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2010 Reproductive Health Matters.


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Reproductive Health Matters 2010;18(36):136146
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Self-induction of abortion among women


in the United States
Daniel Grossman,a Kelsey Holt,b Melanie Pea,c Diana Lara,d Maggie Veatch,e
Denisse Crdova,f Marji Gold,g Beverly Winikoff,h Kelly Blanchardi
a Senior Associate, Ibis Reproductive Health, Oakland, CA, USA. E-mail: dgrossman@ibisreproductivehealth.org
b Project Manager, Ibis Reproductive Health, Cambridge, MA, USA
c Senior Program Associate, Gynuity Health Projects, New York, NY, USA
d Project Manager, Ibis Reproductive Health, Oakland, CA, USA
e Program Research Coordinator, Gynuity Health Projects, New York, NY, USA
f Research Assistant, Ibis Reproductive Health, Cambridge, MA, USA
g Professor of Family and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine,
New York, NY USA
h President, Gynuity Health Projects, New York, NY, USA
i President, Ibis Reproductive Health, Cambridge, MA, USA

Abstract: Recent media coverage and case reports have highlighted women's attempts to end their
pregnancies by self-inducing abortions in the United States. This study explored women's
motivations for attempting self-induction of abortion. We surveyed women in clinic waiting rooms
in Boston, San Francisco, New York, and a city in Texas to identify women who had attempted
self-induction. We conducted 30 in-depth interviews and inductively analyzed the data. Median
age at time of self-induction attempt was 19 years. Between 1979 and 2008, the women used
a variety of methods, including medications, malta beverage, herbs, physical manipulation and,
increasingly, misoprostol. Reasons to self-induce included a desire to avoid abortion clinics, obstacles
to accessing clinical services, especially due to young age and financial barriers, and a preference
for self-induction. The methods used were generally readily accessible but mostly ineffective and
occasionally unsafe. Of the 23 with confirmed pregnancies, three reported a successful abortion
not requiring clinical care. Only one reported medical complications in the United States. Most
would not self-induce again and recommended clinic-based services. Efforts should be made to
inform women about and improve access to clinic-based abortion services, particularly for medical
abortion, which may appeal to women who are drawn to self-induction because it is natural,
non-invasive and private. 2010 Reproductive Health Matters. All rights reserved.
Keywords: self-induced abortion, medical abortion, adolescents and young people,
misoprostol, United States

N settings where access to safe, legal abortion


is restricted, women may attempt to self-induce
abortion outside of a clinic setting using a variety
of techniques, including inserting objects into the
uterus, ingesting harmful substances, exerting
external force, or using medications such as misoprostol,1 particularly in Latin America and the
Caribbean, where there is widespread availability

136

of the drug.24 Self-induction with misoprostol


has also been reported in Africa and by African
immigrants in Europe.57 Studies indicate that
misoprostol is safer than other techniques used
to self-induce abortion.8
Recent evidence suggests that some women in
the United States (US) also attempt to self-induce
abortion. Two clinical case reports documented

D Grossman et al / Reproductive Health Matters 2010;18(36):136146

a woman in Massachusetts who used misoprostol9 and another in Washington who inserted
a metal coat hanger into her uterus and presented with sepsis.10 There have also been reports
in the media of women using various selfinduction methods.11,12 Yet the assumption has
been that women would no longer be driven to
self-induce after abortion was legalized in the
US in 1973, when complications from unsafe
abortion decreased.13
A recent national survey of US abortion
patients found that 1.2% reported ever using
misoprostol, and 1.4% reported using other substances to self-induce an abortion.14 In another
study, among mostly Dominican women in New
York City obstetrics and gynecology (ob/gyn)
clinics, 37% knew about misoprostol and 5%
had used it themselves, although the study did
not specify whether the women had done so in
the US.15
The purpose of this qualitative study was to
explore experiences of abortion self-induction
by women living in the US, to better understand
women's motivations and suggest practice and
policy recommendations to improve access to
safe abortion care.

Methods
Participants were recruited as part of a larger
study examining knowledge and experience
with abortion among women in San Francisco,
Boston, New York City and a city in Texas adjacent to the US-Mexico border. The sites were
selected to oversample Latinas and low-income
women, since prior reports have documented selfinduction with misoprostol among these populations in the US.11,15 We received ethical approval
from all relevant institutional review boards.
Between June 2008 and February 2009, we
recruited a convenience sample of 1,425 women
aged 1545 speaking English or Spanish at primary care or ob/gyn clinics (and an abortion clinic
in Texas) to participate in a survey (in Texas, the
minimum age was 18). In the survey, the women
were asked if they had ever attempted to selfinduce an abortion, and if so, were invited to participate in an in-depth interview on their most
recent experience.
The number of survey participants was: San
Francisco (448); Boston (402); New York City
(412); Texas (163). Fifty-six women who com-

pleted the survey (4.6% of those who had ever


been pregnant) reported attempted self-induction,
and 29 agreed to participate in an interview. We
also did one pilot interview with a woman from
one of the San Francisco clinics. We did not ask
women why they did not want to do an interview,
but many cited time constraints or logistics, while
two were not willing and at least two were inadvertently not invited.
Because only minimal changes were made in
the interview guide after piloting, we included
the pilot interview in the analysis, for a total
of 30 interviews (2 from San Francisco, 14 from
Boston, 9 from New York, and 5 from Texas).
Trained bilingual interviewers conducted interviews in English or Spanish in private areas of
the clinics. Questions focused on motivations for
self-induction, description of the attempt, and
reflections on advantages and disadvantages
of self-induction compared with clinic abortion.
Interviews were recorded and transcribed. Four
participants declined to be recorded, and the
interviewer took detailed notes; quotes are not
reported for the unrecorded interviews. Interviews lasted an average of 44 minutes. Participants were given US$25.
The interviews were semi-structured, and
designed and implemented according to grounded
theory.16 Data were analyzed inductively using
ATLAS.ti 5.5 for identification of emerging themes.
We aimed to identify recurring patterns and outliers of the varying situations in which women
attempted self-induction. Six investigators
reviewed transcripts and interviewer notes and
participated in the coding. Each initial coding
was reviewed by another investigator to ensure
reliability. Analysis was in the original language
of the interview; Spanish quotes were translated
into English.

Findings
Participants
At the time of their last self-induction attempt,
three participants were living in countries where
abortion was legally restricted: Uganda, Nigeria
and the Dominican Republic. Two women were
living in Puerto Rico, where they incorrectly
believed abortion was illegal. We felt it was
important to include them in our analysis as
their perceptions and beliefs at the time of selfinduction may still be current.
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D Grossman et al / Reproductive Health Matters 2010;18(36):136146

Methods of self-induction
Table 1 provides information about the women,
their self-induction experiences and the methods
they used. We grouped the methods into six categories; 13 of the women used multiple methods
from different categories. The most commonly
reported methods were medications (n=12),
including vitamin C, aspirin, laxatives, oral contraceptives, hormonal injections, and unspecified
pills or injections (but not misoprostol). Among
those who used hormonal medications to selfinduce, several believed that high doses of contraceptives could cause a miscarriage.
The pills was my idea if you get pregnant on
birth control, they say to stop, cause it can cause
miscarriages. (Boston 1, age 16)*

*Ages noted are at the time of self-induction.

138

Despite previous reports, less than one quarter of


the women reported using misoprostol (n=7).
Though our convenience sample makes it difficult to draw any strong conclusions about differences in method use across the country or
over time, it is notable that misoprostol was more
common among recent cases (see Figure 1) and
in Texas. All seven women who used misoprostol
were living in the US at the time: four in Texas
and one each in the three other cities. The women
reported obtaining misoprostol from friends and
shops, or (in Texas) across the border in Mexican
pharmacies. Of the three women who obtained
misoprostol directly from a vendor, only one
received limited information about its use; none
described using a regimen likely to be effective.17
Ten women reported using a food or beverage,
including coffee with lemon, warm Coca-Cola
with baking soda, unspecified syrups, and
malta, a non-alcoholic malted beverage from

D Grossman et al / Reproductive Health Matters 2010;18(36):136146

the Caribbean. Malta was the most commonly


used method of self-induction overall (n=8),
and all those who reported using it were living
in New York or Boston and were aged 19 years
or less at the time. They reported using it alone
or with aspirin or salt. One woman explained
that one had to use a certain Dominican malta
that had a label saying pregnant women should
avoid it.

Finally, one woman reported using cocaine


and alcohol to attempt self-induction.
The women reported learning about methods from
friends and family most commonly, sometimes

I have no idea how it works. I just know that


growing up it was something that was spoken
about. Like you would hear people, you know,
older family members talking and they would
say, [whispering] oh yeah and she took the malta
and the aspirin and that's it, there was no more
pregnancy. (New York 1, age 17)
Eight women reported using herbs, including
rue and sage tea, St John's wort, black and
blue cohosh, black walnut, oak bark, and other
unspecified plants.
Six women used physical manipulation, including abdominal trauma, intravaginal trauma, and
excessive exercise. Of the two women who reported
using intravaginal methods, one attempt occurred
in Uganda; the other was in the US around 1983. In
general, methods involving abdominal or intravaginal manipulation were attempted more frequently in the more distant past (see Figure 1).

Herbs used for self-induction that did not work


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D Grossman et al / Reproductive Health Matters 2010;18(36):136146

from those living in another country or who had


stronger links to practices in that country.
Experience of self-induction
The methods the women used were generally
ineffective and caused only mild symptoms like
cramping or diarrhoea. Seven never confirmed
their pregnancies with a test or clinic visit but
believed they were pregnant and said their
periods returned after self-induction (Figure 2).
Of the 23 women whose pregnancies were confirmed, only three reported a complete abortion
not requiring further attention. One was from
Texas and took misoprostol daily for 45 days
starting at 6 weeks' gestation. Two others who
reported successful abortions used unspecified
herbs or malta.
Seven of the remaining 20 women with confirmed pregnancies reported bleeding five in
the US after using misoprostol, one in Puerto Rico
after a hormonal injection and one in Uganda
after inserting a pen and matchstick into her
vagina. Four of these seven women had light
bleeding for several days and subsequently had
procedures to complete the abortion. The other
three, including both of the cases that occurred
outside of the US and one of the US misoprostol
cases, reported heavy bleeding that required
treatment in a hospital, where a D&C was performed, and in one case a blood transfusion was
140

required. Two of these three women with more


serious complications said they were in the second
trimester of pregnancy.
The remaining 13 women with confirmed
pregnancies whose self-induction attempts
were unsuccessful experienced only mild symptoms. Six subsequently attended a clinic for
abortion, though it took two of these women
several weeks before they realized their attempts
had been unsuccessful. Such delay, if it means
a second trimester abortion, could make the
procedure more expensive and more difficult
to access.18
Seven women whose attempts were unsuccessful decided to continue the pregnancy. Two
were living in countries where abortion was
legally restricted, and had limited options or
were concerned about health risks. Several who
were living in the US realized they were unsuccessful only one or more months later, by which
time they felt they were too far along to have
an abortion. No woman who took misoprostol
decided to continue her pregnancy.
Motivations for self-induction
The women overwhelmingly described negative
and desperate emotions upon learning or suspecting they were pregnant and most described
knowing immediately that they did not want to
continue the pregnancy; only one described being

D Grossman et al / Reproductive Health Matters 2010;18(36):136146

conflicted about her decision. They reported a


variety of, and sometimes multiple, reasons to
attempt self-induction. Some of these motivating
factors pushed women away from clinics, while
others drew them toward self-induction.
Desire to avoid clinic abortion
The majority of participants wanted to avoid a
clinic abortion. Although most who had a prior
clinic abortion did not emphasize negative
aspects of the experience, a few did cite this as
a reason for avoiding clinics.
I don't want to deal again and the questioning
and to test me for STDs and it's this big, long
process I don't want to have to go through that
[again] if I don't have to. (San Francisco 1, age 21)

factor; either they were unfamiliar with clinics


they could go to or they wanted to avoid involving parents. These findings are consistent with
several other reports of self-induction in the US
among adolescents.9,11,19 Several young women
thought they needed parental consent for abortion, although some lived in states where this
was not required. One woman knew about the
option of a court order to bypass the parental consent requirement, but still preferred self-induction:
I didn't wanted my mom to know. I didn't want
to go to court cause it was gonna be too long and
probably he was gonna say no, so I just [said],
you know, skip all that, I'm gonna do it. Myself.
(Boston 2, age 16)

Although some felt concern at the quality of


care in US abortion clinics at the time of selfinduction, it was more common at interview
that women saw clinic abortions as safer than
self-induction. Most women who ended up
having a clinic abortion described the staff as
supportive or good. However, two women
who had clinic abortions after a failed selfinduction attempt had negative feelings afterwards because they perceived it to be more like
killing than self-induction.

A few women sought information from a physician when they suspected they were pregnant
but were not told where they could obtain an
abortion. One found out she was pregnant at her
doctor's surgery and when she became upset,
he told her to do whatever [she] could within
reach because he wasn't going to get involved.
(New York 3, age 31)
A third of women described financial barriers
as a motivating factor. This is not surprising
given that the average cost of a non-hospital,
first trimester abortion in the US in 2005 was
US$413.18 Only 17 states pay for abortion services for Medicaid patients (the national health
care plan for low-income individuals), while
four states restrict coverage of abortion by private insurance plans.20 Some women said they
went to a clinic and were discouraged when
they were told the price, while others never went
because they believed it was too expensive. A
few were concerned their insurance would not
cover abortion or that a parent would find out
if they used their insurance. The participant
who haemorrhaged, requiring a D&C and blood
transfusion, lived in Texas where Medicaid does
not pay for abortion. Cost was a factor that prevented her from using the clinic. She had used
misoprostol and an injection at 13 weeks' gestation. When asked if she would do the same again
if she could go back in time, she said:

Barriers to accessing clinic abortion


While some chose to avoid clinics, other women
described difficulties accessing abortion care
before they attempted self-induction. Half reported
that being young at the time was an important

If I knew all this would happen, I probably still


would do it, because I would have had no choice
but to do it, because I didn't have the money But,
if I had the money? Well, of course, I would go
probably to a regular clinic or something. But,

Another said the thought of going to a clinic


brought back bad memories of an abortion she
had when she was young. More women said
they had heard negative things about abortion
clinics and procedures, often from friends. Some
mentioned being worried about the possibility
of complications, such as uterine perforation, or
believed that general anaesthesia was required.
Some had concerns about confidentiality or the
stigma of being seen at a clinic, especially one
woman who had been raped. A few expressed a
generalized fear of doctors:
A lot of things. It could be a lack of information.
And another thing is that I was scared to actually go to a doctor and maybe they'll do worse than
what, you know, I was going to do. I said, a malta
is nothing, you know. (New York 2, age 18)

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D Grossman et al / Reproductive Health Matters 2010;18(36):136146

if I was put in the same exact situation all over


again? I'd probably do it again. (Texas 1, age 30)
Other obstacles mentioned were immigration
status, language, and distance to a clinic.
Several women who eventually had a clinic
abortion were surprised to find out how accessible services were. One went to her doctor about
a week after taking pills from Puerto Rico and
malta that had no effect:
Did I think that maybe they did it there? No.
I didn't know. I was shocked, actually, when
they told me that they could do it there. Cause
I always thought you had to go to a special abortion clinic. (Boston 3, age 19)
Preference for self-induction
A number of women also reported a preference
for self-induction. A third mentioned that selfinduction was not the same as clinic abortion,
and many compared self-induction to menstrual regulation, inducing a period, or emergency contraception.
You can do it fairly quickly and you just
get your period, and you don't even associate
it with a possible pregnancy There's Plan B
[emergency contraception]. I used that just when
a condom broke That was essentially the same
thing. (San Francisco 1, age 21)
Often women spoke about the idea that menstrual
regulation with self-induction was something that
could avoid an abortion. The woman who drank
Coca-Cola with baking soda emphasized:
It's not a baby already. It's just blood. So I don't
feel like it's killing a baby, because it's just developing. (Boston 4, age 22)
For some, the idea of menstrual regulation was more
compatible with their religious or ethical views.
When I was growing up I was against abortion You know the whole Catholic.. you know
it's wrong. You get pregnant then you keep it
and that's it. But I never really thought of the
whole malta and aspirin thing as inducing your
own abortion (New York 1, age 17)
Some thought self-induction would be easier or
faster than a clinic abortion, either because it
would have less impact on their daily routine,
or because the method was readily accessible.
Several women thought self-induction would
142

be more natural than a clinic abortion. Most of


the women who described the process as natural ingested a beverage or vitamins; one used
unspecified prescription pills from Puerto Rico;
none used an invasive method. Two women had
a general interest in alternative medicine and
linked their attempt to self-induce with herbs or
vitamins with a preference for natural self-care.
A few women chose to self-induce because it
was more private than a clinic abortion, and
even more considered it more private looking
back on their experience. The benefits they
described included being able to hide it from
others and to have a less medicalized procedure.
In a clinic, it's more clinical, you know You
have people walking back and forth, you have
people opening up the doors when you're in
there and there's just no privacy, it's more hard
harsh As opposed to being at home, you're in
your own environment, you're surrounded by
things that make you feel safe and make you feel
comfortable. (Boston 5, age 20)
Many of those who saw these advantages tried
self-induction even before confirming pregnancy.
Reflections on self-induction
Twenty-four women indicated they would not
attempt self-induction again in the future, and
many said this because the method they had
used was ineffective, unsafe, or could cause complications. These women had used a range of
methods; only one of them had experienced
serious complications. Others reflected that they
were young when they attempted self-induction,
and being older or in a different place in their lives,
they would not do it again.
Most women mentioned the potential risks to
their own reproductive system, or to the fetus if
the pregnancy continued, as a disadvantage of
self-induction. For two, fear of having harmed
the fetus motivated them to seek a clinic abortion
after an unsuccessful attempted self-induction.
Many described uncertainty while self-inducing,
not knowing how to use the method properly or
what to expect would happen, what to do in case
of a problem, and whether it was successful all
as disadvantages.
When you're doing it yourself, you don't know
what you're doing. So, you could be killing yourself. (Boston 6, age 26)

D Grossman et al / Reproductive Health Matters 2010;18(36):136146

Only four women thought they would try something on their own again in the future if they
wanted to end a pregnancy. Three of them said it
was something they would do early in pregnancy,
and all still had negative views of clinic abortions.

Discussion
Only 4.6% of ever-pregnant women participating
in our survey reported a history of attempting
self-induction, and several of these cases occurred
outside the US. Our study did not measure the
prevalence of abortion self-induction, but these
findings are consistent with a recent survey that
found that less than 3% of abortion patients
reported attempting self-induction, suggesting
that this phenomenon is uncommon in the US.14
Medical complications were rare in this sample,
although another recent case report of a woman
using intravaginal trauma highlights that major
complications still occur with unsafe abortion in
the US.10 Women may also face legal prosecution
for self-inducing their abortion, which has occurred
in several cases.11,21
The media have focused on Latinas self-inducing
abortion in the US.11,21,22 In the national survey
of abortion patients, being foreign-born, but not
race or ethnicity, was significantly associated
with a history of ever attempting self-induction.14
While self-medication with pain medicine, antibiotics and other drugs obtained at pharmacies
without a prescription for a variety of conditions
has been documented in several countries in Latin
America,23 this may be more related to barriers to
access or concerns about quality of care than any
cultural preference. A third of the women that we
interviewed did not identify as Hispanic or Latina.
Despite facing barriers to clinical services and
often failing in their self-induction attempts,
women in this study were generally resolute to
end the pregnancy. Although many tried easily
accessible methods unlikely to terminate a pregnancy, this did not usually reflect ambivalence
about abortion. Two-thirds of participants with a
failed self-induction attempt went for a clinical
abortion, and many of those who continued with
their pregnancies did so because they felt they
had no other option.
Our study has several limitations. Women
were recruited from clinic settings and therefore
had knowledge of and access to clinic-based
health services. The study was also conducted

in three states where Medicaid covers abortion


(but not Texas). Gaps in knowledge and barriers
to abortion services highlighted here may be
more acute for women with even less access to
health care. Additionally, while the women mostly
said they would not attempt self-induction again,
it is important to remember that most of their
self-induction attempts were not successful. This
might have been different had more of them successfully terminated their pregnancies. Finally,
the extent to which our findings are reflective of
the experiences of women more generally in the
US is uncertain, given our small sample size and
convenience sampling. Despite these limitations,
this research provides important insights into the
practice of abortion self-induction in the US.
The factors that pushed women away from
clinics demonstrate the negative impacts of
policies such as parental notification and lack
of insurance coverage for abortion, and the
problems faced by women, especially young
women, who are not well informed about these
policies. The impact of limitations on public funding for abortion may only worsen with the recent
passage of the Patient Protection and Affordable
Care Act (2010), which aimed to reform the inequitable US health care system. While 94% of the
12.4 million uninsured women in the US are likely
to qualify for Medicaid or federal subsidies when
the health care overhaul is fully implemented,
women will still be unable to use Medicaid for
elective abortions, except those who live in the
17 states that provide abortion coverage from state
contributions.24 Additionally, states will be able to
ban abortion coverage in federally-subsidized private insurance plans. Undocumented immigrants
will continue to have problems, as they will not
be eligible for Medicaid in most states.25
Our findings point to the need for provider
education about the laws and policies that govern
abortion access, and the importance of informing
women about services, including funding sources.
Many women learned about the methods they
used from family and friends, suggesting that
broader social networks need to be targeted to disseminate information about safe abortion care,
while at the same time addressing issues of stigma.
Some women chose to self-induce for many
of the same reasons that some prefer medical
abortion over a surgical procedure: because it
is non-invasive, natural, easy and private.26 Most
women in our study equated a clinic abortion with
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D Grossman et al / Reproductive Health Matters 2010;18(36):136146

a surgical procedure and did not mention the


option of obtaining mifepristone+misoprostol
abortion at the clinic. Clinic-based medical abortion might be an acceptable alternative to women
considering self-induction, especially as standard practice now includes taking misoprostol
at home.27 A recent study among low-income,
Spanish-speaking women in New York found that
medical abortion was highly acceptable.28 Primary
care clinicians, including paediatricians, should
inform their patients about the option of medical abortion and ideally offer the pills on-site
to make it as accessible as possible.
Given that some women prefer a less medicalized abortion experience, is there a way that
medical abortion could be made even simpler to
offer and more acceptable to women? The evidence suggests that ultrasound is not required to
determine gestational age29 or to confirm completion of abortion,30 and research is underway on
the acceptability of home use of mifepristone
as well as misoprostol. Mid-level clinicians can
safely provide the method with physician backup as needed.31 Putting this evidence into practice, while addressing the issue of cost, removing

unnecessary legal restrictions, and informing


women about the option of medical abortion,
would better meet women's needs, improve
access, and perhaps make self-induction with
ineffective and unsafe methods even less necessary in the US context.
Acknowledgements
This study was funded by grants from the Society
of Family Planning, Wallace A Gerbode Foundation, David and Lucille Packard Foundation,
Mary Wohlford Foundation, and an anonymous
donor. A version of the paper was presented at
the annual meetings of the American Public
Health Association, 9 November 2009, and the
Society for Applied Anthropology, 24 March
2010. We would like to thank Signy Judd and
Liza Fuentes, who helped design and carry out
the study, as well as our interviewers: Alma
Avila Pilchman, Monti Castaeda, Cecilia
Marquez, Erica Seppala, Silvia Patricia Solis,
and Margarita Velasco. We also thank Christine
Dehlendorf, Nilda Moreno, and Lynn Borgatta,
and the clinic staff who helped coordinate the
study at each site.

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Resumen
En recientes reportajes e informes de casos se
han destacado los intentos de interrupcin del
embarazo mediante la autoinduccin del aborto
en Estados Unidos. Este estudio explor las
motivaciones de las mujeres para intentar la
autoinduccin del aborto. Encuestamos mujeres
en las salas de espera de clnicas en Boston, San
Francisco, Nueva York y una ciudad en Texas
para identificar a las que haban intentado la
autoinduccin. Realizamos 30 entrevistas a
145

D Grossman et al / Reproductive Health Matters 2010;18(36):136146

donnes par induction. L'ge mdian au


moment de la tentative d'auto-avortement tait
de 19 ans. Entre 1979 et 2008, les femmes ont
utilis diverses mthodes, notamment des
mdications, des boissons maltes, des plantes,
des manipulations physiques et, de plus en plus,
du misoprostol. Parmi les raisons de l'autoavortement figuraient le dsir des femmes
d'viter les centres d'avortement, les difficults
d'accs aux services cliniques, particulirement
en raison de leur jeunesse et du manque de
moyens financiers, et une prfrence pour
l'auto-avortement. Les mthodes utilises taient
gnralement aisment disponibles, mais pour
la plupart inefficaces et occasionnellement
dangereuses. Des 23 femmes avec une grossesse
confirme, trois ont fait tat d'un avortement
russi n'ayant pas ncessit de soins cliniques.
Une femme a rapport des complications
mdicales aux tats-Unis. La plupart d'entre
elles ne recommenceraient pas s'auto-avorter
et recommandaient des services institutionnels.
Il faut informer les femmes sur les services
d'avortement dans des centres et en largir l'accs,
en particulier pour l'avortement mdicamenteux
qui peut convenir aux femmes attires par
l'auto-avortement parce que c'est une mthode
naturelle, non invasive et qui respecte l'intimit.

146

profundidad y analizamos los datos de manera


inductiva. La edad mediana en el momento del
intento de autoinduccin fue de 19 aos. Entre
1979 y 2008, las mujeres utilizaron una variedad
de mtodos, como medicamentos, malta, hierbas,
manipulacin fsica y, cada vez ms, misoprostol.
Los motivos para autoinducirse un aborto eran: el
deseo de evitar las clnicas de aborto, obstculos
al acceso a los servicios clnicos, especialmente
debido a la temprana edad y a las barreras
financieras, y la preferencia por la autoinduccin.
Los mtodos utilizados generalmente eran fciles
de obtener pero la mayora ineficaces y a veces
inseguros. De las 23 con embarazos confirmados,
tres dijeron que lograron abortar sin necesitar
atencin mdica. Solo una relat haber presentado
complicaciones mdicas en Estados Unidos. La
mayora no volvera a autoinducirse un aborto y
recomend servicios clnicos. Se deberan realizar
esfuerzos por informar a las mujeres acerca de los
servicios de aborto en las clnicas y por mejorar el
acceso a estos, particularmente al aborto con
medicamentos, una opcin que probablemente
les interese a las mujeres que se inclinan hacia
la autoinduccin, por ser natural, no invasivo
y privado.