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.

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.

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.

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.

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.

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."

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.

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.

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.

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