Abortion self-induction among women living in San Francisco, Boston and New York City: A qualitative analysis

Recent high profile cases in the US have drawn attention to the practice of abortion self-induction. While self-inducing an abortion with misoprostol has been widely documented in Latin America, little research has examined the practice in the US. We performed a survey in primary care clinics serving low-income women in San Francisco, Boston and New York City. Among 1,262 women, 39 women gave a history of attempted abortion self-induction. We performed in-depth interviews with 25 women to understand their motivations and experiences. Fifteen women were Latina; 13 were born outside of the US or in Puerto Rico. Women reported a variety of abortion methods, including drinking malta (n=8), a malted non-alcoholic beverage, herbs (n=8), misoprostol (n=3), aspirin (n=3), other medications (n=6), abdominal trauma (n=2) and intravaginal trauma (n=2). Ten women reported using more than one method. Five attempts occurred in Puerto Rico, Dominican Republic or Africa; the remainder occurred in the US. Women reported a variety of motivations for attempting self-induction, including ignorance or fear of abortion services, inability to pay, belief that they could not access services because of their immigration status, and a preference for self-care. Ten women believed their abortion was successful, although some did not confirm they were pregnant. No woman who self-induced in the US reported serious medical complications, but most recommended clinic-based services. Although rare, attempted abortion self-induction frequently uses ineffective methods, some of which are unsafe. More effort should be made to inform women about abortion services and improve access to these services, including removing financial barriers to clinic-based care.