Self-Managed Abortion in Post-Dobbs America: Family Physician Libby Wetterer, MD, Looks Back and Ahead

The landscape of abortion care in the United States has shifted dramatically since the US Supreme Court ruling in Dobbs vs Jackson Women's Health Organization in 2022. In a recent interview with Patient Care, family physician and abortion care provider Libby Wetterer, MD, explained that "post Dobbs, medication abortion has been just under two-thirds of the abortions that happen in the US."

With limited access to specialty clinics in many regions, patients are increasingly turning to medication abortion—and many are managing the process themselves. Understanding this evolving reality is essential for family physicians and other primary care clinicians who may be the first point of contact for patients seeking guidance on or follow-up care for self-managed medication abortion.

In this interview, Wetterer, assistant professor, clinical and family medicine, University of Pennsylvania, discusses the current state of medication abortion in the US, the rise of self-managed abortion, and what these changes mean for family and primary care practice. The conversation explores how access has expanded for some marginalized communities even as overall access has contracted, and why primary care physicians need to be prepared to support patients navigating these options.

The following transcript has been lightly edited for flow and style.

Interviewer: I recently read that medication abortion now accounts for approximately two thirds of all of the abortions in the United States. Is that accurate? And could you provide a little bit of history on medication abortion?

Physician: Yeah, so post Dobbs, medication abortion has been just under two thirds of the abortions that happen in the US, and some of the reason we know that is actually a wonderful study called hashtag we count. It's been done by a lot of different organizations, but has helped us understand the landscape as many people are self managing and such medication abortion, or abortion in and of itself, has existed for generations before we use the medications we use today, but in terms of using mifepristone and misoprostol, mifepristone has been used in Europe longer than it's been used here, but it's been improved in the US for a couple of decades now. And medication abortion happens, I mean, within mostly specialty clinics, family planning clinics, mostly because it's difficult to integrate medication abortion in various clinical practices due to the policy restrictions.

So self managed abortion has happened for many generations and many centuries. People have taken control of their bodies and their menstruation. We think back to menstrual extraction, yeah, we and that things like that still happen today. The idea that we call it abortion is part of our own culture, but it's existed for many, many years. Self managed abortion has come to the forefront in the last few years, post Dobbs because of the lack of abortion providers or places to receive abortion care across the US. So many people with reproductive potential live in a county without an abortion clinic or without a place where they could have an abortion, whether in a primary care or other hospital setting. So self managed abortion has, I don't want to say erupted, but post COVID and then post Dobbs has become a way for people to continue to access care, whether it be from ordering pills online or through a telehealth platform, mifepristone and misoprostol, or through self managing with herbs or getting pills from another country. There's many different ways to self manage, but it's definitely becoming much, much more prevalent, and helping to not only help fill in the gaps that were created post Dobbs, but also increased access for the people that have had difficulty accessing abortion for longer than that time, so people of color, LGBTQ people, people with disabilities, teens. So while, while it's been a difficult time for everyone in the abortion community, it's also been a time that we've been able to rise up and expand access across lots of different communities.