Self-managed abortion (SMA) with pills refers to self-sourcing abortion pills (usually online), and using them at home without physician supervision. It is not the same as receiving abortion pills from a clinic or having a telehealth appointment with an online service like Abortion on Demand, carafem, Choix, Forward Midwifery, Hey Jane, or Just The Pill, (among others) where a clinician has video call with you and then mails you the pills to use at home. If you received abortion pills by getting them from a licensed clinician in the U.S., this is legal and not subject to criminalization. In this case, just follow the instructions that you were given by the clinician overseeing your care. But if you intend to self-manage your abortion by getting your pills from another source, be sure to make a plan to keep yourself safe from potential legal consequences.
SMA with pills is medically safe and effective throughout early pregnancy, but there is a risk of criminalization in many U.S. states. While only three states—Nevada, South Carolina, and Oklahoma—currently have explicit bans on SMA, around 20 other states have laws that prosecutors could misuse to charge someone who ends a pregnancy on their own. At least 22 people have been arrested for SMA since 2000. Although it is impossible to fully eliminate the risk of criminalization when having or planning to have an abortion at home, there are several things you can do to help protect yourself:
Leave no online footprint of searches or purchases. Digital Defense Fund's abortion privacy guide is your go-to resource for this. Using private browsers, two-factor authentication, encrypted messaging, strong passwords, etc. is critical. Google searches have been presented as evidence in an SMA trial before. Do not leave a digital trail.
Use the medications properly to prevent interactions with healthcare providers. The pills are very effective, but they have to be used right. Carefully follow the instructions provided on the How to Use Abortion Pill website. Note that misoprostol tablets should always be taken by dissolving them under the tongue. Do NOT insert misoprostol vaginally if you are self-managing an abortion. While this is medically safe, it can leave incriminating pill remnants that can be detected in the vagina during a pelvic exam if you end up needing to seek medical care.
If it's not an emergency but you need expert health advice, use a free calling service like Google Voice to call or text the Miscarriage + Abortion Hotline at 1-833-246-2632. Medical complications are very uncommon with abortion pills, but they’re not impossible. The M+A Hotline is safe to use and is staffed by trustworthy clinicians who volunteer their time to help those who choose SMA. Do not use your own phone number to call as this will create a record that is visible to your cell service provider.
Don't disclose any information about SMA to emergency room staff if you do need to seek medical care. This is how most people who are arrested for SMA are reported. Healthcare providers are almost always who calls the police in cases of SMA criminalization. Contrary to popular belief, HIPAA does not protect your private health information from being shared with police if you are suspected of doing something that could be considered a crime. If you believe you need to seek urgent medical care, do not hesitate to go. Say "I think I'm having a miscarriage" and provide your symptoms. Do not mention any use of or purchase of abortion pills. There is no widely available test to detect misoprostol in your bloodstream. If you do not disclose it, there is no way for a medical provider to tell the difference between a medication abortion and a spontaneous miscarriage.
Do not talk to the cops. Period. Do. Not. Talk. To. The. Cops. If you are questioned by police you should state, "I am exercising my right to remain silent, and I wish to speak with an attorney." Do not speak again or nod in response to a question. Contact the Repro Legal Helpline as soon as possible for expert legal advice: 1-844-868-2812. Do not agree to questioning or speak to any law enforcement official without a lawyer present.
Again, none of these precautions can completely eliminate the risk of criminalization. Sadly, many have been arrested and charged for miscarriages over the years. Black folks, Indigenous folks, and Latine/Hispanic folks, in particular, have been disproportionately impacted. Sometimes these strategies can make all the difference for someone who is suspected of having an at-home abortion.
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