Wednesday, December 23, 2020

Prevalence of Self-Managed Abortion Among Women of Reproductive Age in the United States

Original Investigation
Public Health
December 18, 2020

Prevalence of Self-Managed Abortion Among Women of Reproductive Age in the United States
Lauren Ralph, PhD1; Diana G. Foster, PhD1; Sarah Raifman, MS1; et alM. Antonia Biggs, PhD1; Goleen Samari, PhD2; Ushma Upadhyay, PhD1; Caitlin Gerdts, PhD2,3; Daniel Grossman, MD1
Author Affiliations Article Information
JAMA Netw Open. 2020;3(12):e2029245. doi:10.1001/jamanetworkopen.2020.29245

Key Points

Question What is the prevalence of self-managed abortion (SMA) among US women of reproductive age?

Findings In this cross-sectional survey of 7022 women aged 18 to 49, 1.4% reported ever having attempted SMA. Using age at SMA attempt and adjusting for underreporting of abortion, it is estimated that 7.0% of US women will attempt SMA at some point in their lives.

Meaning These findings suggest that SMA is occurring in the US, highlighting the need for innovative models to ensure people have access to the safest and most effective methods of SMA, particularly where facility-based care is inaccessible.
Abstract

Importance Increasing evidence indicates that people are attempting their own abortions outside the formal health care system. However, population-based estimates of experience with self-managed abortion (SMA) are lacking.

Objective To estimate the prevalence of SMA attempts among the general US population.

Design, Setting, and Participants This cross-sectional survey study was fielded August 2 to 17, 2017 among English- and Spanish- speaking, self-identified female panel members from the GfK web-based KnowledgePanel. Women ages 18 to 49 years were approached to complete a 1-time survey. Data were analyzed from September 22, 2017, to March 26, 2020.

Main Outcomes and Measures SMA was defined as “some women may do something on their own to try to end a pregnancy without medical assistance. For example, they may get information from the internet, a friend, or family member about pills, medicine, or herbs they can take on their own, or they may do something else to try to end the pregnancy.” SMA was assessed using the question, “Have you ever taken or used something on your own, without medical assistance, to try to end an unwanted pregnancy?” Participants reporting SMA were asked about methods used, reasons, and outcomes. Factors associated with SMA experience, including age, race/ethnicity, socioeconomic status, nativity, reproductive health history, and geography, were assessed. Projected lifetime SMA prevalence was estimated using discrete-time event history models, adjusting for abortion underreporting

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