Erin Worden (NYU Wagner) | Ipas | Kenya
The way we talk about self-managed abortion (SMA) in the humanitarian space is changing – and for the better.
Long-standing discourses around abortion care in the humanitarian sector have historically failed to fully recognize SMA, in which pregnant people induce their abortions outside of clinical settings. These traditional discourses instead emphasized “safe” and “unsafe” abortion, centering the medicalization of abortion over the autonomy and efficacy of the pregnant person.
Thanks in large part due to the growing evidence base around the efficacy and availability of medication abortion (notably misoprostol and/or mifepristone), abortion discourses in the humanitarian world now hold more space for SMA.
Within recent years, the World Health Organization shifted to formally acknowledging self-administered abortions, often referred to as “self-care,” occurring outside of clinical healthcare spaces and published guidelines for embracing SMA in interventions.
Humanitarian INGOs, too, are gradually embracing long-standing SMA practices. Médecins Sans Frontières and International Rescue Committee, for example, recently recognized the unique potential of SMA in humanitarian settings where fragile health systems, disruptions to contraceptive access, and upticks in sexual violence heighten risks of unwanted pregnancy.
This sector-wide discursive shift – from neglecting the radical act of SMA by dubbing it “unsafe” to now acknowledging the role of self-efficacy in terminating one’s pregnancy – reflects a harm reduction approach. If pregnant folks in emergency settings have long managed their abortions, creating abortion ecosystems that maximize SMA information, minimize risks, and make effective abortion methods such as MA more accessible promises to reduce maternal mortality.
In embracing SMA both as a radical, feminist act and an enduring, everyday approach to abortion, the humanitarian sector moves closer to elevating the personal and political agency of displaced women and girls worldwide.