Perspectives on options for self-sourcing medication abortion after implementation of Texas Senate Bill 8.

Objectives: To examine experiences of pregnant Texans who considered self-sourcing medication abortion following the September 2021 implementation of Texas Senate Bill 8, which prohibited abortions after detectable embryonic cardiac activity.

Study design: This qualitative research study used in-depth telephone interviews conducted between October 2021 and August 2022 with pregnant and recently pregnant Texas residents ≥16 years of age who considered abortion. We recruited participants from two sources: flyers posted at abortion facilities in nearby states and an online survey of Texans seeking abortion care. We interviewed participants who obtained out-of-state abortion care or who reported self-managing their abortion, having a miscarriage or an ectopic pregnancy, or continuing their pregnancy. We used inductive and deductive coding in our thematic analysis examining perceptions of self-sourcing medication abortion and potential use of a hypothetical telehealth abortion model.

Results: Of the 120 participants interviewed, 50 researched or considered self-sourcing medication abortion, including 15 who ultimately sourced medications to self-manage their abortion. Participants described uncertainty about the safety and legality of their options for self-sourcing abortion medications, and most would have preferred to use telehealth abortion in a hypothetical legal policy context, including those who self-managed their abortion.

Conclusions: In the context of an abortion ban, people considered self-sourcing abortion medications, but had concerns about the legality and safety of doing so. People in states with restrictive abortion laws may benefit from information about how to access medication abortion from safe and reliable sources and mitigate their legal risks.

Implications: People perceive meaningful differences between the legality and safety of telehealth and self-managed medication abortion. Strategies are needed to provide pregnant people in restricted settings with clear information so they can make an informed choice for their personal circumstances.