Given the many obstacles facing reproductive rights in our current political climate, we as physicians are seeing some people take abortion into their own hands. No, I’m not talking about coat-hanger abortions or any of the other infamous and tragic methods that people in the past (and, sadly, even some in the present) have explored.

Specifically, I’m talking about those who are self-managing medication abortions, meaning that they’re getting and taking abortion medications without going through a health-care provider at all.

To be clear, neither SELF nor I advocate self-managing a medication abortion for a variety of safety and legal concerns which we’ll go over in more detail here. However, the reality is that some people may end up in this situation, and for those people, I want to provide accurate and responsible information on all of the potential risks and alternatives.

How surgical abortions and medication abortions work

Surgical abortions are in-clinic procedures using suction or other medical tools to remove a pregnancy from the uterus. According to the Guttmacher Institute, nearly one in four U.S. women (about 24 percent) will have an abortion by age 45, and the majority of those abortions are surgical. Surgical abortions can take anywhere from 5 to 20 minutes and they are a safe, effective, and common medical procedure. The vast majority of surgical abortions occur in the first trimester; this is the most common abortion option available after 10 weeks of pregnancy.

Medication abortions (also referred to as “medical abortions”—but we’ll use “medication abortion” to be totally clear) generally include taking two pills—mifepristone and misoprostol—to terminate a pregnancy. With a medication abortion, you take the first pill (mifepristone) either at a physician’s office or at home (depending on the laws in your state) and then you take the second pill (misoprostol) 6 to 48 hours later. (The FDA-approved regimen states that you should take misoprostol 24 to 48 hours later, but many abortion providers actually have patients administer the second pill as early as six hours later, as evidence has shown this is effective when administering misoprostol vaginally.) Together, these medications are approved by the FDA for abortion purposes up to 10 weeks (70 days) gestation, and the regimen is known to be about 95 percent effective.

Cramping and bleeding typically start within a few hours of taking the second medication. Nausea, vomiting, cramping, heavy vaginal bleeding, and diarrhea are all common side effects of a medication abortion. As many as 5 percent of people may not completely pass the pregnancy, which is why follow-up is key. Most clinics will have you return for another ultrasound appointment to make sure the abortion is over, but as of March 2016, the FDA guidelines changed and no longer explicitly state that an in-clinic follow-up is always necessary, so a follow-up may also take place over the phone.

As you can imagine, various obstacles can make it difficult to access a medication abortion. In fact, the first pill, mifepristone, cannot be distributed to or dispensed at pharmacies. There is something called a Risk Evaluation and Mitigation Strategies (REMS) program in effect with mifepristone, which is used by the FDA to lessen the risk of adverse events happening in relation to certain medications, as the FDA explains. But we abortion providers near universally agree that, with mifepristone, this is unnecessary and interferes with abortion access, as the medication is very safe.

As the Guttmacher Institute states: “Anyone seeking a medication abortion must locate a registered provider who has a supply of mifepristone—a task made more difficult because the stringent registration and stocking requirements [that] limit the number of providers willing and able to offer mifepristone. That much regulation can delay—and ultimately prevent—an individual from accessing a medication abortion altogether, especially in underserved communities such as those in rural areas.”

The reality of self-managed abortions

For the purpose of this article, I’m using the terms “self-induced” or “self-managed” abortions to mean abortions involving medication that’s sourced by a person on their own, via an online site or alternative route—in other words, without going through an abortion provider or telemedicine service to obtain the medications.