Medical views on self-managed abortion shifting since overturn of Roe

Summary

Consider This from NPR: Medical Views on Self-Managed Abortion Shifting Since Overturn of Roe

Release Date: June 24, 2025

In this episode of NPR's Consider This, host Mary Louise Kelly delves into the evolving perspectives within the medical community regarding self-managed abortions following the Supreme Court's decision to overturn Roe v. Wade three years prior. The episode explores the legal, medical, and societal ramifications of this monumental shift, highlighting personal stories, expert insights, and recent developments that shape the current landscape of reproductive healthcare in the United States.

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1. The Overturning of Roe v. Wade: A Pivotal Moment

The episode opens with Mary Louise Kelly setting the stage for the discussion:

Mary Louise Kelly [00:00]: "Three years ago today, the Supreme Court ended the constitutional right to an abortion in the United States."

Poppy Luthan adds gravity to the moment, capturing the profound impact of the decision:

Poppy Luthan [00:09]: "Never done before, expressly take away a constitutional right that is so fundamental to so many Americans that had already been recognized."

The overturning of Roe v. Wade marked a significant transformation in the American legal and social landscape, prompting diverse reactions across the nation.

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2. Divergent Reactions: Grief and Celebration

The immediate aftermath of the decision saw a spectrum of emotions:

• Grief and Concern:

  Poppy Luthan shares her personal anguish and fears:

  Poppy Luthan [00:49]: "Women are gonna die. That's... I’m just overcome with grief."

  Nancy Northup from the Center for Reproductive Rights echoes this sentiment:

  Nancy Northup [02:02]: "It's absolutely devastating... utterly destroy the protections of Roe versus Wade."

• Celebration and Relief:

  In contrast, pro-life advocates like Kelsey Smith expressed jubilation:

  Kelsey Smith [01:23]: "The pro life generation vote... wants to really make abortion illegal, unthinkable, and unnecessary."

  Ann Scheidler from the Pro Life Action League reflects optimism:

  Ann Scheidler [01:43]: "It's hard to believe this day is here... we knew the country would come to its senses."

These conflicting responses underscored the deeply polarized views on abortion rights in America.

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3. Legal and Medical Implications Post-Roe

Following the Supreme Court's decision, the legal framework surrounding abortion underwent rapid changes:

• State-Level Bans and Restrictions:

  By the following Monday after the decision, 11 states had implemented bans or severe limitations on abortion services.

• Uncertainties in Medical Practice:

  The overturn raised critical questions for the medical community:

  • Criminal Prosecution: Potential legal consequences for doctors performing abortions.
  • Miscarriage Laws: How spontaneous abortions would be treated under the new legal standards.
  • IVF and Reproductive Technologies: The legality and accessibility of in vitro fertilization amid tightening restrictions.

Alexis McGill Johnson, CEO of Planned Parenthood, highlighted the looming uncertainties:

Alexis McGill Johnson [03:08]: "We will support and educate people around methods of self managed care."

These shifts necessitated a reevaluation of reproductive healthcare delivery and accessibility.

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4. The Rise of Self-Managed Abortion

With traditional abortion services facing increased restrictions, self-managed abortion emerged as a critical alternative:

• Definition and Methods:

  Self-managed abortion primarily involves the use of medication, such as mifepristone and misoprostol, obtained without direct medical supervision.

• Statistical Trends:

  Since Roe's overturn in 2022, there has been a notable increase in self-managed abortions and online orders for abortion pills.

Abby Windle from NPR's Embedded team explores these trends and their implications throughout the episode.

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5. Shifting Medical Community Perspectives

The medical community's stance on self-managed abortions has undergone significant transformation:

a. Initial Concerns and Skepticism

Dr. Maya Bass, a family medicine doctor from Oklahoma, initially expressed apprehension regarding self-managed abortions:

Dr. Maya Bass [06:05]: "Gosh, what if people are dropping like flies because they're taking meds that are actually rat poison and hurting themselves?"

Similarly, Jen Carlin, a UCSF professor, sought to understand clinicians' worries about the safety of self-managed abortions:

Jen Carlin [07:14]: "People felt it was really unsafe."

b. Research and Evidence-Based Reassessment

In 2019, Jen Carlin conducted a study surveying 40 abortion providers about their views on self-managed medication abortions. The findings revealed that:

• Half were Ambivalent: Many providers were unsure or neutral about the safety and efficacy of self-managed methods.

• Impact of Evidence: After presenting providers with a fact sheet summarizing multiple peer-reviewed studies supporting the safety of self-managed abortions, perceptions began to shift.

Dr. Bass reflected on her change in perspective:

Dr. Maya Bass [07:36]: "Realizing that I was unnecessarily putting people through hoops... I felt also excited, slash maybe relieved."

c. The COVID-19 Effect

The COVID-19 pandemic accelerated the adoption of telemedicine practices, reducing the need for in-person clinic visits:

Dr. Maya Bass [08:37]: "Now all of a sudden the healthcare profession is saying, wait, wait, wait, does that person really need to come in... there's all this evidence... they don't."

This period validated the efficiency and safety of remote abortion care, further influencing medical opinions.

d. Current Practices and Acceptance

By 2024, 19% of all abortions in the U.S. were conducted via telehealth. Moreover, authoritative bodies have endorsed self-managed abortion:

• World Health Organization (2022): Declared self-managed abortion safe and effective in the first trimester.
• American College of Obstetricians and Gynecologists (2024): Released a statement supporting self-managed methods.

Dr. Bass now actively participates in the Miscarriage and Abortion Hotline, assisting individuals with self-managed abortions:

Dr. Maya Bass: "I’m practicing evidence based medicine that is the leading edge of what reproductive healthcare might look like."

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6. Ongoing Challenges and Future Directions

Despite growing acceptance, challenges persist:

• Regulatory Pushbacks:

  In 2025, Health and Human Services Secretary Robert F. Kennedy Jr. ordered the FDA to review regulations on mifepristone, potentially reinstating strict access requirements.

  Mary Louise Kelly [10:45]: "If abortion pills get harder to access through the formal health care system, even more women may look to self managed abortion."

• Risks of Increased Self-Management:

  Stricter regulations may drive more individuals to procure abortion pills online, raising concerns about safety and misinformation.

Abby Windle highlights the delicate balance between access and regulation, emphasizing the need for evidence-based policies that protect women's health without imposing unnecessary barriers.

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7. The Global Perspective

The episode concludes by drawing parallels to international contexts:

Mary Louise Kelly [12:24]: "Decades ago, Brazilian women made a discovery they could have an abortion without a doctor thanks to a tiny pill. That pill spawned a global movement helping millions of women have safe abortions regardless of the law."

This global movement underscores the universal quest for reproductive autonomy and the critical role of medication in expanding access to safe abortion practices.

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Conclusion

"Medical Views on Self-Managed Abortion Shifting Since Overturn of Roe" offers a comprehensive exploration of how the medical community in the United States is adapting to the post-Roe landscape. Through personal narratives, expert interviews, and analysis of recent studies, the episode underscores the complexities of ensuring safe reproductive healthcare in a legally restrictive environment. As regulations continue to evolve, the dialogue between medical professionals, policymakers, and the public remains crucial in shaping the future of abortion access and women's health rights.

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Produced by Noah Caldwell and Lauren Hodges, edited by Jeanette Wilson Woods, with executive production by Sami Yenigun.

Transcript

[Mary Louise Kelly]

Three years ago today, the Supreme Court ended the constitutional right to an abortion in the United States. The court has done what it has.

[Poppy Luthan]

Never done before, expressly take away a.

[Mary Louise Kelly]

Constitutional right that is so fundamental to so many Americans that had already been recognized. That's then President Joe Biden a few hours later, reacting to the court overturning Roe v. Wade, which for 49 years had guaranteed the right to an abortion nationwide. There had been some. A draft of the decision had been leaked more than a month before. But that morning outside the court, the news was still monumental.

[Poppy Luthan]

This decision must succeed. When I knew the decision was handed down, they just.

[Mary Louise Kelly]

Women are gonna die. That's Poppy Luthan from Seattle. She happened to be in D.C. for a conference. She worried about the world her teenage daughter was growing up into.

[Poppy Luthan]

The Supreme Court is meant to give us justice, and it's being taken.

[Mary Louise Kelly]

And I'm overcome.

[Poppy Luthan]

I'm just overcome with grief.

[Mary Louise Kelly]

But others were celebrating.

[Poppy Luthan]

Very excited, very happy, very grateful, but.

[Mary Louise Kelly]

Still a lot of work to do. Kelsey Smith from Clemson, South Carolina, was wearing a shirt that read, the pro life generation vote.

[Poppy Luthan]

I mean, the pro life generation and the pro life movement wants to really make abortion illegal, unthinkable, and unnecessary.

[Mary Louise Kelly]

Those two reactions, grief and excitement, played out across the country as the day unfolded. Ann Scheidler, vice president of the Pro Life Action League, spoke to npr.

[Poppy Luthan]

It's hard to believe this day is here. Even though we had the leak, it's just unbelievable. We anticipated this day would come someday. We knew the country would come to its senses.

[Mary Louise Kelly]

Nancy Northup, president of the center for Reproductive Rights, the Mississippi clinic at the center of the court's decision, spoke with NPR as well.

[Poppy Luthan]

You know, it's absolutely devastating. Even though we had that advance leaked draft opinion, it is still emotionally stunning to have this opinion now out and to have had the court just deliver a wrecking ball to the constitutional right to abortion and utterly destroy the protections of Roe versus Wade.

[Mary Louise Kelly]

The Supreme Court decision was announced on a Friday. By Monday, 11 states had banned or severely limited abortion. As the legal landscape shifted, the medical landscape of reproductive care was faced with serious questions. Would doctors be criminally prosecuted for performing abortions? How would miscarriages be treated by the law? Would IVF remain legal and a big unknown? With fewer legal options available? Where would people turn for abortion care? I think that's always a concern, right when you take away access to care.

[Poppy Luthan]

To providers, that people will turn to alternative methods.

[Mary Louise Kelly]

That's Alexis McGill Johnson, CEO of Planned Parenthood, talking with All Things Considered at the time.

[Poppy Luthan]

You know, we will support and educate.

[Mary Louise Kelly]

People around methods of self managed care. Self managed care like abortion pills. Consider this, three years after the fall of Roe v. Wade, more and more people are managing their abortions without doctors. We'll take a look at the changing opinions about self managed abortions within the medical community from npr, I'm Mary Louise Kelly. The House of Representatives has approved a White House request to claw back two years of previously approved funding for public media. The rescissions package now moves on to the Senate. This move poses a serious threat to local stations and public media as we know it. Please take a stand for public media [e-mail] thank you.

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The radio or maybe even at this.

[Poppy Luthan]

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It'S consider this from npr. Mifepristone is one of two drugs used in medication abortions. By the time Roe v. Wade was overturned In June of 2022, its use had been approved by the FDA for 22 years. But after the Supreme Court's decision, access to mifepristone became tangled in the legal fight over abortion rights. U.S. attorney General Merrick Garland released a statement that same day saying that states may not ban mifepristone based on disagreement with the FD expert judgment about its safety and efficacy. Within a few months, a challenge to the safety of mifepristone went to federal court in Texas. It took two years for that case to make it to the Supreme Court, which ruled last summer that access to the pill should be preserved. So where do we stand now? Abby Windle from NPR's Embedded team has been reporting on self managed abortions and how the medical community's views on it have changed in recent years.

[Poppy Luthan]

For nearly four years, Maya Bass commute included a monthly plane ride from Philadelphia to Oklahoma. Do you like flying? Oh no, I Get really motion sick. I'm really good at not vomiting though. So Bass made that trip each month to fill a gap. Oklahoma had a shortage of abortion providers, and she's a family medicine doctor who provides abortion. One way was by prescribing abortion pills. Bass was trained to follow a strict protocol around the pills. It included multiple in person appointments, to get an ultrasound and blood work and to pick up the pills at the clinic. Bass believed many of these steps kept patients safe. Of course I'm going to confirm exactly how big this pregnancy is. Of course I'm going to confirm that my patient has enough blood to handle this. So Bass was concerned when she first heard about self managed abortion. Getting abortion pills without a prescription and taking them without a doctor's oversight. Gosh, what if people are dropping like flies because they're taking meds that are actually rat poison and hurting themselves? A lot of doctors had a similar reaction.

[Mary Louise Kelly]

People felt it was really unsafe.

[Poppy Luthan]

This is Jen Carlin, a professor of family and community medicine at the University of California, San Francisco. In the late 2010s, she became interested in the debate about self managed abortion.

[Mary Louise Kelly]

I wanted to talk with clinicians about this to find out, are you really worried about the safety of this? And if you are, what aspect of the safety are you worried about?

[Poppy Luthan]

In 2019, Carlin turned these questions into a study. First, she surveyed 40 abortion providers and asked what they thought about self managed medication abortions. About half of them were ambivalent. Then Carlin gave them a fact sheet summarizing nearly two dozen peer reviewed studies that showed self managing with pills is safe and effective. Like, wait, what? Like, seriously, I never knew about any of this. Bass was one of the doctors in Karlin's study. The research on that fact sheet showed that the protocol Bass used, the multiple appointments, the ultrasound, wasn't always needed. Realizing that I was unnecessarily putting people through hoops, that's hard. And then I felt also excited, slash maybe relieved. Like, this means that I can be less scared for people who are doing this. The next year, 2020, far more doctors changed their minds because of the COVID 19 pandemic and the need for social distancing.

[Mary Louise Kelly]

Now all of a sudden the healthcare profession is saying, wait, wait, wait, does that person really need to come in to do that ultrasound? And lo and behold, there's all this evidence already out there that no, they don't.

[Poppy Luthan]

During the pandemic, the FDA stopped enforcing regulations on one of the abortion pills. Mifepristone. Patients were no longer federally required to go to a clinic to get abortion pills. Doctors in many states began using telemedicine. Carlin went back to the doctors she had surveyed in 2019 to see what they thought about medication abortion with less medical oversight.

[Mary Louise Kelly]

They're seeing it and they're saying, oh, everything I was reading about in those papers is right. And I'm seeing it from my own eyes. And now I'm even more convinced that it works.

[Poppy Luthan]

Across the country, many doctors who provide abortions embraced a more demedicalized approach. As of 2024, 19% of all abortions happened with telehealth. But telehealth still requires a doctor to give a patient a prescription. Self managed abortion goes a step further. People get the pills on their own, often by ordering them online. More women have done just that since Roe vs Wade was overturned in 2022. Since then, studies have shown that the rate of self managed abortion has increased, and so have online abortion pill orders. And organizations that support people through self managed abortions have seen an explosion in people reaching out. That's true for the Miscarriage and Abortion Hotline, which is run by clinicians. Bass, the family medicine doctor, joined the Hotline after reading the research about self managed abortion. The vast majority of the calls I'm dealing with are people just being like, hey, can you tell me if it worked? Bass knows self managed abortions can't replace all abortions. Some people need medical intervention or just prefer to go to a clinic. But to her, the hotline and the immediate access it gives women to doctors without unnecessary tests feels innovative. It feels like I'm just on the cutting edge of medicine. I'm practicing evidence based medicine that is the leading edge of what reproductive healthcare might look like. The broader mainstream medical community has been moving in this direction too. In 2022, the World Health Organization declared self managed abortion to be a safe and effective method in the first trimester. And in 2024, the American College of Obstetricians and Gynecologists put out a statement in support of it. But there's been movement in the opposite direction too. Last month, Secretary of Health and Human Services Robert F. Kennedy Jr. Ordered the FDA to review regulations on mifepristone, which could restore the rules that require patients to get multiple tests and pick up the pills at a clinic. If abortion pills get harder to access through the formal health care system, even more women may look to self managed abortion.

[Mary Louise Kelly]

That's Abby Windle, reporter for embedded, NPR's home for long Form Documentaries. The podcast just came out with a new series about the history of self managed abortion called the Network. It was produced alongside Futuro Media. This episode was produced by Noah Caldwell and Lauren Hodges. It was edited by Jeanette Wilson Woods. Our executive producer is Sami Yenigun. It's considered this from npr. I'm Mary Louise Kelly. Decades ago, Brazilian women made a discovery they could have an abortion without a doctor thanks to a tiny pill. That pill spawned a global movement helping millions of women have safe abortions regardless of the law. Hear that story on the network from NPR's Embedded and Futuro Media.

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On the Indicator, we unpack the unusual business strategy that transformed a tiny Japanese toy company into into a global multimedia giant. Listen to the Indicator from Planet Money. Wherever you get your podcasts. Want to hear this podcast without sponsor breaks?

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