Self-induced abortions can raise medical — and legal — questions for doctors

WASHINGTON, D.C. — As abortion becomes more difficult — or impossible — to access in many states, some patients are buying pills online and managing the process on their own. That can create new questions for healthcare providers about how to protect their patients – and themselves – if questions or complications arise.

Unlike in years before Roe v. Wade in 1973, when women sometimes died from seeking unsafe and illegal abortions, Dr. Nisha Verma says patients now have more options.

"We know that people can safely manage their own abortions with pills when they have the information and support that they need," Verma said. "We do expect that we will see more people that are self-managing their abortions."

Verma, an OB-GYN and abortion provider, says years of research show abortion pills are safe if taken correctly. Even so, she says some patients will be desperate enough to try riskier methods, and others will face more routine questions or complications that require medical support.

"That hasn't completely disappeared," she said. "We need to be aware of that and able to provide compassionate, non-judgmental care to people that present to the formal medical system after self-managing in any of those ways."

Farah Diaz-Tello, senior counsel with the legal advocacy group If/When/How, says those with questions or concerns about symptoms like heavy bleeding shouldn't be afraid to seek medical help.

"Our big concern is that even if there's no legal basis for them to be criminalized, the fear of being criminalized and being entangled in the legal system is going to drive them away from healthcare if they need it," she said.

At least for now, Diaz-Tello says most abortion laws in the United States don't directly punish patients for seeking or self-inducing abortion. But that could change in a rapidly shifting legal landscape, and she says some patients may fear overzealous prosecutors.

In a new paper co-authored for the Society of Family Planning, Verma offers guidance for healthcare workers who may be treating such patients. She says health care workers should be thoughtful about the information they document — both to protect patients, and themselves.

For example, she says, the treatment for a patient with heavy bleeding is generally the same whether it's caused by a miscarriage or abortion pills — so it may not be necessary to share that information, particularly in a state with restrictive laws. Verma advises doctors to get legal advice about how they can counsel their patients about abortion, including self-managed options.

Dr. Christina Francis, with the American Association of Pro-Life Obstetricians & Gynecologists, says she does not favor criminal penalties for patients who self-induce, but she hopes to see more state lawmakers introduce legislation aimed at those who distribute abortion pills illegally.

"Who I would see at fault would be whoever is providing these pills for these women," Francis said.

Already, Republican lawmakers in many states are having those discussions. Some abortion rights opponents have suggested using the threat of civil ligation or prosecution to prevent people from helping abortion travel across state lines, or distributing abortion pills to people in states with abortion bans.

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