Abstract
Self-managed abortion (SMA) represents a significant shift in the abortion landscape, offering an alternative to facility-based care via the medication misoprostol with or without mifepristone. The World Health Organization recommends SMA with medications as safe and effective up to 12 weeks' gestation and with access to information and health system referrals. Increasing prevalence of SMA can be attributed to a range of factors, including legal and logistical barriers to facility-based care as well as a social movement advocating autonomy and demedicalized practices in the United States, particularly after the US Supreme Court decided Dobbs v Jackson Women's Health Org., 597 US (2022). We document the history, safety and effectiveness, measurement challenges, and models of SMA care and review ongoing legal and policy challenges. Despite its clinical and practical advantages, SMA exists in a complex policy environment that hinders access to safe abortion. Evidence from diverse regions demonstrates the potential for SMA to expand access, especially where care is limited or restricted. As research affirms the safety of SMA, including later in pregnancy, it remains vital to protect and expand access to abortion medications, without threat of criminalization, to ensure that individuals can exercise their reproductive rights and autonomy. (Am J Public Health. 2025;115(10):1734-1741. https://doi.org/10.2105/AJPH.2025.308133).