Self-Management

This resource is for health professionals. If you’re seeking personal health information about abortion with pills, go here: www.ipas.org/abortionwithpills

Key Information:

• Individuals can safely and effectively self-manage medical abortion with either mifepristone and misoprostol, or misoprostol-only when they have accurate information, quality-assured medicines, and access to health services, if needed.

Quality of evidence: High

What is medical abortion self – management?

Self-management of medical abortion is the process by which an individual procures abortion medications (mifepristone and misoprostol, or misoprostol-only) and performs the component parts of their own abortion with or without support of a healthcare provider (World Health Organization [WHO], 2022). While some individuals will prefer to manage all of the component parts of medical abortion outside of the health care system, others may choose to interact with trained health workers via traditional or innovative service delivery mechanisms as needed; importantly it is the individual who decides which aspects of care they will self-manage, and when and where to seek support (WHO, 2024; WHO, 2022). Barriers to clinical access, such as cost or inaccessibility of services, are the most commonly reported reason for self-managed abortion (Amo-Adjei et al., 2025; Aiken, Starling, & Gomperts, 2021). While self-managed abortion has the potential to dramatically increase access to safe abortion, particularly in settings where access is limited (Jayaweera et al., 2021), individuals choose abortion self-management for many reasons. These reasons include more autonomy and control over the experience, possibility of greater comfort or privacy, and the ability to avoid stigma, discrimination, or other barriers associated with seeking care in a health facility (Aiken et al., 2018; Harries et al., 2021; Moseson et al., 2020). The American College of Obstetricians and Gynecologists (ACOG) states that criminalization-not the abortion itself-is the most important source of potential harm associated with abortion self-management (ACOG, 2024).

Many models of medical abortion self-management exist, depending on the extent that the formal health system, health workers, or other supportive services are involved in the process (Dragoman et al., 2022; Sorhaido & Sedgh, 2020). A 2025 systematic review combined data from 21 studies (n=10,693) examining multiple different models of medical abortion self-management with mifepristone and misoprostol to find an overall efficacy rate of 94% through 63 days gestation and 95% through 70 days (Ralph et al., 2025). Uterine evacuation was needed by 4% of patients, rates of ectopic pregnancy and blood transfusion were < 1%, and no deaths were reported.

Self-management of medical abortion

Medical abortion before 13 weeks is a process that takes place over a period of hours to days, consisting of three components: (1) determining eligibility for medical abortion; (2) administration of abortion medicines and management of the abortion process; and (3) assessment of the success of the abortion. Abundant clinical evidence documents the ability of pregnant people to safely and effectively perform each of these components. See 3.2: Recommendations for abortion before 13 weeks: Gestational dating and 3.3: Recommendations for abortion before 13 weeks: Screening for ectopic pregnancy for a summary of evidence supporting individuals’ ability to self-assess their eligibility for medical abortion; see 3.5.6: Recommendations for abortion before 13 weeks: Medical abortion: Home use of medications up to 12 weeks for a summary of evidence supporting individuals’ ability to self-administer abortion medications and manage the abortion process; and see 3.5.7: Recommendations for abortion before 13 weeks: Medical abortion: Confirmation of success for a summary of evidence supporting individuals’ ability to self-assess the success of their abortion.

Models of abortion self-management

Telemedicine abortion

In telemedicine abortion, a health worker geographically separate from the abortion seeker facilitates a medical abortion. Telemedicine health workers assess abortion eligibility based on history, provide medications for abortion seekers to use at home, and offer follow up-this can occur both within or outside of the formal health system, and may be synchronous or asynchronous (Endler et al., 2019 ; Raymond et al., 2020). A 2025 Cochrane review assessed the safety and effectiveness of telemedicine for medical abortion, including six randomized controlled studies and 16 non-randomized studies, accounting for 131,278 individuals undergoing medical abortion up to 12 weeks gestation (Cleeve et al., 2025). This review found that medical abortion provided by telemedicine was as safe and effective as in-person abortion provision. Many prospective comparative cohort studies confirm this finding (Aiken et al., 2021; Anger & Raymond, 2024; Ralph et al., 2024; Upadhyay et al., 2024). The largest of these, a UK-based prospective cohort study that compared outcomes between individuals receiving a traditional, in-person medical abortion (n=22,158) and those receiving a telemedicine abortion with no pre-abortion testing, examination or ultrasonography up to 10 weeks gestation (n=18,435), found that more than 98% of individuals in both groups had a complete abortion and fewer participants in the telemedicine group (0.02%) suffered a serious adverse event than in the traditional care group (0.04%) (Aiken et al., 2021). WHO recommends telemedicine as an alternative to in-person medical abortion care (WHO, 2024).

Accompaniment models

In accompaniment models, trained non-clinical community agents provide abortion seekers with evidence-based medical abortion information, guidance for obtaining medication abortion drugs and step-by-step instructions for their use, guidance assessing abortion success and warning signs of complications, and support during the abortion process when needed.Accompaniment groups typically work outside of the formal health care system and may work in settings where abortion is highly restricted (Zurbriggen, Keefe-Oates, & Gerdts, 2018). A prospective cohort study of abortion accompaniment included 1,352 participants up to 24 weeks gestation in Nigeria, Argentina and Southeast Asia (Moseson et al., 2023; Moseson et al., 2021). For participants with gestations up to nine weeks, self-reported abortion success rates were comparable to in-clinic care: 98% for both the combined mifepristone and misoprostol regimen and the misoprostol-only regimen (Jayaweera et al., 2023a; Jayaweera et al., 2023b; Moseson et al., 2021). Success rates for participants with gestations between 9 and 12 weeks (n=222) were 87% for the combined regimen and 98% for the misoprostol-only regimen (Jayaweera et al., 2023b; Moseson et al., 2021; Moseson et al., 2023). A smaller retrospective cohort study from Bolivia included 302 participants seeking abortion before 12 weeks gestation (Acre et al., 2023). Participants used both the combined and misoprostol-only regimens; the success rate was 99% with only 6 individuals seeking additional care, most commonly to confirm abortion success.

Community-based distribution

Two studies have documented the safety and effectiveness of misoprostol-only, self-managed abortion accessed through community-based distribution (Foster, Arnott, & Hobstetter, 2017; Foster et al., 2022). In these studies, lay or volunteer community health workers provided misoprostol and instructions for its use to individuals seeking abortion before 9 or 10 weeks gestation, based on their reported last menstrual period. In both studies, abortion success rates exceeded those seen in clinical misoprostol-only medical abortion studies (94-96%) with no serious adverse events recorded.

Pharmacy acquisition

Two comparative cohort studies have demonstrated the effectiveness of medical abortion with mifepristone and misoprostol acquired directly from pharmacies or drug sellers, compared to a health clinic. In Cambodia, a study including 1,847 women with an average gestational age of < 7 weeks found that 9% of women in the pharmacy group required additional treatment to complete their abortion, compared to 13% in the health clinic group (Kapp et al., 2023). A similar study in Ghana which included 1,958 women found that 3% of pharmacy patients and 5% of health clinic patients required additional treatment to complete their abortions (Kapp et al., 2024). One prospective cohort study conducted in Nigeria assessed success rates in pregnant individuals (n=394) who self-managed their abortion with misoprostol purchased from drug sellers (Stillman et al., 2020). Despite receiving inadequate information about the drugs, what to expect, or where and when to seek additional care, 94% of the sample reported a complete abortion without surgical intervention; one participant required a blood transfusion. A population based cross sectional study from India found that the self-reported complication rate was lower for women who had self-managed their medical abortion with pharmacy acquired medications (13%, n=2229) than those who had a provider-supported medical abortion (15%, n=2860); the type of complication was not specified (Banerjee, Gulati, & Pearson, 2025). A comparative cohort study in Bangladesh established comparable client-reported quality of abortion care received from pharmacies and in health clinics (Jacobsen et al., 2024). Pharmacy clients were more likely to report that the abortion was affordable, while health clinic clients received better quality of information and were more prepared in case of an adverse event.

Resources

Abortion with pills – Ipas (Several evidence-based resources for people about how to safely self-manage an abortion using pills at at this link.)

Abortion Care Videos – Ipas: Abortion Care Videos for Women (3 videos) 

References

ACOG Committee Statement No. 13: Self-Managed Abortion. (2024). Obstetrics & Gynecology, 144(6), e152.

Acre, V. N., Küng, S. A., Arce, C., Yapu, A., Iriondo, D., & Morales, M. (2023). Reach, experience, and acceptability of an abortion self-care intervention in Bolivia: a mixed-methods evaluation. Sexual and Reproductive Health Matters, 31(1), 2139888.

Aiken, A.R.A., Broussard, K., Johnson, J.M., & Padron, E. (2018). Motivations and experiences of people seeking medical abortion online in the United States. Perspectives on Sexual and Reproductive Health, 50(4), 157-163.

Aiken, A.R.A., Starling, J.E., &am p; Gomperts, R. (2021). Factors associated with use of an online telemedicine service to access self-managed medical abortion in the US. JAMA Network Open, 4(5), e2111852.

Aiken, A., Lohr, P.A, Lord, J., Ghosh, N., & Starling, J. (2021). Effectiveness, safety and acceptability of no-test medical abortion (termination of pregnancy) provided via telemedicine: A national cohort study. BJOG: An International Journal of Obstetrics and Gynaecology, 128(9), 1464-1474.

Aiken, A.R.A., Romanova, E.P., Morber, J.R., & Gomperts, R. (2022). Safety and effectiveness of self-managed medication abortion provided using online telemedicine in the United States: A population based study. Lancet Regional Health Americas, 10, 100200. Doi.10.1016/j.lana.2022.100200.

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Jayaweera, R., Powell, B., Gerdts, C., Kakesa, J., Ouedraogo, R., Ramazani, U., Wado, Y.D., Wheeler, E., & Fetters, T. (2021). The potential of self-managed abortion to expand abortion access in humanitarian contexts. Frontiers in Global Women’s Health, 2:681039. Doi: 10.3389/fgwh.2021.681039

Kapp, N., Bawah, A. A., Agula, C., Menzel, J. L., Antobam, S. K., Asuming, P. O., Eckersberger, E., & Pearson, E. E. (2024). Medical abortion in Ghana: A non-randomized, non-inferiority study of access through pharmacies compared with clinics. Contraception, 140.

Kapp, N., Mao, B., Menzel, J., Eckersberger, E., Saphonn, V., Rathavy, T., & Pearson, E. (2023). A prospective, comparative study of clinical outcomes following clinic-based versus self-use of medical abortion. BMJ Sexual & Reproductive Health, 49(4), 300–307.

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