Category: ReproDialogue: Critical Discussions on Self-managed Abortion

Abortion debt: revolutionary acts and reclamations of care

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Photo credit: Melisa Slep

by Rishita Nandagiri and Lucía Berro Pizzarossa

Discussions about abortion tend to be dominated by considerations pertaining to medicine (e.g., “safety”) and law (e.g., “legality”). Medication abortion — misoprostol alone or in combination with mifepristone — has dramatically shifted these discussions. Brazilian women used misoprostol to self-manage their abortions in the 1980s, galvanizing Latin American and transnational feminist efforts to share knowledge and organize access to pills. In 2005, these medicines were added to the WHO’s Essential Medicines List. Self-managed abortion (SMA), which includes self-sourcing of abortion pills, self-diagnosis, and management of abortion processes and post-abortion care outside formal health systems, unsettles traditional understandings of what an abortion is, where and how it can (or should) occur, who a provider is, and what a “safe” abortion is. 

In April 2024, Polish activists from Abortion Without Borders (AWB) invoiced the Sejm (Polish parliament) €11.5 million ($12.4 million) for the financial costs and reproductive labor associated with  providing abortion access, resources, and care for Polish residents. AWB, an initiative by nine feminist organizations working across multiple countries, was founded in 2019 to provide information, support, and funding for abortion in Poland, either via pills or travel for in-clinic care abroad. Poland has some of the most restrictive abortion laws in Europe, which many describe as constituting a de facto ban on abortions. Ministry of Health statistics report Polish hospitals conducted only 161 abortions in 2022. In contrast, Polish non-governmental organizations estimate that, every year, 120,000-150,000 abortions are obtained via pills or procedurally. 

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Does History Matter?

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by Elena Caruso

While the exact definition of self-managed abortion remains blurred, it currently tends to refer to the end of a pregnancy through the autonomous administration of pills outside of a public health facility. The World Health Organization (WHO) recommends self-management for pregnancies under 12 weeks, using a combination of mifepristone and misoprostol (or misoprostol alone) and it includes both medications in its list of essential medicines. In its Abortion Care Guidelines, the WHO states that medication abortion has “revolutionized” access to abortion care, emphasizing the novelty of this method.  

While the origins of self-managed abortion with pills are not fully elucidated, it is generally accepted that this practice dates back to the second half of the 1980s in Brazil, when women discovered and disseminated the information that misoprostol (a medication legally available for the treatment of stomach and duodenal ulcers) could safely and effectively be used to prevent pregnancies. In the current debate on self-managed abortion, engagement with history is often limited to a few background sentences. This “ahistorical” approach can leave the impression that self-managed abortion lacks a significant and notable history. 

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A full circle moment: legal risks to mifepristone and evidence for abortion with misoprostol alone

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Photo credit: Farrah Skeiky

by Patty Skuster and Heidi Moseson

Medication abortion did not begin with a clinical trial; it began at home as self-managed abortion, or abortion without supervision from a clinician. Decades before the 2000 U.S. Food and Drug Administration’s (FDA) approval of mifepristone for abortion, which is taken alongside misoprostol, feminists in Brazil found an opportunity to self-manage abortion with misoprostol, based on warning labels that cautioned about the risk of miscarriage if taken while pregnant. The genesis of abortion pills was therefore in self-managed abortion with misoprostol alone. 

Today, after several decades of clinical trials and heavy regulation of medication abortion, the practice of self-managed abortion with misoprostol-only is once again driving clinical practice. While medication abortion has been increasing in the U.S. since its introduction, major changes in recent years have dramatically increased usage. In 2021, the FDA relaxed enforcement of the requirement for in-person dispensing of mifepristone. This revolutionary change allowed the pills to be sent by mail for the first time, making them much more accessible. When, in 2022, the Supreme Court eviscerated the federal constitutional right to abortion in Dobbs v. Jackson Women’s Health Organization, the resulting abortion clinic closures led to even larger numbers of abortion seekers turning to medication abortion through telehealth and mailed medication from providers in supportive abortion states and clinicians outside the U.S. Combined, medication abortion now accounts for more than half of all abortions in the US. 

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Doctors as Advocates for Self-Managed Abortion and Reproductive Justice

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Photo credit: Martina Šalov

by Jessica Morris

The International Federation of Gynecology and Obstetrics (FIGO) is the world’s largest alliance of national professional societies of obstetricians and gynecologists. FIGO supports comprehensive, equitable, and accessible sexual and reproductive health (SRH) for everyone, recognizing that these are fundamental human rights and essential components needed to achieve global health goals. 

FIGO works through its technical committee and its programmatic arm to improve access to abortion across the globe. Over the last two decades, FIGO has been a global advocate and played an important role in encouraging progressive, evidence-based thinking on abortion with its 130+ national professional societies and other stakeholder groups. FIGO has worked to strengthen and support these societies in becoming national leaders on SRH and driving important improvements, including  legal and policy developments, service provision, increasing supportive attitudes, and raising awareness and challenging bias.

What is the role of doctors in the de-medicalization of abortion?

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When the right to abortion is more than a law: accompaniment and cultural transformations in the political activism of Argentina’s Socorristas en Red 

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by Julia Burton

English and Spanish versions/Versiones en inglés y español

In December 2020, the Argentinean Congress passed the Voluntary Interruption of Pregnancy Law, (27.610), which legalizes abortion up to and including the 14th week of gestation and, thereafter, in the case of rape or risk to the life or health of the pregnant person. Thus, Argentina became one of the countries that went from having a model of grounds-based legalization (only in the case of rape or risk to the pregnant person) to one that allows abortion on request in the first trimester, and became the second to legalize abortion in the Southern Cone (the first was Uruguay, in 2012). 

Feminist obstinacy and decades of struggle demanding the legalization and decriminalization of abortion added to the movement’s ability to establish alliances and influence existing legal frameworks, making possible the emergence of the “green tide” first and the legalization of abortion later. Within the broad trajectory of struggles for abortion rights, I will focus on Socorristas en Red. 

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After Dobbs: How the Supreme Court Ended Roe but Not Abortion

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Photo credit: Martina Šalov

by David S. Cohen and Carole Joffe

A new story of abortion in America is upon us. Dobbs v. Jackson Women’s Health Organization overturned Roe v. Wade and rejected a constitutional right to abortion, but so far, because of everything we chronicle in our forthcoming book After Dobbs: How the Supreme Court Ended Roe but Not Abortion (Beacon 2025), abortion has continued to be available for most people. Indeed, much to the surprise of many — including the two of us — the best data we have so far reveals that the number of abortions performed in the United States has increased after the decision.

Dobbs was supposed to dramatically decrease the number of abortions in America, but the hard, nimble, and creative work of the providers where clinics have remained open, the growth and new delivery models of abortion pills, and the never-ending work of those advocates who help with abortion travel and funding refused to let that happen. This continuity of care is a cause for celebration in the face of a devastating blow from the Supreme Court.

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ReproDialogue: Critical Discussions on Self-Managed Abortion & Reproductive Justice

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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. Read More