Financial Barriers Are Associated With Self‐Managed Abortion in Indiana: Results From a Mixed‐Methods Study in 2021–2022

Abstract

Objectives: To measure knowledge of and experiences with self-managed abortion among abortion seekers in Indiana before the Supreme Court decision in Dobbs v. Jackson Women's Health Organization (Dobbs). Study design: Between June 2021 and April 2022, we recruited a non-probability sample of Indiana residents of any age who were currently or recently pregnant and considering abortion via online advertisements, referrals from abortion funds, and flyers in abortion clinics. Participants completed two online surveys 1 month apart, and a subset completed in-depth interviews. We conducted descriptive and regression analyses of characteristics, methods, motivations, and knowledge of self-managed abortion. Results: Among 434 total participants, 33 (7.6%, 95% CI: 5.5%-10.5%) reported a self-managed abortion attempt for their current/recent pregnancy; these participants were younger, less likely to be parents, more likely to be pregnant for the first time, and more likely to identify as a sexual and/or gender minority person than were participants who did not attempt to self-manage. Participants cited unaffordability of clinician-supported abortion care (n = 16/33, 49%) as the most common reason for attempting to self-manage. Those who reported challenges paying for abortion were three times more likely to attempt a self-managed abortion than those who did not (aRR: 3.0, 95% CI: 1.1, 8.2). Interviews (n = 40) highlighted low awareness of self-managed medication abortion. Conclusions: Among people who faced financial barriers to clinician-supported abortion care in Indiana, financial distress motivated some residents to self-manage abortions. In the further restricted post-Dobbs period, financial support to obtain clinician-supported care and trusted, accessible information on safe and effective self-managed abortion options are imperative so that Indiana residents can access abortion care in accordance with their preferences.