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Harm Reduction for Abortion in the United States

Tasset, Julia MPH; Harris, Lisa H. MD, PhD

doi: 10.1097/AOG.0000000000002491
Contents: Current Commentary

Access to abortion in the United States has eroded significantly. Accordingly, there is a growing movement to empower women to self-induce abortion. To date, physicians' roles and responsibilities in this changing environment have not been defined. Here, we consider a harm reduction approach to first-trimester abortion as a way for physicians to honor clinical and moral obligations to care for women, negotiate ever-increasing abortion restrictions, and support women who consider abortion self-induction. Harm reduction approaches to abortion have been successfully implemented in a range of countries around the world and typically take the form of teaching women how to use misoprostol. When women self-administer misoprostol, rather than resort to other means such as self-instrumentation or abdominal trauma, to end a pregnancy, maternal mortality falls. There are clinical and ethical benefits as well as limitations to a harm reduction approach to abortion in U.S. settings. Its legal implications for patients and physicians are unclear. Ultimately, we suggest that despite its limitations, a harm reduction approach may help both physicians and patients.

In the current U.S. political environment, a harm reduction approach for abortion may help to ensure women's access to safe abortion.

University of Michigan Medical School, the Department of Obstetrics and Gynecology, Michigan Medicine, and the Department of Women’s Studies, University of Michigan, Ann Arbor, Michigan.

Corresponding author: Julia Tasset, MPH, 1500 E Medical Center Drive, L4000 Women's Hospital, Ann Arbor, MI 48109-0276; email:

Financial Disclosure The authors did not report any potential conflicts of interest.

The authors thank Dan Grossman, MD, for his helpful review of the manuscript.

Each author has indicated that she has met the journal's requirements for authorship.

© 2018 by American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.