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Original research
Abortion attempts without clinical supervision among transgender, nonbinary and gender-expansive people in the United States
  1. Heidi Moseson1,
  2. Laura Fix2,
  3. Caitlin Gerdts1,
  4. Sachiko Ragosta1,
  5. Jen Hastings3,
  6. Ari Stoeffler2,
  7. Eli A Goldberg4,
  8. Mitchell R Lunn5,6,7,
  9. Annesa Flentje7,8,9,
  10. Matthew R Capriotti7,10,
  11. Micah E Lubensky7,8,
  12. Juno Obedin-Maliver6,7,11
  1. 1 Ibis Reproductive Health, Oakland, California, USA
  2. 2 Ibis Reproductive Health, Cambridge, Massachusetts, USA
  3. 3 Department of Family and Community Medicine, University of California San Francisco, San Francisco, California, USA
  4. 4 Department of Family Medicine, The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, Vermont, USA
  5. 5 Department of Nephrology, Stanford University School of Medicine, Stanford, California, USA
  6. 6 Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
  7. 7 The PRIDE Study, Stanford University, Stanford, California, USA
  8. 8 Department of Community Health Systems, University of California San Francisco, San Francisco, California, USA
  9. 9 Alliance Health Project, Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
  10. 10 Department of Psychology, San Jose State University, San Jose, California, USA
  11. 11 Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
  1. Correspondence to Dr Heidi Moseson, Ibis Reproductive Health, Oakland, CA 94612, USA; hmoseson{at}gmail.com

Abstract

Background Transgender, nonbinary and gender-expansive (TGE) people face barriers to abortion care and may consider abortion without clinical supervision.

Methods In 2019, we recruited participants for an online survey about sexual and reproductive health. Eligible participants were TGE people assigned female or intersex at birth, 18 years and older, from across the United States, and recruited through The PRIDE Study or via online and in-person postings.

Results Of 1694 TGE participants, 76 people (36% of those ever pregnant) reported considering trying to end a pregnancy on their own without clinical supervision, and a subset of these (n=40; 19% of those ever pregnant) reported attempting to do so. Methods fell into four broad categories: herbs (n=15, 38%), physical trauma (n=10, 25%), vitamin C (n=8, 20%) and substance use (n=7, 18%). Reasons given for abortion without clinical supervision ranged from perceived efficiency and desire for privacy, to structural issues including a lack of health insurance coverage, legal restrictions, denials of or mistreatment within clinical care, and cost.

Conclusions These data highlight a high proportion of sampled TGE people who have attempted abortion without clinical supervision. This could reflect formidable barriers to facility-based abortion care as well as a strong desire for privacy and autonomy in the abortion process. Efforts are needed to connect TGE people with information on safe and effective methods of self-managed abortion and to dismantle barriers to clinical abortion care so that TGE people may freely choose a safe, effective abortion in either setting.

  • abortion
  • induced
  • abortifacient agents
  • reproductive health
  • family planning services
  • reproductive rights
  • abortion
  • criminal

Data availability statement

Per agreements in the informed consent materials with participants, the authors cannot make the data publicly available. However, in support of transparency in research, we can discuss secure ways to make de-identified quantitative (not qualitative) data available on a per-request basis. Interested researchers should contact the corresponding author (hmoseson@ibisreproductivehealth.org).

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjsrh-2020-200966

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    Data availability statement

    Per agreements in the informed consent materials with participants, the authors cannot make the data publicly available. However, in support of transparency in research, we can discuss secure ways to make de-identified quantitative (not qualitative) data available on a per-request basis. Interested researchers should contact the corresponding author (hmoseson@ibisreproductivehealth.org).

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    Footnotes

    • Contributors HM, LF, JH, JO-M and AS conceived of the study and obtained funding. HM, LF, JH, JO-M, AS, MRL and EAG designed the survey instrument. HM, LF, JH, JO-M, AS, EAG, MRL, AF, MRC and MEL supported recruitment. HM, JO-M and MRL managed data collection. HM, LF and SR conducted analyses. HM wrote the initial draft with revisions and additional writing contributions from all authors: HM, JO-M, CG, EAG, MRL, SR, LF, JH, AS, AF, MRC and MEL.

    • Funding AS, CG, HM, JH, JO-M, LF and SR were partially supported by the Society of Family Planning (Grant Number SFPRF11-II1). AF was partially supported by the National Institute on Drug Abuse (Grant Number K23DA039800). JO-M was partially supported by the National Institute of Diabetes, Digestive, and Kidney Disorders (Grant Number K12DK111028). MRC was partially supported by a Clinical Research Training Fellowship from the American Academy of Neurology and the Tourette Association of America. Research reported in this article was partially funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (Award Number PPRN-1501-26848) to MRL. The statements in this article are solely the responsibility of the authors and do not necessarily represent the views of PCORI, its Board of Governors or Methodology Committee, nor of the National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

    • Competing interests MRL has consulted for Hims, Inc. (2019–present) and Folx, Inc. (2020). JO-M has consulted for Sage Therapeutics (5/2017) in a one-day advisory board, Ibis Reproductive Health (a non-for-profit research group 2017–present), Hims, Inc. (2019–present) and Folx, Inc. (2020–present). JH is consultant advisor for Plume, Inc. (2020–present). None of these roles present a conflict of interest with this work as described here. All other authors report no conflict of interest.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Provenance and peer review Not commissioned; externally peer reviewed.