"I Was Determined to Take Control of My Own Body": Self-Managed Abortion in the US Appalachian Region

Many people living along the Appalachian mountain region, which spread down the eastern side of the United States, experience limited access to abortion care and report high levels of distrust in health care providers. Therefore, Appalachians are likely to have a unique lens through which to view the use of self-managed abortion. The purpose of this study is to better understand Appalachians' perceptions of self-managed abortions.

Data was collected via an online survey. Participants were recruited by trusted community partners and boosted ads on social media. Inclusion criteria included pregnancy-capacity, 18+ years old, living in an Appalachian county, and having a history of either considering or attempting self-managed abortion. Open-ended responses were coded using deductive thematic analysis guided by our theoretical framework.

Participants [N = 159] representing every Appalachian state responded to the survey. Three themes were identified: (1) self-managed abortion is often a decision made in the absence of choice but can be empowering within these constraints, (2) anticipating failure: the expectation of failure and health complications for those using self-managed abortion, and (3) connection with others is critical to having a more positive self-managed abortion experience.

These findings reveal 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. Improving access to accurate information, emotional support, and follow-up care could greatly enhance confidence in the safety of abortion and improve the well-being of those seeking abortion care in Appalachia.