CNN
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Access to abortion facilities has become more limited since the Supreme Court overturned the federal right to abortion in the United States, and new research suggests that self-directed abortions — often using unsafe and ineffective methods — have increased in the wake of those restrictions.

The percentage of women who say they performed an abortion themselves has increased by about 40% since the Dobbs decision, according to a study published Tuesday in the medical journal JAMA Network Open — up from 2.4% in late 2021, a few months before the court decision, to 3.4% in the summer of 2023, about a year after the decision.

The findings are based on surveys of more than 14,000 women under the age of 50 who reported on their own experiences, including hundreds of teenagers.

Survey data likely underestimate how common self-induced abortion is; the study authors say that underreporting is expected when asking about “sensitive, stigmatized and now, in some contexts, criminalized behavior.” However, it is unclear whether women may have become less likely to disclose their experiences due to the increased criminalization of pregnancy and abortion or more emboldened to share due to increased public attention on the subject, they wrote.

Overall, when accounting for underreporting, the researchers estimate that more than 1 in 10 women will try to self-manage an abortion at some point in their lives.

Self-directed abortions take place outside the formal health care system and without formal supervision by a doctor or nurse. For this research, women were asked if they had “ever taken or done anything on their own, without medical help, to try to end a pregnancy.”

Earlier research have found that requests for abortion pills through sources outside the formal health care system increased after Dobb’s decision. Many of the sources that provide self-directed medication abortion pills also provide information and support through online help or peer-to-peer networks. The safety and efficiency of medication abortion is well established, and recent research has shown that it is just as safe through telehealth such as through personal clinics and similarly when self-management.

The new study suggests that self-administration of an abortion with the abortion pill has become more common, rising from about 18% of attempts before Dobbs to 24% after Dobbs.

But many other ineffective, and sometimes unsafe, methods were also common. More than a quarter of women who tried to self-manage an abortion said they took herbs, more than 1 in 5 said they punched themselves, and almost 1 in 5 said they used alcohol or other substances.

Other research have found that abortions within the formal health care system have increased in the post-Dobbs United States, due to an increase in medication abortions, particularly those provided through telehealth.

But privacy is one of the most common reasons for women to self-manage their abortions, according to the new survey data. Almost a third of women cited this as a reason in 2023, a slight increase from the share in 2021. About 1 in 5 women reported that the clinic would be too expensive, and about 13% said they were worried about facing protesters at a clinic.

Despite these concerns, about 15% of women who performed an abortion themselves said they had complications such as bleeding or pain that required them to seek medical attention. About 5% visited hospital, emergency department or urgent care.

Black women and those who grew up poor were more likely than others to say they had performed an abortion themselves.

“As barriers to facility-based abortion grow, (self-directed abortion) may increasingly become an individual’s only or preferred option for terminating a pregnancy,” the researchers wrote. “These findings suggest the need to expand access to alternative models of safe and effective abortion care and ensure that those seeking medical care after (self-directed abortion) do not face legal risk.”