil Liberties Union Reproductive Freedom Project, and other organizations work through the courts to block legislation that impinges on abortion access. Advocacy groups, including NARAL Pro-Choice America and Planned Parenthood, lobby for legislative change and seek to block efforts that defund reproductive health services. The SIA Legal Team works to decriminalize self-managed abortion and raise awareness about the issue in the field.

We support all of these strategies and also see the need for immediate direct action approach. Those who have a current unwanted pregnancy need access now.

As part of our advocacy, we reject the framing of self-managed abortion with pills as an act of desperation. This framing dismisses the fact that by putting the tools in the hands of individuals and communities, organizations that see self-managed abortion in the context of reproductive justice are working to change the power dynamics in society.

Whenever abortion has been criminalized or heavily restricted by law, policy, economics, or culture, people have responded by creating safe alternatives outside the formal medical system—such as feminist clinics and services, hotlines, training for lay providers, and the engagement of dedicated and sympathetic providers in giving care despite the legal risks. In this country, the Jane Collective is a historic example of feminists providing care; in the international context, safe abortion hotlines supported by Women Help Women embody the philosophy of community provision of supportive self-care information. In the tradition of this history, the SASS project embraces the reproductive justice principle of building power and knowledge in the communities most impacted by restrictive policies.

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