How TikTok is being used to talk about abortion post-Roe: A content analysis of the most liked abortion TikToks.

OBJECTIVES: Access to information about abortion is essential for ensuring reproductive autonomy, particularly post-Roe. TikTok, a popular video-sharing application, may be a source of information about abortion, yet little is known about the tone and content of such videos. To fill this gap, we analyze the most liked abortion videos on TikTok three months following the U.S. Supreme Court decision Dobbs v. Jackson Women's Health Organization. STUDY DESIGN: We downloaded the top 200 most liked, publicly available TikTok videos when searching "abortion" on September 26, 2022 and recorded and summarized key video characteristics. We then qualitatively analyzed for content, tone, and common themes. RESULTS: The top 200 most liked TikTok videos collectively had approximately 164 million likes, nearly 10 million shares, and 4 million comments. Most videos expressed support for abortion and presented information that was political or personal in nature. Only two videos contained health information about obtaining or completing an abortion, and only five videos featured or were created by a medical provider. CONCLUSIONS: Findings reveal the far reach of TikTok, which underscores the importance of analyzing online sources of information about abortion. However, our mixed-methods analysis indicates that the most liked TikToks are a source of abortion news, political opinion, personal stories, and debate rather than a source of health information for abortion seekers. IMPLICATIONS: Our analysis finds that the top 200 most liked TikTok videos three months post-Dobbs are primarily political in nature. Relatively few videos provided practical information about accessing abortion care, presenting an opportunity for healthcare providers, public health advocates, and activists to improve access and awareness of new pathways to care. The most popular TikTok videos appear to disseminate news and political information rather than health information about abortion.

Strategic (Non)Disclosure: Activation and Avoidance of Social Ties among Women Seeking Abortion.

The increased politicization of sexual and reproductive health has created barriers to medically necessary care. In absence of formal health care, social ties become critical sources of information and resources, yet the disclosure of stigmatized health needs carries significant risk. How do people navigate the risks and benefits of disclosure when seeking care for stigmatized needs? Drawing on original survey data (N = 153) and in-depth interviews (N = 55) with women who attempted a self-managed abortion, I first describe the distinct roles of weak and strong ties in women's health-seeking experiences. I then demonstrate how both partial disclosure and nondisclosure are critical tools for obtaining information, resources, and emotional support during periods of health-seeking. Findings advance understanding of disclosure as a continuum that can be strategically wielded by people with stigmatized needs to confront and evade stigma and surveillance from their networks, the state, and the formal health care system.

Factors Associated With Knowledge and Experience of Self-managed Abortion Among Patients Seeking Care at 49 US Abortion Clinics.

Importance: Patients attending US abortion clinics may consider or try self-managing their abortion before coming to the clinic, yet little is known about the factors associated with self-management behavior. Objective: To examine the prevalence and factors associated with considering or attempting a self-managed abortion before attending a clinic. Design, Setting, and Participants: This survey study included patients obtaining an abortion at 49 independent, Planned Parenthood, and academic-affiliated clinics chosen to maximize diversity in geographic, state policy, and demographic context in 29 states between December 2018 and May 2020. Data were analyzed from December 2020 to July 2021. Exposures: Obtaining an abortion at a clinic. Main Outcomes and Measures: Knowledge of medications used to self-manage an abortion, having considered medication self-management before attending the clinic, having considered any method of self-management before attending the clinic, and having tried any method of self-management before attending the clinic. Results: The study included 19 830 patients, of which 99.6.% (17 823 patients) identified as female; 60.9% (11 834 patients) were aged 20 to 29 years; 29.6% (5824 patients) identified as Black, 19.3% (3799 patients) as Hispanic, and 36.0% (7095 patients) as non-Hispanic White; 44.1% (8252 patients) received social services; and 78.3% (15 197 patients) were 10 weeks pregnant or less. Approximately 1 in 3 (34%) knew about self-managed medication abortion, and among this subsample of 6750 patients, 1 in 6 (1079 patients [16.1%]) had considered using medications to self-manage before attending the clinic. Among the full sample, 1 in 8 (11.7%) considered self-managing using any method before clinic attendance, and among this subsample of 2328 patients, almost 1 in 3 (670 patients [28.8%]) attempted to do so. Preference for at-home abortion care was associated with considering medication self-management (odds ratio [OR], 3.52; 95% CI, 2.94-4.21), considering any method of self-management (OR, 2.80; 95% CI, 2.50-3.13), and attempting any method of self-management (OR, 1.37; 95% CI, 1.10-1.69). Experiencing clinic access barriers was also associated with considering medication self-management (OR, 1.98; 95% CI, 1.69-2.32) and considering any method of self-management (OR, 2.09; 95% CI, 1.89-2.32). Conclusions and Relevance: In this survey study, considering self-managed abortion was common before accessing in-clinic care, particularly among those on the margins of access or with a preference for at-home care. These findings suggest a need for expanded access to telemedicine and other decentralized abortion care models.

U.S. college students' perspectives on contraception and abortion post-Dobbs: the influence of socioeconomic privilege and gender inequity.

This study examined college students' perspectives about contraception and abortion in the context of the United States Supreme Court's decision to eliminate the constitutional right to abortion in June 2022. Individual, semi-structured interviews were conducted between October 2022 and February 2023 with a convenience sample of 20 college students, ages 18-22, attending a public university in the southeastern United States. Qualitative data analysis revealed three main themes. First, most participants conveyed fear, dismay, and anger about the decision in Dobbs v. Jackson Women's Health Organization to overturn Roe v. Wade and a few expressed concerns about potential restrictions on contraception. Second, women participants felt heightened pressure to continue or initiate use of a highly effective contraceptive method, with some lamenting inequitable experiences of the gendered contraceptive burden in their relationships with men. Third, when asked what they would do if they or their partner became pregnant while in college, most asserted they would seek abortion. Notably, participants assumed their socioeconomic advantages would ensure their or their partner's access to abortion, regardless of growing restrictions. The findings illustrate that among a group of relatively privileged young adults, the Dobbs decision simultaneously compelled their increased vigilance regarding contraceptive use and conferred the perception that they would not be personally impacted should they need an abortion.

Near-universal marriage, early childbearing, and low fertility: India's alternative fertility transition.

OBJECTIVE: To compare fertility in India to both low-to-middle-income and high-income countries (LMICs and HICs) and describe the patterns that have accompanied India's transition to low fertility. METHODS: We use data from the Demographic and Health Surveys (DHS), the United Nations (UN), and the Organisation for Economic Co-operation and Development (OECD) to observe factors associated with fertility decline in 36 Indian states and 76 countries. RESULTS: Although fertility in India has declined to levels similar to HICs, women's entry into marriage and initiation of childbearing are more in line with patterns found in LMICs. The vast majority of women in India (97%) are married by age 30, and their average age at first birth is only 21.3 years old. In spite of these patterns, average fertility has declined in India as a result of earlier termination of childbearing. Among more recent cohorts, fewer women progressed to higher-order births and about half of women obtained a sterilization by age 35. CONCLUSIONS: India has reached low fertility by mechanisms outside the traditional indicators of fertility decline. In contrast to countries that have achieved low fertility through delayed age at first birth, women in India have continued to enter unions and bear children early, lowered their age at last birth, and increasingly ended their fertility via sterilization following the birth of two children. CONTRIBUTION: Evidence from India reveals an alternative pathway to low fertility, highlighting the limitations of traditional socioeconomic indicators for explaining fertility decline.

Satisfaction, Resignation, and Dissatisfaction with Long-Acting Reversible Contraception among Low-Income Postpartum Texans.

INTRODUCTION: Prior longitudinal studies of long-acting reversible contraception (LARC) satisfaction and continuation guaranteed their participants access to LARC removal. Under real-world conditions, LARC users who wish to discontinue may experience barriers to LARC removal. METHODS: A prospective cohort study recruited 1,700 postpartum Texans without private insurance from 8 hospitals in 6 cities. Our analysis included the 418 respondents who initiated LARC in the 24 months after childbirth. A content analysis of open-ended survey responses identified three categories of LARC users: satisfied, resigned, and dissatisfied. Satisfied LARC users were using their method of choice. Resigned users were using LARC as an alternative method when their preferred method was inaccessible. Dissatisfied users were unhappy with LARC. Multinomial logistic regression models identified risk factors for resignation and dissatisfaction. Cox proportional hazards models assessed differences in LARC discontinuation by satisfaction and sociodemographic characteristics. RESULTS: Participants completed 1,505 surveys while using LARC. LARC users were satisfied in 83.46% of survey responses, resigned in 5.25%, and dissatisfied in 11.30%. Resignation was more likely if respondents were uninsured or wanted sterilization at the time of childbirth. The risk of dissatisfaction increased with time using LARC and was higher among uninsured respondents. U.S.-born Hispanic LARC users were more likely than foreign-born Hispanic LARC users to be dissatisfied and less likely to discontinue when dissatisfied. Dissatisfaction-but not resignation-predicted discontinuation. Cost, lack of insurance, and difficulty obtaining an appointment were frequent barriers to LARC removal. CONCLUSIONS: Most postpartum LARC users were satisfied, but users who wished to discontinue frequently encountered barriers.

U.S. Abortion Care Providers' Perspectives on Self-Managed Abortion.

State-level restrictions on abortion access may prompt greater numbers of people to self-manage their abortion. The few studies exploring perspectives of providers towards self-managed abortion are focused on physicians and advanced practice clinicians. Little is known about the wider spectrum of abortion care providers who encounter self-managed abortion in their clinic-based work. To gain a deeper understanding of this issue and inform future care delivery, we conducted in-depth interviews with 46 individuals working in a range of positions in 46 abortion clinics across 29 states. Our interpretative analysis resulted in themes shaped by beliefs about safety and autonomy, and a tension between the two: that self-managed abortion is too great a risk, that people are capable of self-managing an abortion, and that people have a right to a self-managed abortion. Our findings highlight the importance of increasing knowledge and clarifying values among all abortion care providers, including clinic staff.

Experiences seeking, sourcing, and using abortion pills at home in the United States through an online telemedicine service.

A growing number of people in the United States seek to self-manage their abortions by self-sourcing abortion medications online. Prior research focuses on people's motivations for seeking self-management of abortion and experiences trying to obtain medications. However, little is known about the experiences of people in the U.S. who actually complete a self-managed abortion using medications they self-sourced online. We conducted anonymous in-depth interviews with 80 individuals who sought abortion medications through Aid Access, the only online telemedicine service that provides abortion medications in all 50 U.S. states. Through grounded theory analysis we identified five key themes: 1) participants viewed Aid Access as a "godsend"; 2) Fears of scams, shipping delays, and surveillance made ordering pills online a "nerve-racking" experience; 3) a "personal touch" calmed fears and fostered trust in Aid Access; 4) participants were worried about the "what ifs" of the self-managed abortion experience; and 5) overall, participants felt that online telemedicine met their important needs. Our findings demonstrate that online telemedicine provided by Aid Access not only provided a critical service, but also offered care that participants deemed legitimate and trustworthy.

Self-removal of long-acting reversible contraception: A content analysis of YouTube videos.

OBJECTIVE: To explore publicly available information about the self-removal of long-acting reversible contraception (LARC) on a popular video-sharing website. STUDY DESIGN: We conducted a comprehensive keyword search of YouTube videos related to self-removal of LARC-namely intrauterine devices and implants. We analyzed video content to explore demographic characteristics, method and duration of LARC use, and motivations and experiences of self-removal. RESULTS: Our keyword search identified 58 videos that met the criteria for inclusion, including 48 videos that featured individuals who removed an intrauterine device and 10 who removed an implant. Collectively, videos had over 4 million views. We identified most video creators as white (53%), 31% as Black, and 14% as Latinx. Users were motivated to remove their own device by both preferences and barriers to formal care. Most individuals in our sample (n = 56/58) successfully removed their device and described their experience in positive terms related to the ease of removal. Reasons for LARC discontinuation included negative side effects, fear of potential side effects, and desire for pregnancy. CONCLUSION: This study builds upon prior research by describing publicly available information about LARC self-removal. The over representation of Black women in our sample may reflect a higher prevalence of LARC self-removal among this population. Positive experiences of self-removal and high levels of viewer engagement with online videos suggest a need for provider counseling on LARC removal at the time of insertion. IMPLICATIONS: Prior to LARC insertion, patients should be made aware of any financial requirements for discontinuation. Provider counseling for self-removal at the time of insertion will likely minimize health risks and affirm patient reproductive autonomy.

Improving assessment of demand for postpartum tubal ligation among publicly insured women in Texas.

OBJECTIVE: To assess an alternative method for estimating demand for postpartum tubal ligation and evaluate reproductive trajectories of low-income women who did not obtain a desired procedure. STUDY DESIGN: In a 2-year cohort study of 1700 publicly insured women who delivered at 8 hospitals in Texas, we identified those who had an unmet demand for tubal ligation prior to discharge from the hospital. We classified unmet demand as explicit or prompted based on survey questions that included a prompt regarding whether the respondent would like to have had a tubal ligation at the time of delivery. We assessed persistence of demand for permanent contraception, contraceptive use, and repeat pregnancies among all study participants who wanted but did not get a postpartum procedure. RESULTS: Some 426 women desired a postpartum tubal ligation; 219 (51%) obtained one prior to discharge. Among the 207 participants with unmet demand, 62 (30%) expressed an explicit preference for the procedure, while 145 (70%) were identified from the prompt. Most with unmet demand still wanted permanent contraception 3 months after delivery (156/184), but only 23 had obtained interval procedures. By 18 months, the probability of a woman with unmet demand conceiving a pregnancy that she would likely carry to term was 12.5% (95% CI: 8.3%-18.5%). CONCLUSIONS: The majority of unmet demand for postpartum tubal ligation among publicly insured women in Texas was uncovered via a prompt and would not have been evident in clinical records or from consent forms. Women unable to obtain a desired procedure had a substantial chance of pregnancy within 18 months after delivery. IMPLICATIONS: Estimates of unmet demand for postpartum tubal ligation based on clinical records and consent forms likely underestimate desire for permanent contraception. Among low-income women in Texas, those with unmet demand for postpartum tubal ligation require improved access to effective contraception.

Sibling loss and fertility desires in the high-mortality context of Peru.

Despite demographers' long-standing preoccupation with the effects of child mortality on women's fertility desires, scholars continue to know little about the consequences of other pervasive mortality exposures. We use nationally representative data from the high-mortality context of Peru to examine whether the desire to have a(nother) child varies as a function of sibling loss and to assess heterogeneity in this association by women's current number of children and a range of conditions related to siblings' deaths. Women who have experienced sibling bereavement and have two or more children report higher odds of desiring another child. These effects are not contingent on the age or sex of the deceased sibling but are only significant if the sibling died during the respondent's lifetime (not before). These findings highlight the theoretical and empirical import of investigating the relationship between fertility desires and a wider range of familial mortality exposures beyond own child mortality.

Knowledge, interest, and motivations surrounding self-managed medication abortion among patients at three Texas clinics.

BACKGROUND: A rapid increase in restrictive abortion legislation in the United States has sparked renewed interest in self-managed abortion as a response to clinic access barriers. Yet little is known about knowledge of, interest in, and experiences of self-managed medication abortion among patients who obtain abortion care in a clinic. OBJECTIVES: We examined patients' knowledge of, interest in, and experience with self-managed medication abortion before presenting to the clinic. We characterized the clinic- and person-level factors associated with these measures. Finally, we examined the reasons why patients express an interest in or consider self-management before attending the clinic. MATERIALS AND METHODS: We surveyed 1502 abortion patients at 3 Texas clinics in McAllen, San Antonio, and Fort Worth. All individuals seeking abortion care who could complete the survey in English or Spanish were invited to participate in an anonymous survey conducted using iPads. The overall response rate was 90%. We examined the prevalence of 4 outcome variables, both overall and separately by site: (1) knowledge of self-managed medication abortion; (2) having considered self-managing using medications before attending the clinic; (3) interest in medication self-management as an alternative to accessing care at the clinic; and (4) having sought or tried any method of self-management before attending the clinic. We used binary logistic regression models to explore the clinic- and patient-level factors associated with these outcome variables. Finally, we analyzed the reasons reported by those who had considered medication self-management before attending the clinic, as well as the reasons reported by those who would be interested in medication self-management as an alternative to in-clinic care. RESULTS: Among all respondents, 30% knew about abortion medications available outside the clinic setting (37% in Fort Worth, 33% in McAllen, 19% in San Antonio, P < .001), and among those with prior knowledge, 28% had considered using this option before coming to the clinic (36% in McAllen, 25% in Fort Worth, 21% in San Antonio, P = .028). Among those without prior knowledge of self-management, 39% expressed interest in this option instead of coming to the clinic (54% in San Antonio, 30% in McAllen, 29% in Fort Worth, P < .001). Overall, 13% had sought out or tried any method of self-management before presenting to the clinic (16% in McAllen and 15% in Fort Worth vs 9% in San Antonio, P < .001). Experiencing barriers to clinic access was associated with having considered medication self-management (odds ratio, 2.2; 95% confidence interval, 1.7-3.0) and with seeking or trying any method of self-management before attending the clinic (odds ratio, 1.9; 95% confidence interval, 1.3-2.7). Difficulty affording the cost of in-clinic care was the most commonly cited reason for having considering medication self-management before attending the clinic. Reasons for interest in medication self-management as an alternative to clinic care included both access barriers and preferences for the privacy and comfort of home. CONCLUSION: Considering or attempting self-managed abortion may be part of the pathway to seeking in-clinic care, particularly among those experiencing access barriers. However, considerable interest in medication self-management as an alternative to the clinic also suggests a demand for more autonomous abortion care options.

Demand for Self-Managed Medication Abortion Through an Online Telemedicine Service in the United States.

Objectives. To examine demand for abortion medications through an online telemedicine service in the United States.Methods. We examined requests from US residents to the online telemedicine abortion service Women on Web (WoW) between October 15, 2017, and August 15, 2018. We calculated the population-adjusted rate of requests by state and examined the demographics, clinical characteristics, and motivations of those seeking services, comparing those in states with hostile versus supportive abortion policy climates.Results. Over 10 months, WoW received 6022 requests from US residents; 76% from hostile states. Mississippi had the highest rate of requests (24.9 per 100 000 women of reproductive age). In both hostile and supportive states, a majority (60%) reported a combination of barriers to clinic access and preferences for self-management. Cost was the most common barrier (71% in hostile states; 63% in supportive states; P < .001). Privacy was the most common preference (49% in both hostile and supportive states; P = .66).Conclusions. Demand for self-managed medication abortion through online telemedicine is prevalent in the United States. There is a public health justification to make these abortions as safe, effective, and supported as possible.

The changing landscape of abortion care: Embodied experiences of structural stigma in the Republic of Ireland and Northern Ireland.

The private use of abortion medication outside of the formal healthcare setting is an international phenomenon. Despite new and expanding pathways to abortion access, we know little about how women's perceptions and experiences of abortion may also be changing. This study examines the embodied experience of 68 women who sought abortion services in Northern Ireland and the Republic of Ireland. Social stigma and restrictive abortion laws were major barriers to care at the time of study, providing the opportunity to explore the ways biological, social, and structural factors shape embodiment. Those who obtained an abortion either traveled abroad for clinical care or self-managed a medication abortion at home. Participant's perceptions of pain, the fetus, the method (medication vs. surgical), and environment in which they sought abortion care (at home vs. in a clinic) were shaped by structural stigma. Women gained greater experiential knowledge through medication self-management, allowing them to relate abortion to other natural bodily processes and redefine their beliefs about pregnancy and the fetus. Preferences and attitudes about the environment of abortion care were informed by stigma and differential perceptions of risk. Those who traveled most often emphasized legal and medical risks of abortion at home, while those who self-managed emphasized social, financial, and emotional risks of pursuing clinical abortion care abroad. Given the increase in reproductive self-care alternatives, these findings situate self-managed abortion in the literature of (de)medicalization and reveal the ways technology and structural factors shape perceptions and beliefs about pain, the fetus, method, and environment. For some, self-managed medication abortion may be a preferred pathway to care. Policies that consider medication self-management as part of a spectrum of legitimate options can improve abortion access for marginalized groups while also offering an improved abortion experience for those who prefer medication abortion and an out-of-clinic environment.

Assessing public awareness and use of medical abortion via mobile phone survey in India.

OBJECTIVE: We assess the feasibility of measuring awareness and use of medical abortion via a mobile phone survey on social attitudes in India. STUDY DESIGN: In 2018, we conducted a mobile phone survey with 3455 married men and women in Bihar and Maharashtra, two of India's most populous states. As part of a broader survey on social inequality, welfare programs, and health, we asked respondents about their awareness of medical abortion and whether they (or their wife) had ever had a medical abortion. RESULTS: Among men and women in Bihar and Maharashtra, one fifth to one third of respondents said that they had heard of medical abortion. In Bihar, men were more likely than women to report having heard of pills that can be used to end a pregnancy. Awareness of medical abortion was positively associated with education and with women's status within the household. Consistent with results from representative face-to-face surveys, reported use of abortion medications was low. CONCLUSION: Our findings demonstrate that respondents are willing to answer abortion-related questions via mobile phone survey and reveal differences in reported awareness of medical abortion according to region, sex, education, and household status. IMPLICATIONS: Inclusion of abortion-related questions in a large-scale, social attitudes phone survey is a feasible option for assessing public awareness of medical abortion in India.

The impact of Northern Ireland's abortion laws on women's abortion decision-making and experiences.

BACKGROUND: In Northern Ireland, abortion is illegal except in very limited circumstances to preserve a woman's life or to prevent permanent or long-term injury to her physical or mental health. Abortions conducted outside the law are a criminal offence punishable by imprisonment. We assessed the impacts of Northern Ireland's abortion laws on women's decision-making and experiences in accessing abortion. METHODS: Between April 2017 and February 2018 we interviewed 30 women living in Northern Ireland who had sought abortion by travelling to a clinic in Great Britain or by using online telemedicine to self-manage a medication abortion at home. We interviewed women both before and after a policy change that allowed women from Northern Ireland access to free abortion services in Great Britain. We used a semi-structured in-depth approach and analysed the interviews using grounded theory methodology to identify key themes. RESULTS: Four key findings emerged from our analysis: (1) women experience multiple barriers to travelling for abortion services, even when abortion is provided without charge; (2) self-management is often preferred over travel, but its criminalisation engenders fear and isolation; (3) obstruction of import of abortion medications by Northern Ireland Customs contributes to stress, anxiety, a higher risk of complications, and trial of ineffective or unsafe methods; and (4) lack of clarity surrounding the obligations of healthcare professionals in Northern Ireland causes mistrust of the healthcare system. CONCLUSIONS: Northern Ireland's abortion laws negatively affect the quality and safety of women's healthcare and can have serious implications for women's physical and emotional health. Our findings offer new perspectives for the current policy debate over Northern Ireland's abortion laws and suggest a public health rationale for decriminalising abortion.

Experiences of women in Ireland who accessed abortion by travelling abroad or by using abortion medication at home: a qualitative study.

BACKGROUND: The Republic of Ireland has one of the world's most restrictive abortion laws, allowing abortion only to preserve a pregnant woman's life. We examined the impact of the law on women's options for accessing abortion, their decision-making regarding whichpathway to follow, and their experiences with their chosen approach. METHODS: We conducted semi-structured in-depth interviews with 38 women who had either travelled abroad to access abortion in a clinic or had self-managed a medical abortion at home using online telemedicine, between 2010 and 2017. We coded interview transcripts according to an iteratively developed coding guide and performed a thematic analysis to identify key themes. RESULTS: We identified four key themes: (1) self-managing a medical abortion at home using online telemedicine can be a preference over travelling abroad to access abortion services; (2) regardless of the pathway chosen, women experience a lack of pre- and post-abortion support in the Irish healthcare system; (3) feelings of desperation while searching for safe abortion care can lead to considering or attempting dangerous methods; and (4) Irish abortion law and attitudes have impacts beyond physical health considerations, engendering shame and stigma. CONCLUSIONS: Despite the country's restrictive abortion law, women in Ireland do obtain abortions, using methods that are legal and safe elsewhere. However, the law negatively impacts women's ability to discuss their options with their healthcare professionals and to seek follow-up care, and can have serious implications for their physical and emotional health. This study's findings provide evidence to inform public and policy discourse on Ireland's abortion laws.

Motivations and Experiences of People Seeking Medication Abortion Online in the United States.

CONTEXT: State legislation restricting access to abortion in the clinic setting raises the possibility that an increasing number of individuals in the United States will self-manage their abortion at home. Medications sourced online represent a potential pathway to abortion self-management. Yet, very little is known about the reasons U.S. residents may seek abortion online or their experiences finding medications and information. METHODS: In January-June 2017, anonymous in-depth interviews were conducted with 32 people from 20 states who sought abortion medications online (30 women and two men seeking medications for their partners). Participants were asked about their (or their partners') motivations for considering self-managed abortion, the sources of medications they identified and any other methods they considered. Transcripts were coded and analyzed according to the principles of grounded theory. RESULTS: The analysis revealed four key themes: Seeking abortion medications online can be a response to clinic access barriers both in states with and in ones without restrictive abortion laws; self-managed abortion can be a preference over clinical care; online options offer either information or medications, but not both; and the lack of trusted online options can delay care and lead to consideration of ineffective or unsafe alternatives. CONCLUSION: Current online options for abortion medications leave many important needs unmet, particularly for women who encounter barriers to obtaining clinic-based abortion services. There is a public health justification to reduce clinic access barriers and to make medication abortion that is sourced online and managed at home as safe and supported as possible.