Beyond Roe: Why the Biden Administration Should Decriminalize Self-Managed Abortion

This blog is the third in our series on priorities for the incoming Biden administration. Read our plan for combatting reproductive coercion, here, and our top-level priorities for the administration, here. 


With the inauguration of President-elect Joe Biden straddling the 48th anniversary of Roe v. Wade, the incoming Biden administration has the opportunity to not only celebrate and protect the historic anniversary by codifying Roe, but also to act beyond it by offering specific plans to expand abortion access using a human rights and reproductive justice framework.

One key action is decriminalizing self-managed abortion.

Self-managed abortion with pills is safe and effective when the pills are accessible and people have access to reliable information and, if needed, quality follow-up medical care. There are many reasons why someone may want to self-manage their abortion. Some choose it for convenience, to terminate in the privacy of their own home. Others decide to self-manage to offset the long distances—27 major US cities qualify as “abortion deserts”—cost, time off work, etc. of traveling to the nearest clinic. Others self-manage their abortion because it is the only safe and legal option available to them. In 1996, the US had 452 abortion clinics, in 2005 there was 381, and in 2014, only 272. Today, there are six states with only one abortion provider. Other reasons include mandatory waiting periods, vaginal ultrasounds, and third-party consents, to name a few.

More recently, fear of contracting COVID-19 while attempting to access abortion services has increasingly led people to self-manage their abortion at home—drawing attention to what we have long known: self-managed abortion is safe and effective. Regardless the reason, every person deserves unrestricted access to abortion, free from fear of arrest or prosecution.

This is why, as noted in the Blueprint for Sexual and Reproductive Health, Rights, and Justice, the president, within the first 90 days of taking office, must issue guidance to the Department of Justice to end practices and policies that place pregnant people at risk of criminal charges for any act or omission with respect to their own pregnancy. By ensuring the federal criminal code is not used to prosecute people who self-manage or help others self-manage their abortion, the administration can enable people to freely control their own bodies, lives, and futures.

Through the Blueprint, IWHC urges the administration to fully promote self-managed abortion by creating and supporting public health resources on the full range of abortion options, including self-managed abortions, through the following:

  • Materials for pregnant people, created or supported by the Department of Health and Human Services, should include information about self-managed abortion with pills, what the common side effects are, and under what conditions a person may need to seek medical help following a medication abortion or miscarriage.
  • Materials geared towards health care providers, first responders, and social workers, created or supported by the Department of Health and Human Services and Department of Justice, should also make it clear that mandatory reporting laws do not apply to people who self-manage and emphasize a harm reduction approach to treating patients in a supportive, non-stigmatizing manner.

The administration should encourage and pursue evidence-based policies and protocols, and work to remove the Risk Evaluation Mitigation Strategy (REMS) requirement on mifepristone. Currently, the outdated and burdensome restriction requires in-person dispensing for mifepristone. Though the requirement was lifted due to COVID-19, allowing abortion patients to safely access the pill through mail or at pharmacies, on January 12, 2021, the Supreme Court ruled 6-3 to reinstate the ideologically motivated and unnecessary restrictions. Additionally, the incoming Biden administration should work with the World Health Organization’s Expert Committee on the Selection and Use of Essential Medicines to remove the disclaimer notes attached to the combination use of mifepristone and misoprostol on the WHO’s List of Essential Medicines.

Such administrative actions are pivotal when COVID-19 continues to disproportionally impact women, girls, LGBTQ and gender non-conforming people, and other marginalized communities at all their intersections. Furthermore, these actions would align US policy with the United Nation’s recent Global Humanitarian Response Plan for COVID-19, which deems vital the security and continuity of sexual and reproductive health services.

Even in the post-COVID world, decriminalizing self-managed abortion will remain central to expanding abortion access. As noted by reproductive justice advocates, codifying Roe is the floor. The legal right to abortion means nothing when states erect and regulate restrictions on abortion, further curtailing abortion access. The reproductive justice framework demands the US go beyond Roe—to envision a world in which every person has the ability to freely exercise bodily autonomy and power to determine if, when, and how to parent, and to have access to the services needed to support that choice.

IWHC’s evidence-based guide provides step-by-step instructions on self-managing an abortion with misoprostol in ArabicEnglishEspañolFrançais, and Português.

Photo: Nina Robinson/Getty Images/Images of Empowerment

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