204898 Abortion self-induction among women living in San Francisco, Boston and New York City: A qualitative analysis

Monday, November 9, 2009: 11:10 AM

Daniel Grossman, MD , Ibis Reproductive Health, Oakland, CA
Kelsey Otis, MPH , Ibis Reproductive Health, Cambridge, MA
Melanie Peña, MPH , Gynuity Health Projects, New York, NY
Diana Lara, MD, MPH , Ibis Reproductive Health, Oakland, CA
Beverly Winikoff, MD, MPH , Gynuity Health Projects, New York, NY
Kelly Blanchard, MS , Ibis Reproductive Health, Cambridge, MA
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.

Learning Objectives:
1. List the methods reportedly used to self-induce abortion and their relative safety and effectiveness 2. Describe the factors that motivate some women to attempt to self-induce their abortion 3. Discuss the relevance of the study’s findings to the larger issue of access to abortion services in the US

Keywords: Abortion, Access

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I performed the research
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.