Exploring the Motivations and the Concerns Behind Self-Managed Medication Abortion Done by Purchasing Medication Online: Qualitative Interview Study With US Abortion Seekers Post-Roe

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Abstract
Background: As restrictive abortion laws continue to emerge in various states of the United States, pregnant individuals are turning to alternative channels to seek abortion medication, one of which is engaging in self-managed medication abortion, purchasing the medication from online websites without any medical prescriptions. Objective: This study explores the phenomenon of self-managed abortion medication sought by using online tools, by focusing mainly on the motivational factors and concerns behind such a decision, and the abortion seekers’ journey throughout this process. Methods: We conducted 20 semistructured interviews with individuals who have sought an abortion in the United States by buying medication online. The interviews occurred online, and participants were compensated for their participation. Participants were recruited from Reddit communities centered around abortion access. The interviews were audio-recorded and transcribed. The data were analyzed using a grounded theory approach. Results: The results showed that participants expressed the need for anonymity, digital and physical, when seeking an abortion and considered self-managed abortion to be more economically and time-convenient. They also discussed how much self-managed abortion can lead to isolation and anxiety because of the lack of medical support and the sole reliance on information found online. The risks, such as counterfeit medication, possible fraud, and issues of timing, associated with seeking a self-managed abortion were extensively discussed by participants. Conclusions: Our research uncovered the motivational factors behind relying on online tools to purchase abortion medication and engaging in self-managed abortion. Moreover, our research provides evidence of the importance of digital services to offer pregnant individuals a way to find abortion medication detached from their physical communities, circumventing the stigma associated with seeking an abortion and the sociocultural consequences of it. This promised anonymity is the core motivational factor that encourages pregnant individuals to prefer these systems compared to legal options. However, behind this promised anonymity, privacy and security concerns might be hidden.

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