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{{short description|Abortion performed by the pregnant woman herself outside the recognized medical system}}
{{short description|Abortion performed by the pregnant woman herself outside the recognized medical system}}
A '''self-induced abortion''' (or '''self-induced miscarriage''') is an [[abortion]] performed by the pregnant woman herself or with the help of other, non-medical assistance. Although the term includes abortions induced with legal [[over-the-counter medication]], it also refers to efforts to terminate a pregnancy through alternative, sometimes more dangerous means. Such practices may present a threat to the health of women.<ref name="Haddad 2009 122–126">{{Cite journal|last=Haddad|first=Lisa B|last2=Nour|first2=Nawal M|date=2009|title=Unsafe Abortion: Unnecessary Maternal Mortality|journal=Reviews in Obstetrics and Gynecology|volume=2|issue=2|pages=122–126|issn=1941-2797|pmc=2709326|pmid=19609407}}</ref> If the abortion does not result in termination of the pregnancy, the woman or fetus may experience negative health outcomes.
A '''self-induced abortion''' (or '''self-managed abortion''' or '''self-induced miscarriage''') is an [[abortion]] performed by the pregnant woman herself or with the help of other, non-medical assistance. Although the term includes abortions induced with legal [[over-the-counter medication]], it also refers to efforts to terminate a pregnancy through alternative means. Such practices may present a threat to the health of women.<ref name="Haddad 2009 122–126">{{Cite journal|last=Haddad|first=Lisa B|last2=Nour|first2=Nawal M|date=2009|title=Unsafe Abortion: Unnecessary Maternal Mortality|journal=Reviews in Obstetrics and Gynecology|volume=2|issue=2|pages=122–126|issn=1941-2797|pmc=2709326|pmid=19609407}}</ref> If the abortion does not result in termination of the pregnancy, the woman or fetus may experience negative health outcomes.


Self-induced abortion is often attempted during the earliest stages of pregnancy (the first eight weeks from the last [[menstruation|menstrual period]]).<ref>{{cite web|url=https://www.womenonweb.org/en/page/511/about-the-i-need-an-abortion-project|title=About the "I need an abortion" project — Women on Web|first=Marc|last=Worrell}}</ref><ref>Sage-Femme Collective, ''Natural Liberty: Rediscovering Self-Induced Abortion Methods'' (2008).</ref> In recent years, significant reductions in [[maternal death]] and injury resulting from self-induced abortions have been attributed to the growing use of [[misoprostol]] (known commercially at "Cytotec"), an inexpensive, widely available drug with multiple uses, including the treatment of [[Postpartum bleeding|post-partum hemorrhage]], [[peptic ulcer|stomach ulcers]], and [[Labor induction|induction of labor]].<ref>{{cite journal |doi=10.1056/NEJM200101043440107 |title=Misoprostol and Pregnancy |year=2001 |last1=Wood |first1=Alastair J. J. |last2=Goldberg |first2=Alisa B. |last3=Greenberg |first3=Mara B. |last4=Darney |first4=Philip D. |journal=New England Journal of Medicine |volume=344 |pages=38–47 |pmid=11136959 |issue=1}}</ref> The [[World Health Organization]] has endorsed a standardized regimen of misoprostol to induce abortion up to 9 weeks of pregnancy. This regimen has been shown to be up to 83% effective in terminating a pregnancy.<ref>{{cite web|url=http://gynuity.org/resources/read/misoprostol-selfguide-engpdf/|title=Gynuity Health Projects » Abortion With Self-Administered Misoprostol: A Guide For Women}}</ref>
Self-induced abortion is often attempted during the earliest stages of pregnancy (the first eight weeks from the last [[menstruation|menstrual period]]).<ref>{{cite web|url=https://www.womenonweb.org/en/page/511/about-the-i-need-an-abortion-project|title=About the "I need an abortion" project — Women on Web|first=Marc|last=Worrell}}</ref><ref>Sage-Femme Collective, ''Natural Liberty: Rediscovering Self-Induced Abortion Methods'' (2008).</ref> In recent years, significant reductions in [[maternal death]] and injury resulting from self-induced abortions have been attributed to the growing use of [[misoprostol]] (known commercially at "Cytotec"), an inexpensive, widely available drug with multiple uses, including the treatment of [[Postpartum bleeding|post-partum hemorrhage]], [[peptic ulcer|stomach ulcers]], and [[Labor induction|induction of labor]].<ref>{{cite journal |doi=10.1056/NEJM200101043440107 |title=Misoprostol and Pregnancy |year=2001 |last1=Wood |first1=Alastair J. J. |last2=Goldberg |first2=Alisa B. |last3=Greenberg |first3=Mara B. |last4=Darney |first4=Philip D. |journal=New England Journal of Medicine |volume=344 |pages=38–47 |pmid=11136959 |issue=1}}</ref> The [[World Health Organization]] has endorsed a standardized regimen of mifepristone and misoprostol or misoprostol alone to induce abortion up to 12 weeks of pregnancy, and provides an additional regimen for pregnancies over 12 weeks. These regimens have been shown to be up to 83% effective in terminating a pregnancy.<ref>{{cite web|url=http://gynuity.org/resources/read/misoprostol-selfguide-engpdf/|title=Gynuity Health Projects » Abortion With Self-Administered Misoprostol: A Guide For Women}}</ref>


==Methods attempted==
==Methods attempted==
Women have historically used many different methods to self-induce an abortion.<ref>{{Cite journal|last=Tuttle|first=Leslie|last2=Riddle|first2=John M.|date=1995|title=Contraception and Abortion from the Ancient World to the Renaissance.|url=http://dx.doi.org/10.2307/2543870|journal=Sixteenth Century Journal|volume=26|issue=4|pages=1033|doi=10.2307/2543870|issn=0361-0160}}</ref> Some are safe and effective, while others are dangerous to the health of the woman and/or ineffective at terminating a pregnancy.
Women in [[India]] are reported to use the following to induce abortion:
* Lifting of heavy weights;
* Consumption of [[mutton]] [[bone marrow|marrow]];
* Consumption of dried [[henna]] powder;
* Consumption of carrot seed soup;<ref name="KhokharGulati-ProfileInducedAbortion">{{cite journal|last=Khokhar|first=A.|author2=Gulati, N. |year=2000|title= Profile of Induced Abortions in Women from an Urban Slum of Delhi|journal=Indian Journal of Community Medicine|publisher=Indian Association of Preventive & Social Medicine|location=[[Chandigarh]], [[Republic of India]]|volume=25|issue=4|pages=177–80|issn=1998-3581|oclc=60622662|url=http://medind.nic.in/iaj/t00/i4/iajt00i4p177g.pdf|accessdate=2009-07-11}}</ref>
*Consumption of Papaya seeds


Self-induced abortion methods vary around the world. The most commonly recorded are ingestion of plants or herbs, ingesting toxic substances, causing trauma to the uterus, causing physical trauma to the body, ingesting a combination of [[mifepristone]] and [[misoprostol]] pills, ingesting [[misoprostol]] pills alone, using alcohol and drugs in an attempt to end the pregnancy, and ingesting other substances and mixtures.<ref>{{Cite journal|last=Gerdts|first=Caitlin|last2=Baum|first2=Sarah E.|last3=Barr-Walker|first3=Jill|last4=Filippa|first4=Sofia|last5=Herold|first5=Steph|last6=Moseson|first6=Heidi|date=2019-08-14|title=Self-managed abortion: a systematic scoping review|url=https://escholarship.org/uc/item/1mj5832t|language=en}}</ref> There are no known effectiveness studies for plants, herbs, drugs, alcohol, or other substances. These methods are more likely to cause bodily harm to the pregnant woman than to be effective in terminating a pregnancy. Causing physical trauma to a woman's body or uterus may also result in physical harm or even death to the woman instead of causing an abortion.<ref>{{Cite journal|last=Singh|first=S.|last2=Maddow‐Zimet|first2=I.|date=2016|title=Facility-based treatment for medical complications resulting from unsafe pregnancy termination in the developing world, 2012: a review of evidence from 26 countries|url=https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/1471-0528.13552|journal=BJOG: An International Journal of Obstetrics & Gynaecology|language=en|volume=123|issue=9|pages=1489–1498|doi=10.1111/1471-0528.13552|issn=1471-0528|pmc=PMC4767687|pmid=26287503}}</ref>
There are a number of narratives that have described self-induced abortions. Many of the following methods present significant danger (see below) to the life or health of the woman:
* physical exertion designed to bring about a miscarriage
* [[wikt:belly flop|bellyflop]]ping onto a hard surface, or throwing herself down a flight of stairs
* attempted removal of the fetus with a steel wire [[Clothes hanger|coat-hanger]] or similar device inserted into the [[uterus]] through the [[cervix]] (the historical use of this method has led to instances of its use as a symbol of the pro-choice movement, illustrating dangers of barring medically-administered legal abortion)<ref>Tom Strode, "[http://mail.erlc.com/article/life-digest-berkeley-sends-coat-hangers-to-congress Berkeley sends coat hangers to Congress]", ''LIFE DIGEST'' (December 15, 2009).</ref><ref name="Fielding">Waldo L. Fielding, M.D., Tony Cenicola, ed., "[https://www.nytimes.com/2008/06/03/health/views/03essa.html?_r=1& Repairing the Damage, Before Roe]", ''[[The New York Times]]'' (June 3, 2008).</ref>{{Medical citation needed|date=September 2017}}
* attempted piercing of the fetus with a knitting needle, crochet hook, hat pin, bobby pin or similar device inserted into the uterus through the cervix
* insertion of a rubber tube or catheter into the uterus and attempting to suck the fetus out, or, alternatively, blowing air into the uterus to cause a miscarriage (if the tube or catheter pierced a blood vessel, this would sometimes lead to air embolism, which could be fatal{{Medical citation needed|date=April 2018}})
* ingesting [[abortifacient]]s, [[vitamin C megadosage]], [[Mentha pulegium|pennyroyal]] or other substances believed to induce miscarriage
* [[douche|douching]] with substances believed to induce miscarriage, such as turpentine, clorox bleach, or lye, all of which could cause intense chemical burns (beginning in the 1960s, many women used [[Coca-Cola]] for this purpose, although its utility is at best dubious)
* [[Pessary|vaginal pessaries]]
* [[yoga]]
* [[acupuncture]] at points linked to miscarriage
* [[hypothermia]] (many women would lie for periods of time in snowbanks, which could be fatal to them) or [[hyperthermia]] (women would lie in tubs filled with hot or even scalding water for periods of time, often while simultaneously drinking gin)


The only scientifically studied effective self-induced abortion method is ingesting a combination of [[mifepristone]] and [[misoprostol]] or [[misoprostol]] alone.<ref name=":0">{{Cite book|title=Medical management of abortion|last=|first=|publisher=World Health Organization|year=2018|isbn=|location=Geneva|pages=}}</ref> Both of these medications are on the [[World Health Organization]]'s list of Essential Medicines.<ref>{{Cite web|url=http://apps.who.int/iris/bitstream/handle/10665/273826/EML-20-eng.pdf|title=WHO model list of essential medicines (20th List).|last=|first=|date=2017|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref> In some countries, these pills may be available in over-the-counter in pharmacies, although some pharmacists do not provide accurate instructions on use.<ref>{{Cite journal|last=Footman|first=Katharine|last2=Keenan|first2=Katherine|last3=Reiss|first3=Kate|last4=Reichwein|first4=Barbara|last5=Biswas|first5=Pritha|last6=Church|first6=Kathryn|date=2018|title=Medical Abortion Provision by Pharmacies and Drug Sellers in Low- and Middle-Income Countries: A Systematic Review|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/sifp.12049|journal=Studies in Family Planning|language=en|volume=49|issue=1|pages=57–70|doi=10.1111/sifp.12049|issn=1728-4465|pmc=PMC5947709|pmid=29508948}}</ref> In Latin America, women have reported self-inducing abortions with [[misoprostol]] alone since the 1980s.<ref name=":1">{{Cite journal|last=Zamberlin|first=Nina|last2=Romero|first2=Mariana|last3=Ramos|first3=Silvina|date=2012-12-22|title=Latin American women’s experiences with medical abortion in settings where abortion is legally restricted|url=https://doi.org/10.1186/1742-4755-9-34|journal=Reproductive Health|volume=9|issue=1|pages=34|doi=10.1186/1742-4755-9-34|issn=1742-4755|pmc=PMC3557184|pmid=23259660}}</ref> The history of women self-managing abortion with pills includes projects such as the Socorristas in Argentina and Las Libres in Mexico.<ref>{{Cite journal|last=Gerdts|first=Caitlin|last2=Keefe-Oates|first2=Brianna|last3=Zurbriggen|first3=Ruth|date=2018-02-01|title=Accompaniment of second-trimester abortions: the model of the feminist Socorrista network of Argentina|url=https://www.contraceptionjournal.org/article/S0010-7824(17)30393-1/abstract|journal=Contraception|language=English|volume=97|issue=2|pages=108–115|doi=10.1016/j.contraception.2017.07.170|issn=0010-7824|pmid=28801052}}</ref><ref>{{Cite web|url=http://www.safeabortionwomensright.org/las-libres-guanajuato-a-feminist-approach-to-abortion-within-and-around-the-law/|title=Las Libres, Guanajuato: A feminist approach to abortion within and around the law – Safe Abortion : Women's Right|last=Abortion {{!}}|first=Safe|language=en-US|access-date=2019-08-24}}</ref> Other countries have "safe abortion hotlines," which facilitate access to pills, provide instructions on proper use of the pills, and provide emotional, logistical, and/or financial support.<ref>{{Cite journal|last=Gerdts|first=Caitlin|last2=Jayaweera|first2=Ruvani T|last3=Baum|first3=Sarah E|last4=Hudaya|first4=Inna|date=2018|title=Second-trimester medication abortion outside the clinic setting: an analysis of electronic client records from a safe abortion hotline in Indonesia|url=http://jfprhc.bmj.com/lookup/doi/10.1136/bmjsrh-2018-200102|journal=BMJ Sexual & Reproductive Health|language=en|volume=44|issue=4|pages=286–291|doi=10.1136/bmjsrh-2018-200102|issn=2515-1991|pmc=PMC6225793|pmid=30021794|via=}}</ref><ref>{{Cite journal|last=Drovetta|first=Raquel Irene|date=2015|title=Safe abortion information hotlines: An effective strategy for increasing women’s access to safe abortions in Latin America|url=https://www.tandfonline.com/doi/full/10.1016/j.rhm.2015.06.004|journal=Reproductive Health Matters|language=en|volume=23|issue=45|pages=47–57|doi=10.1016/j.rhm.2015.06.004|issn=0968-8080|via=}}</ref> Some women use online abortion pill help services such as [[Women on Web]], [https://womenhelp.org/ Women Help Women], and [https://aidaccess.org/ Aid Access] to order [[mifepristone]] and/or [[misoprostol]], with reported effectiveness and safety in pregnancy termination and satisfaction in the service.<ref>{{Cite journal|last=Gomperts|first=Rebecca|last2=Petow|first2=Sabine a. M.|last3=Jelinska|first3=Kinga|last4=Steen|first4=Louis|last5=Gemzell‐Danielsson|first5=Kristina|last6=Kleiverda|first6=Gunilla|date=2012|title=Regional differences in surgical intervention following medical termination of pregnancy provided by telemedicine|url=https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0412.2011.01285.x|journal=Acta Obstetricia et Gynecologica Scandinavica|language=en|volume=91|issue=2|pages=226–231|doi=10.1111/j.1600-0412.2011.01285.x|issn=1600-0412}}</ref><ref>{{Cite journal|last=Gomperts|first=R. J.|last2=Jelinska|first2=K.|last3=Davies|first3=S.|last4=Gemzell‐Danielsson|first4=K.|last5=Kleiverda|first5=G.|date=2008|title=Using telemedicine for termination of pregnancy with mifepristone and misoprostol in settings where there is no access to safe services|url=https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/j.1471-0528.2008.01787.x|journal=BJOG: An International Journal of Obstetrics & Gynaecology|language=en|volume=115|issue=9|pages=1171–1178|doi=10.1111/j.1471-0528.2008.01787.x|issn=1471-0528}}</ref>
In a letter to the ''New York Times'', gynecologist Waldo L. Fielding wrote:


For pregnancies before 12 weeks, the [[World Health Organization]] recommends 200 mg (usually one pill) of [[Mifepristone]], taken by mouth, followed one to two days later by 800 mg (usually four pills) of [[misoprostol]], which can be swallowed or left in the cheek or under the tongue to dissolve.<ref name=":0" /> If using [[misoprostol]] alone and the pregnancy is under 12 weeks, the World Health Organization recommends taking 800 mg (usually 4 pills), which can be swallowed or left in the cheek or under the tongue to dissolve. <ref name=":0" /> If the pregnancy is over 12 weeks, the [[World Health Organization]] recommends 200 mg (usually one pill) of [[Mifepristone]], taken by mouth, followed one to two days later by 400 mg (usually two pills) of [[misoprostol]], which can be swallowed or left in the cheek or under the tongue to dissolve, and repeating this every three hours until the abortion is complete.<ref name=":0" /> If using [[misoprostol]] alone, the [[World Health Organization]] recommends taking 400 mg (usually 2 pills) which can be swallowed or left in the cheek or under the tongue to dissolve, and repeating this every three hours until the abortion is complete.<ref name=":0" />
{{quote|The familiar symbol of illegal abortion is the infamous "coat hanger" — which may be the symbol, but is in no way a myth. In my years in New York, several women arrived with a hanger still in place. Whoever put it in — perhaps the patient herself — found it trapped in the cervix and could not remove it...However, not simply coat hangers were used. Almost any implement you can imagine had been and was used to start an abortion — darning needles, crochet hooks, cut-glass salt shakers, soda bottles, sometimes intact, sometimes with the top broken off.<ref name="Fielding"/>}}


These instructions are widely available on the website of the [[World Health Organization]] as well as reputable public health health organizations, including [https://gynuity.org/resources/abortion-with-self-administered-misoprostol-a-guide-for-women Gynuity] and [https://iwhc.org/resources/abortion-self-administered-misoprostol-guide-women/ International Women's Health Coalition].
Charles Jewett wrote ''The Practice of Obstetrics'' in 1901. In it, he stated, "Oil of tansy and oil of rue are much relied on by the laity for the production of abortion, and almost every day one may read of fatal results attending their use. Oil of tansy in large doses is said to excite epileptiform convulsions; quite recently one of my colleagues met such a case in his practice."


Fist trimester medical abortion is a highly safe and effective.<ref>{{Cite journal|last=Kapp|first=Nathalie|last2=Eckersberger|first2=Elisabeth|last3=Lavelanet|first3=Antonella|last4=Rodriguez|first4=Maria Isabel|date=Feb 2019|title=Medical abortion in the late first trimester: a systematic review|url=https://linkinghub.elsevier.com/retrieve/pii/S0010782418304864|journal=Contraception|language=en|volume=99|issue=2|pages=77–86|doi=10.1016/j.contraception.2018.11.002|pmc=PMC6367561|pmid=30444970|via=}}</ref> The side effects of medication abortion include uterine cramping and prolonged bleeding, and common side effects include nausea, vomiting and diarrhea. The majority of women who use abortion pills on their own do not need an ultrasound or a clinician, although one may be recommended to ensure that the pregnancy is not ectopic.<ref>{{Cite journal|last=Gomperts|first=Rebecca|last2=Petow|first2=Sabine A. M.|last3=Jelinska|first3=Kinga|last4=Steen|first4=Louis|last5=Gemzell-Danielsson|first5=Kristina|last6=Kleiverda|first6=Gunilla|date=2012-2|title=Regional differences in surgical intervention following medical termination of pregnancy provided by telemedicine: Surgery following medical termination of pregnancy|url=http://doi.wiley.com/10.1111/j.1600-0412.2011.01285.x|journal=Acta Obstetricia et Gynecologica Scandinavica|language=en|volume=91|issue=2|pages=226–231|doi=10.1111/j.1600-0412.2011.01285.x}}</ref> In the rare case of a complication, a woman can access to a clinician skilled in miscarriage management, which is available in all countries.<ref>{{Cite journal|last=Gomperts|first=Rebecca|last2=Jelinska|first2=K|last3=Davies|first3=S|last4=Gemzell-Danielsson|first4=K|last5=Kleiverda|first5=G|date=2008|title=Using telemedicine for termination of pregnancy with mifepristone and misoprostol in settings where there is no access to safe services|url=http://doi.wiley.com/10.1111/j.1471-0528.2008.01787.x|journal=BJOG: An International Journal of Obstetrics & Gynaecology|language=en|volume=115|issue=9|pages=1171–1178|doi=10.1111/j.1471-0528.2008.01787.x|via=}}</ref>
In the 1994 documentary ''Motherless: A Legacy of Loss from Illegal Abortion'', Louis Gerstley, M.D., said that, in addition to knitting needles, some women would use the spokes of bicycle wheels or umbrellas. "Anything that was metal and long and thin would be used," he claimed. He stated that a common complication from such a procedure was that the object would puncture through the uterus and injure the intestines, and the women would subsequently die from [[peritonitis]] and infection. Later in the film he mentioned that [[potassium permanganate]] tablets were sometimes used. The tablets were inserted into the vagina where they caused a chemical burn so intense that a hole may be left in the tissue. He claimed the tablets left the surrounding tissue in such a state that doctors trying to stitch up the wound couldn't do so because "the tissue was like trying to suture butter." Dr. Mildred Hanson also described the use of potassium permanganate tablets in the 2003 documentary ''Voices of Choice: Physicians Who Provided Abortions Before Roe v. Wade''. She said, "the women would bleed like crazy because it would just eat big holes in the vagina."


Women choose to self-induce an abortion for many reasons, including perceiving that having an abortion at home is more private, wanting to have someone with her during the abortion, not being able to afford the cost of an abortion in a health facility, or not being able to access an abortion in a clinic because of legal restrictions.<ref name=":1" /><ref>{{Cite journal|last=Wainwright|first=Megan|last2=Colvin|first2=Christopher J|last3=Swartz|first3=Alison|last4=Leon|first4=Natalie|date=Jan 2016|title=Self-management of medical abortion: a qualitative evidence synthesis|url=https://www.tandfonline.com/doi/full/10.1016/j.rhm.2016.06.008|journal=Reproductive Health Matters|language=en|volume=24|issue=47|pages=155–167|doi=10.1016/j.rhm.2016.06.008|issn=0968-8080|via=}}</ref>
Dr. [[David Reuben (sex author)|David Reuben]] mentions that many African women use a carved wooden "abortion stick" to induce, which has often been handed down.<ref>{{cite book|last=Reuben|first=David|authorlink=David Reuben (sex author)|title=Everything You Always Wanted to Know About Sex* (*But Were Afraid to Ask)|edition=17th|date=c. 1971|publisher=Bantam|isbn=0-553-05570-4<!-- from SBN -->|pages=323–324|chapter=Abortion|title-link=Everything You Always Wanted to Know About Sex* (*But Were Afraid to Ask) (book)}}</ref>


Studies confirm a correlation between the increase in the self-administration of medical abortion with [[misoprostol]], and a reduction in [[maternal morbidity]] and mortality.<ref>{{Cite journal|last=Singh|first=S|last2=Maddow-Zimet|first2=I|date=2015-08-19|title=Facility-based treatment for medical complications resulting from unsafe pregnancy termination in the developing world, 2012: a review of evidence from 26 countries|url=http://dx.doi.org/10.1111/1471-0528.13552|journal=BJOG: An International Journal of Obstetrics & Gynaecology|volume=123|issue=9|pages=1489–1498|doi=10.1111/1471-0528.13552|issn=1470-0328}}</ref> Some studies argue that unfettered access to medication abortion is a key tenant of public health, human rights, and reproductive rights. <ref>{{Cite journal|last=Yanow|first=Susan|last2=Jelinska|first2=Kinga|date=2018-02-01|title=Putting abortion pills into women's hands: realizing the full potential of medical abortion|url=https://www.contraceptionjournal.org/article/S0010-7824(17)30372-4/abstract|journal=Contraception|language=English|volume=97|issue=2|pages=86–89|doi=10.1016/j.contraception.2017.05.019|issn=0010-7824|pmid=28780241}}</ref>
Attempts to insert hazardous objects into the uterus are particularly dangerous, as they can cause punctures leading to [[sepsis]]. Ingesting or douching with harmful substances can have poisonous results. Receiving blows to the abdomen, whether self-inflicted or at the hands of another, can damage organs. Furthermore, the less dangerous methods – physical exertion, abdominal massage, and ingestion of relatively harmless substances thought to induce miscarriage – are less effective, and may result in the fetus developing [[birth defect]]s. However, abdominal massage abortion is traditionally practised in [[Myanmar]], [[Thailand]], [[Malaysia]], [[the Philippines]], and [[Indonesia]].<ref>Malcolm Potts, Martha Campbell, [http://big.berkeley.edu/ifplp.history.pdf History of Contraception] {{webarchive|url=https://web.archive.org/web/20081217025152/http://big.berkeley.edu/ifplp.history.pdf |date=17 December 2008 }}, Vol. 6, Chp. 8, Gynecology and Obstetrics, 2002.</ref><ref>Population Policy Data Bank maintained by the Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, [https://www.un.org/esa/population/publications/abortion/doc/thailand.doc Thailand: Abortion Policy].</ref>

The prescription synthetic [[prostaglandin]] drug [[misoprostol]] – used in the U.S. to treat [[Peptic ulcer|gastric ulcers]] – is often used as an abortifacient in self-induced abortion in [[Latin America]]n countries where legal abortions are unavailable, and its use has also been observed in immigrant populations in [[New York (state)|New York]].<ref>[[John Leland (journalist)|John Leland]]: "Abortion Might Outgrow Its Need for Roe v. Wade", ''[[The New York Times]]'', 2 October 2005.</ref> Although proponents of this method deem it to be safer than those using insertion of objects or chemicals into the uterus, they also note that failure to effect an abortion by this method can lead to the child being born with serious birth defects. Furthermore, the drug causes a drastic drop in blood pressure, and women may hemorrhage as a result of misusing the drug for the purpose of abortion.<ref>Kathy Simmonds, Susan Yanow, ''[http://www.abortionaccess.org/AAP/publica_resources/fact_sheets/use_of_Misoprostol.htm Use of Misoprostol for Self-induced Abortion Around the World]''.</ref>

Current [[medical procedure]]s are significantly safer than traditional at-home methods,<ref name="lancet-grimes">{{cite journal |author=Grimes DA |title=Unsafe abortion: the preventable pandemic |journal=Lancet |volume=368 |issue=9550 |pages=1908–19 |year=2006 |pmid=17126724 |doi=10.1016/S0140-6736(06)69481-6 |url=http://www.who.int/reproductivehealth/publications/general/lancet_4.pdf |name-list-format=vanc|author2=Benson J |author3=Singh S |display-authors=3 |last4=Romero |first4=Mariana |last5=Ganatra |first5=Bela |last6=Okonofua |first6=Friday E |last7=Shah |first7=Iqbal H}}</ref> and are in fact safer than childbirth.<ref>{{Cite journal|last=Raymond|first=Elizabeth G.|last2=Grimes|first2=David A.|date=2012-02-01|title=The Comparative Safety of Legal Induced Abortion and Childbirth in the United States|pmid=22270271|journal=Obstetrics & Gynecology|language=ENGLISH|volume=119|issue=2|pages=215–219|doi=10.1097/AOG.0b013e31823fe923|issn=0029-7844}}</ref>


==Rates==
==Rates==
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It is difficult to measure the prevalence or rate of self-induced abortions. In the United States, the estimate is that one in 10 abortions is self-induced.<ref>{{Cite journal|last=Foster|first=D. G.|last2=Biggs|first2=A.|last3=Gerdts|first3=C.|last4=Upadhyay|first4=U.|last5=Raifman|first5=S.|last6=Ralph|first6=L.|last7=Grossman|first7=D.|date=2018-05-01|title=Lifetime prevalence of self-induced abortion among a nationally representative sample of U.S. women|url=https://www.contraceptionjournal.org/article/S0010-7824(18)30098-2/abstract|journal=Contraception|language=English|volume=97|issue=5|pages=460|doi=10.1016/j.contraception.2018.03.017|issn=0010-7824}}</ref>
It is difficult to measure the prevalence or rate of self-induced abortions. In the United States, the estimate is that one in 10 abortions is self-induced.<ref>{{Cite journal|last=Foster|first=D. G.|last2=Biggs|first2=A.|last3=Gerdts|first3=C.|last4=Upadhyay|first4=U.|last5=Raifman|first5=S.|last6=Ralph|first6=L.|last7=Grossman|first7=D.|date=2018-05-01|title=Lifetime prevalence of self-induced abortion among a nationally representative sample of U.S. women|url=https://www.contraceptionjournal.org/article/S0010-7824(18)30098-2/abstract|journal=Contraception|language=English|volume=97|issue=5|pages=460|doi=10.1016/j.contraception.2018.03.017|issn=0010-7824}}</ref>

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==History==
==History==

Revision as of 15:46, 25 August 2019

A self-induced abortion (or self-managed abortion or self-induced miscarriage) is an abortion performed by the pregnant woman herself or with the help of other, non-medical assistance. Although the term includes abortions induced with legal over-the-counter medication, it also refers to efforts to terminate a pregnancy through alternative means. Such practices may present a threat to the health of women.[1] If the abortion does not result in termination of the pregnancy, the woman or fetus may experience negative health outcomes.

Self-induced abortion is often attempted during the earliest stages of pregnancy (the first eight weeks from the last menstrual period).[2][3] In recent years, significant reductions in maternal death and injury resulting from self-induced abortions have been attributed to the growing use of misoprostol (known commercially at "Cytotec"), an inexpensive, widely available drug with multiple uses, including the treatment of post-partum hemorrhage, stomach ulcers, and induction of labor.[4] The World Health Organization has endorsed a standardized regimen of mifepristone and misoprostol or misoprostol alone to induce abortion up to 12 weeks of pregnancy, and provides an additional regimen for pregnancies over 12 weeks. These regimens have been shown to be up to 83% effective in terminating a pregnancy.[5]

Methods attempted

Women have historically used many different methods to self-induce an abortion.[6] Some are safe and effective, while others are dangerous to the health of the woman and/or ineffective at terminating a pregnancy.

Self-induced abortion methods vary around the world. The most commonly recorded are ingestion of plants or herbs, ingesting toxic substances, causing trauma to the uterus, causing physical trauma to the body, ingesting a combination of mifepristone and misoprostol pills, ingesting misoprostol pills alone, using alcohol and drugs in an attempt to end the pregnancy, and ingesting other substances and mixtures.[7] There are no known effectiveness studies for plants, herbs, drugs, alcohol, or other substances. These methods are more likely to cause bodily harm to the pregnant woman than to be effective in terminating a pregnancy. Causing physical trauma to a woman's body or uterus may also result in physical harm or even death to the woman instead of causing an abortion.[8]

The only scientifically studied effective self-induced abortion method is ingesting a combination of mifepristone and misoprostol or misoprostol alone.[9] Both of these medications are on the World Health Organization's list of Essential Medicines.[10] In some countries, these pills may be available in over-the-counter in pharmacies, although some pharmacists do not provide accurate instructions on use.[11] In Latin America, women have reported self-inducing abortions with misoprostol alone since the 1980s.[12] The history of women self-managing abortion with pills includes projects such as the Socorristas in Argentina and Las Libres in Mexico.[13][14] Other countries have "safe abortion hotlines," which facilitate access to pills, provide instructions on proper use of the pills, and provide emotional, logistical, and/or financial support.[15][16] Some women use online abortion pill help services such as Women on Web, Women Help Women, and Aid Access to order mifepristone and/or misoprostol, with reported effectiveness and safety in pregnancy termination and satisfaction in the service.[17][18]

For pregnancies before 12 weeks, the World Health Organization recommends 200 mg (usually one pill) of Mifepristone, taken by mouth, followed one to two days later by 800 mg (usually four pills) of misoprostol, which can be swallowed or left in the cheek or under the tongue to dissolve.[9] If using misoprostol alone and the pregnancy is under 12 weeks, the World Health Organization recommends taking 800 mg (usually 4 pills), which can be swallowed or left in the cheek or under the tongue to dissolve. [9] If the pregnancy is over 12 weeks, the World Health Organization recommends 200 mg (usually one pill) of Mifepristone, taken by mouth, followed one to two days later by 400 mg (usually two pills) of misoprostol, which can be swallowed or left in the cheek or under the tongue to dissolve, and repeating this every three hours until the abortion is complete.[9] If using misoprostol alone, the World Health Organization recommends taking 400 mg (usually 2 pills) which can be swallowed or left in the cheek or under the tongue to dissolve, and repeating this every three hours until the abortion is complete.[9]

These instructions are widely available on the website of the World Health Organization as well as reputable public health health organizations, including Gynuity and International Women's Health Coalition.

Fist trimester medical abortion is a highly safe and effective.[19] The side effects of medication abortion include uterine cramping and prolonged bleeding, and common side effects include nausea, vomiting and diarrhea. The majority of women who use abortion pills on their own do not need an ultrasound or a clinician, although one may be recommended to ensure that the pregnancy is not ectopic.[20] In the rare case of a complication, a woman can access to a clinician skilled in miscarriage management, which is available in all countries.[21]

Women choose to self-induce an abortion for many reasons, including perceiving that having an abortion at home is more private, wanting to have someone with her during the abortion, not being able to afford the cost of an abortion in a health facility, or not being able to access an abortion in a clinic because of legal restrictions.[12][22]

Studies confirm a correlation between the increase in the self-administration of medical abortion with misoprostol, and a reduction in maternal morbidity and mortality.[23] Some studies argue that unfettered access to medication abortion is a key tenant of public health, human rights, and reproductive rights. [24]

Rates

An estimated fifty-six million abortion occurred worldwide, of which twenty-five million are less safe or least safe.[25] "Induced abortion is medically safe when World Health Organization recommended methods are used by trained persons, less safe when only one of those two criteria is met, and least safe when neither is met."[26] Self-induced abortions can be safe or unsafe depending on the methods used.[27] [28]

It is difficult to measure the prevalence or rate of self-induced abortions. In the United States, the estimate is that one in 10 abortions is self-induced.[29]

History

The practice of attempted self-induced abortion has long been recorded in the United States. Turn-of-the-20th-century birth control advocate Margaret Sanger wrote in her autobiography of a 1912 incident in which she was summoned to treat a woman who had nearly died from such an attempt.[30]

A study concluded in 1968[31] determined that over 500,000 illegal abortions were performed every year in the United States, a portion of which were performed by women acting alone. The study suggested that the number of women dying as a result of self-induced abortions exceeded those resulting from abortions performed by another person. A 1979 study noted that many women who required hospitalization following self-induced abortion attempts were admitted under the pretext of having had a miscarriage or spontaneous abortion.[32]

WHO estimates that approximately 22 million abortions continue to be performed unsafely each year, resulting in the death of an estimated 47,000 women and disabilities for an additional 5 million women. Almost every one of these deaths and disabilities could have been prevented through sexual education, family planning, and the provision of safe abortion services. Abortion pills, which began be used by women themselves in Brazil in the 1980s, can prevent many of these deaths from unsafe abortion.[33]

Law

In the United States, experts report that self-induced abortion can be medically safe but legally risky. The 1973 Supreme Court decision Roe v. Wade made abortion more readily available throughout the U.S., yet women who have abortions with pills ordered online or through non-clinical means may face risk of arrest. A small number of people in the U.S. have been arrested for ending their own pregnancies with pills ordered online, including Purvi Patel, Jennie Linn McCormack, and Kenlissia Jones[34]. These women were prosecuted under a variety of laws including: laws directly criminalizing self-induced abortions, laws criminalizing harm to fetuses, criminal abortion laws misapplied to people who self-induce, and various laws deployed when no other legal authorization could be found.[35] As of 2019, there are seven states with laws directly criminalizing self-induced abortion, 11 states with laws criminalizing harm to fetuses that lack adequate exemptions for the pregnant woman, and 15 states with criminal abortion laws that could be applied to women who self-induce an abortion.[36] Both the National Lawyers Guild and the American Medical Association passed resolutions condemning the criminalization of self-induced abortion.[37][38]

See also

References

  1. ^ Haddad, Lisa B; Nour, Nawal M (2009). "Unsafe Abortion: Unnecessary Maternal Mortality". Reviews in Obstetrics and Gynecology. 2 (2): 122–126. ISSN 1941-2797. PMC 2709326. PMID 19609407.
  2. ^ Worrell, Marc. "About the "I need an abortion" project — Women on Web".
  3. ^ Sage-Femme Collective, Natural Liberty: Rediscovering Self-Induced Abortion Methods (2008).
  4. ^ Wood, Alastair J. J.; Goldberg, Alisa B.; Greenberg, Mara B.; Darney, Philip D. (2001). "Misoprostol and Pregnancy". New England Journal of Medicine. 344 (1): 38–47. doi:10.1056/NEJM200101043440107. PMID 11136959.
  5. ^ "Gynuity Health Projects » Abortion With Self-Administered Misoprostol: A Guide For Women".
  6. ^ Tuttle, Leslie; Riddle, John M. (1995). "Contraception and Abortion from the Ancient World to the Renaissance". Sixteenth Century Journal. 26 (4): 1033. doi:10.2307/2543870. ISSN 0361-0160.
  7. ^ Gerdts, Caitlin; Baum, Sarah E.; Barr-Walker, Jill; Filippa, Sofia; Herold, Steph; Moseson, Heidi (14 August 2019). "Self-managed abortion: a systematic scoping review". {{cite journal}}: Cite journal requires |journal= (help)
  8. ^ Singh, S.; Maddow‐Zimet, I. (2016). "Facility-based treatment for medical complications resulting from unsafe pregnancy termination in the developing world, 2012: a review of evidence from 26 countries". BJOG: An International Journal of Obstetrics & Gynaecology. 123 (9): 1489–1498. doi:10.1111/1471-0528.13552. ISSN 1471-0528. PMC 4767687. PMID 26287503.{{cite journal}}: CS1 maint: PMC format (link)
  9. ^ a b c d e Medical management of abortion. Geneva: World Health Organization. 2018.
  10. ^ "WHO model list of essential medicines (20th List)" (PDF). 2017. {{cite web}}: Cite has empty unknown parameter: |dead-url= (help)
  11. ^ Footman, Katharine; Keenan, Katherine; Reiss, Kate; Reichwein, Barbara; Biswas, Pritha; Church, Kathryn (2018). "Medical Abortion Provision by Pharmacies and Drug Sellers in Low- and Middle-Income Countries: A Systematic Review". Studies in Family Planning. 49 (1): 57–70. doi:10.1111/sifp.12049. ISSN 1728-4465. PMC 5947709. PMID 29508948.{{cite journal}}: CS1 maint: PMC format (link)
  12. ^ a b Zamberlin, Nina; Romero, Mariana; Ramos, Silvina (22 December 2012). "Latin American women's experiences with medical abortion in settings where abortion is legally restricted". Reproductive Health. 9 (1): 34. doi:10.1186/1742-4755-9-34. ISSN 1742-4755. PMC 3557184. PMID 23259660.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  13. ^ Gerdts, Caitlin; Keefe-Oates, Brianna; Zurbriggen, Ruth (1 February 2018). "Accompaniment of second-trimester abortions: the model of the feminist Socorrista network of Argentina". Contraception. 97 (2): 108–115. doi:10.1016/j.contraception.2017.07.170. ISSN 0010-7824. PMID 28801052.
  14. ^ Abortion |, Safe. "Las Libres, Guanajuato: A feminist approach to abortion within and around the law – Safe Abortion : Women's Right". Retrieved 24 August 2019.
  15. ^ Gerdts, Caitlin; Jayaweera, Ruvani T; Baum, Sarah E; Hudaya, Inna (2018). "Second-trimester medication abortion outside the clinic setting: an analysis of electronic client records from a safe abortion hotline in Indonesia". BMJ Sexual & Reproductive Health. 44 (4): 286–291. doi:10.1136/bmjsrh-2018-200102. ISSN 2515-1991. PMC 6225793. PMID 30021794.{{cite journal}}: CS1 maint: PMC format (link)
  16. ^ Drovetta, Raquel Irene (2015). "Safe abortion information hotlines: An effective strategy for increasing women's access to safe abortions in Latin America". Reproductive Health Matters. 23 (45): 47–57. doi:10.1016/j.rhm.2015.06.004. ISSN 0968-8080.
  17. ^ Gomperts, Rebecca; Petow, Sabine a. M.; Jelinska, Kinga; Steen, Louis; Gemzell‐Danielsson, Kristina; Kleiverda, Gunilla (2012). "Regional differences in surgical intervention following medical termination of pregnancy provided by telemedicine". Acta Obstetricia et Gynecologica Scandinavica. 91 (2): 226–231. doi:10.1111/j.1600-0412.2011.01285.x. ISSN 1600-0412.
  18. ^ Gomperts, R. J.; Jelinska, K.; Davies, S.; Gemzell‐Danielsson, K.; Kleiverda, G. (2008). "Using telemedicine for termination of pregnancy with mifepristone and misoprostol in settings where there is no access to safe services". BJOG: An International Journal of Obstetrics & Gynaecology. 115 (9): 1171–1178. doi:10.1111/j.1471-0528.2008.01787.x. ISSN 1471-0528.
  19. ^ Kapp, Nathalie; Eckersberger, Elisabeth; Lavelanet, Antonella; Rodriguez, Maria Isabel (February 2019). "Medical abortion in the late first trimester: a systematic review". Contraception. 99 (2): 77–86. doi:10.1016/j.contraception.2018.11.002. PMC 6367561. PMID 30444970.{{cite journal}}: CS1 maint: PMC format (link)
  20. ^ Gomperts, Rebecca; Petow, Sabine A. M.; Jelinska, Kinga; Steen, Louis; Gemzell-Danielsson, Kristina; Kleiverda, Gunilla (2012-2). "Regional differences in surgical intervention following medical termination of pregnancy provided by telemedicine: Surgery following medical termination of pregnancy". Acta Obstetricia et Gynecologica Scandinavica. 91 (2): 226–231. doi:10.1111/j.1600-0412.2011.01285.x. {{cite journal}}: Check date values in: |date= (help)
  21. ^ Gomperts, Rebecca; Jelinska, K; Davies, S; Gemzell-Danielsson, K; Kleiverda, G (2008). "Using telemedicine for termination of pregnancy with mifepristone and misoprostol in settings where there is no access to safe services". BJOG: An International Journal of Obstetrics & Gynaecology. 115 (9): 1171–1178. doi:10.1111/j.1471-0528.2008.01787.x.
  22. ^ Wainwright, Megan; Colvin, Christopher J; Swartz, Alison; Leon, Natalie (January 2016). "Self-management of medical abortion: a qualitative evidence synthesis". Reproductive Health Matters. 24 (47): 155–167. doi:10.1016/j.rhm.2016.06.008. ISSN 0968-8080.
  23. ^ Singh, S; Maddow-Zimet, I (19 August 2015). "Facility-based treatment for medical complications resulting from unsafe pregnancy termination in the developing world, 2012: a review of evidence from 26 countries". BJOG: An International Journal of Obstetrics & Gynaecology. 123 (9): 1489–1498. doi:10.1111/1471-0528.13552. ISSN 1470-0328.
  24. ^ Yanow, Susan; Jelinska, Kinga (1 February 2018). "Putting abortion pills into women's hands: realizing the full potential of medical abortion". Contraception. 97 (2): 86–89. doi:10.1016/j.contraception.2017.05.019. ISSN 0010-7824. PMID 28780241.
  25. ^ "Induced Abortion Worldwide". Guttmacher Institute. 10 May 2016. Retrieved 12 August 2019.
  26. ^ Alkema, Leontine; Kang, Zhenning; Bearak, Jonathan; Popinchalk, Anna; Bankole, Akinrinola; Singh, Susheela; Sedgh, Gilda; Assifi, Anisa; Tunçalp, Özge (25 November 2017). "Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model". The Lancet. 390 (10110): 2372–2381. doi:10.1016/S0140-6736(17)31794-4. ISSN 0140-6736. PMID 28964589.
  27. ^ Ngo, Thoai D; Park, Min Hae; Shakur, Haleema; Free, Caroline (4 March 2011). "Comparative effectiveness, safety and acceptability of medical abortion at home and in a clinic: a systematic review". Bulletin of the World Health Organization. 89 (5): 360–370. doi:10.2471/blt.10.084046. ISSN 0042-9686.
  28. ^ Kiran, U.; Amin, P.; Penketh, R. J. (1 February 2004). "Self-administration of misoprostol for termination of pregnancy: safety and efficacy". Journal of Obstetrics and Gynaecology. 24 (2): 155–156. doi:10.1080/01443610410001645451. ISSN 0144-3615.
  29. ^ Foster, D. G.; Biggs, A.; Gerdts, C.; Upadhyay, U.; Raifman, S.; Ralph, L.; Grossman, D. (1 May 2018). "Lifetime prevalence of self-induced abortion among a nationally representative sample of U.S. women". Contraception. 97 (5): 460. doi:10.1016/j.contraception.2018.03.017. ISSN 0010-7824.
  30. ^ Margaret Sanger. An Autobiography. (New York, W. W. Norton & Company, 1938).
  31. ^ Richard Schwarz, Septic Abortion (Philadelphia: JB Lippincott Co., 1968).
  32. ^ Bose C., A comparative study of spontaneous and self-induced abortion cases in married women. J Indian Med Assoc. 1979 August; 73 (3-4): 56-9.
  33. ^ DeZordo, Silvia (January–March 2016). "The biomedicalisation of illegal abortion: the double life of misoprostol in Brazil". Hist. Cienc. Saude-Manguinhos. 23 (1). ISSN 1678-4758.
  34. ^ Paltrow, Lynn M.; Flavin, Jeanne (15 January 2013). "Arrests of and Forced Interventions on Pregnant Women in the United States, 1973–2005: Implications for Women's Legal Status and Public Health". Journal of Health Politics, Policy and Law. 38 (2): 299–343. doi:10.1215/03616878-1966324. ISSN 0361-6878.
  35. ^ "Self-Managed Medication Abortion: Expanding the Available Options for U.S. Abortion Care". Guttmacher Institute. 12 October 2018. Retrieved 10 August 2019.
  36. ^ "Prosecuting Women for Self-Inducing Abortion: Counterproductive and Lacking Compassion". Guttmacher Institute. 25 September 2015. Retrieved 10 August 2019.
  37. ^ "Criminalization of Self-Induced Abortion Intimidates and Shames Women Unnecessarily - ACOG". www.acog.org. Retrieved 10 August 2019.
  38. ^ "Resolution Opposing the Criminalization of People's Reproductive Lives" (PDF). National Lawyers Guild. Retrieved 10 August 2019. {{cite web}}: Cite has empty unknown parameter: |dead-url= (help)

External links

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