“IT WAS THE SCARIEST FEW DAYS OF MY LIFE”: APPALACHIAN VIEWS OF SELF-MANAGED ABORTION

Objectives

We aimed to contextualize individual concerns and needs around self-managed abortions among a sample of Appalachians who have either considered or utilized it.

Methods

Data collection occurred via an anonymous Qualtrics survey. The survey was designed for this study, building upon prior data about self-managed abortion and our work in Appalachia. Eligible respondents were pregnancy-capable, older than 18, living in an Appalachian county, and had a history of either considering or utilizing self-managed abortion, regardless of outcome. The survey was pilot-tested by community partners, including abortion doulas and community-based partners in Appalachia. Recruitment took place over social media, both by posting from community partners and using boosted Facebook ads. Open-ended responses were coded using thematic analysis.

Results

Some 177 participants representing every state in Appalachia responded to the survey. Four themes were identified from the open-text responses: 1) Emotional turmoil and psychological distress; 2) Motivations rooted in privacy, accessibility, and cost; 3) Concerns about health risks and need for guidance; and 4) Desire for information, support, and connection.

Conclusions

These findings highlight that self-managed abortion is often pursued not out of preference but due to barriers such as cost, legal restrictions, stigma, or lack of access to clinical care. While some individuals reported positive or manageable experiences, many described self-managed abortion as physically and emotionally distressing, particularly when undertaken without adequate support or reliable information. The need for accessible, evidence-based resources and nonjudgmental support is clear. Improving access to accurate information, emotional support, and follow-up care could greatly enhance the safety and well-being of those who consider or attempt self-managed abortion in Appalachia.