Reproductive health service providers, community-based organizations, and women’s health and rights advocates in the US have become increasingly aware of the use of misoprostol to self-induce abortion outside of the clinic setting. Abortion self-induction has been reported predominantly among immigrant women, particularly those from Latin America and the Caribbean, but anecdotal reports suggest that US-born Latinas and other marginalized communities are also using misoprostol.
Study Design and Results
Ibis conducted a mixed-methods study to better understand the phenomenon of abortion self-induction in three US cities with large immigrant populations: San Francisco, Boston, and New York. For the first part of the study, we administered a survey to 400 women in general reproductive health and abortion clinics in these cities (total n=1,200) in which we measured the prevalence of attempted self-induction and the agents used, and assessed knowledge about self-induction and about abortion laws and services. Logistic regression was used to determine which background, demographic, knowledge, and attitude factors correlate with misoprostol use. We also performed in-depth interviews with 15 women reporting previous self-induction in each city (total n=45) to explore qualitatively their experiences with self-induction, the reasons why they chose initially not to use legal abortion clinics, and insights about how their reproductive health needs might be better met. Ibis began recruitment in McAllen, TX, when field work in the other three cities was nearly complete. The McAllen site is the only site where women were recruited exclusively from an abortion clinic. This fourth site was added because Ibis was interested in exploring the situation of immigrant women living near the US-Mexico border, and the same study design was used as in the other three cities. Data collected from the McAllen site was analyzed separately. The results from all research in this study will be used to develop policy and practice recommendations for improving women’s reproductive health services, with a focus on access to safe abortion care for low-income and immigrant women.
Approximately 5% of women named misoprostol or the “pill to bring down your period” as a method. Of those who mentioned a method, 55% said they knew someone who had used a method to attempt self-induction. Younger women, Latinas, those who received government economic assistance, those that reported a barrier accessing reproductive health services, and women with two or more prior abortions were more likely to know someone who tried to self-induce. Forty-one women (4% of those who had ever been pregnant) had used a method themselves. Misoprostol use appears to more common in McAllen than in the other cities; there most women purchased the medication in Mexican pharmacies just across the border. We also completed 30 in-depth interviews with women who had attempted to self-induce an abortion in the past. A lack of knowledge about abortion services or a desire to avoid clinic-based care, young age and a desire to hide the abortion from parents, financial barriers to clinic services, and a preference for self-induction because it seemed more natural or private were among the reasons women gave for why they self-induced.