Photo credit: Martina Šalov
International Safe Abortion Day is 28 September.
This new digital symposium, ReproDialogue: Critical Discussions on Self-managed Abortion & Reproductive Justice by guest editor Lucía Berro Pizzarossa in collaboration with Birmingham Law School and the Centre for Health Law, Science and Policy at the University of Birmingham, brings the international revolution in self-managed reproductive healthcare into focus. Additional posts will run weekly.
Introduction by Lucía Berro Pizzarossa
Long before telemedicine emerged as a popular avenue for accessing reproductive health services outside of hospitals and clinics, feminist organisations had already pioneered a similar revolution in self-managed reproductive care. For decades, these grassroots groups have been on the frontlines of abortion care, offering essential information and reliable medications to people seeking to manage their reproductive health outside traditional medical institutions. What started as activism driven by necessity has evolved into a global movement that challenges the very structure of abortion care. Today, self-managed abortion (SMA) is more than just a method for accessing abortion services — it’s a transformative force, a model that invites us to reimagine the role of medical systems, policy frameworks, and power in reproductive rights.
At its core, SMA disrupts entrenched ideas about who holds authority over reproductive decisions. By providing inexpensive, accessible, and effective methods for ending pregnancies, SMA moves control away from institutional healthcare systems and into the hands of individuals. It allows those seeking abortions to assert their autonomy, with trusted tools and knowledge that bypass the gatekeepers—whether they be doctors, lawmakers, or societal norms.
This shift is profound. In challenging the medicalization of abortion care, SMA questions deeply held assumptions about “safety” and “risk.” For many, the idea that abortions outside of clinical settings could be safe, effective, and empowering seems radical. However, decades of research, practice, and cultural shifts tell a different story. SMA, when supported by access to information and reliable medications, has proven to be low-risk and highly effective. Moreover, it reduces barriers to access, helping to address global inequities in reproductive care and reinforcing the importance of bodily autonomy.
A Movement Rooted in Activism
The genealogy of the self-managed abortion movement is inextricably tied to feminist and reproductive justice activism. From Latin America’s “Green Wave” to the activism of Women Help Women, feminist collectives have long sought to challenge the control medical and legal institutions exert over reproductive bodies. These groups have not only expanded access to abortion care but have also redefined what that care looks like. In this context, SMA emerges not just as an alternative to clinic-based abortion but as a form of resistance — a rejection of the idea that abortion must always occur within the confines of a medical institution.
This digital symposium, which I am honored to convene, serves as a critical platform for engaging with these complex issues. Hosted in collaboration with Birmingham Law School, the Centre for Health Law, Science and Policy at the University of Birmingham, and Bill of Health, the blog of Harvard Law School’s Petrie-Flom Center, the symposium brings together voices from around the world. Scholars, practitioners, activists, and policymakers join forces to explore the evolving landscape of SMA, its potential as a tool for reproductive justice, and its capacity to shift global paradigms.
The discussions we’re fostering go beyond access. They delve into the cultural, legal, and emotional dimensions of SMA. As Julia Burton eloquently puts it, the self-managed abortion movement — or aborto acompañado — in Argentina challenges the dominant emotional narratives surrounding abortion — narratives steeped in guilt, shame, and secrecy. Instead, SMA opens space for a discourse grounded in empowerment, care, and community.
The ongoing efforts to connect self-managed abortion with broader activist movements are crucial. The genealogy of this practice is rooted in feminist and reproductive justice activism, which has long sought to challenge the control exerted by medical and legal institutions over reproductive health. Recognizing and celebrating this lineage is essential, as it underscores the power of grassroots movements in effecting change. Elena Caruso invites us to think about the legacy of the Italian movement for self-management and what this can inspire in the current moment.
This paradigm shift also prompts us to rethink the role of healthcare providers. Historically, doctors have been positioned as the gatekeepers of abortion care, deciding who can access services and under what conditions. But the International Federation of Gynecology and Obstetrics (FIGO) has increasingly recognized the need for a more facilitative role. In supporting self-managed abortion, healthcare professionals can transition from being gatekeepers to being allies — offering guidance and support while trusting individuals to make their own decisions. Jessica Morris explores how SMA can catalyze this transformation, urging healthcare providers to abandon the “doctor knows best” approach. By embracing a model of care that prioritizes autonomy, healthcare systems can begin to dismantle the power imbalances that have historically defined the patient-provider relationship in reproductive health.
The legal and political landscape surrounding abortion is rapidly shifting, particularly in the wake of the U.S. Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision. This ruling has drastically altered abortion access across the United States, underscoring the need for creative and resilient responses. Self-managed abortion has risen to meet this challenge. In countries with restrictive abortion laws or limited access to clinical services, online platforms and underground networks have stepped in to fill the gap, providing critical information, medications, and support to those in need. David S. Cohen and Carole Joffe, explore the implications of Dobbs, illustrating how the movement has responded with innovation and solidarity. Patty Skuster and Heidi Moseson discuss the potential of misoprostol as a powerful strategy for expanding access to abortion overall in the United States.
Self-managed abortion represents a critical shift — not just in access to abortion but in how we think about reproductive health as a whole. As my colleague Rishita Nandagiri and I argue, SMA reframes abortion as a “debt of democracy,” a revolutionary act that calls on the state to acknowledge and support the reproductive rights of its citizens. From Argentina to Nigeria to Poland, SMA movements are demanding more than just access — they are calling for a re-imagination of rights and possibilities.
In conclusion, the movement towards self-managed abortion is more than a response to restricted access. It is a bold challenge to the systems that have long dictated who gets to decide how, when, and if we access abortion care. Shifting power away from institutions and into the hands of individuals, SMA opens the door to a new era of reproductive justice — one that is inclusive, collective, and profoundly disruptive. As this movement grows, it asks us to imagine a world where reproductive care is defined not by gatekeepers but by the people who seek it. And in doing so, it offers a powerful vision of what reproductive justice could — and should — look like.
Lucía Berro Pizzarossa is a British Academy International Fellow at Birmingham Law School and an Affiliated researcher of the Global Health and Rights Project at The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School. Her project sits at the intersection of law, social movements and human rights. She works in solidarity with Women Help Women and various feminist collectives in the self-managed abortion movement and is one part of the collaborative writing/thinking project, Lucíta Nandarossa.
