Have Others Had This Experience? A Qualitative Analysis of Posts on Self‐Managed Abortion to US‐Based Reddit Community

ABSTRACT

Objectives

Limiting abortion within the formal health care system is associated with more self‐managed abortion (SMA). Reddit is a publicly available social networking site that allows users to create and join communities (“subreddits”) around a specific topic. R/abortion is a subreddit dedicated to providing support and advice to people seeking or having an abortion. The purpose of this study is to analyze r/abortion data after the Dobbs leak in 2022 to explore SMA access and use experiences shared in the community.

Methods

We employed a hybrid qualitative thematic analysis approach to describe experiences, concerns, and questions related to SMA as shared in posts from r/abortion. A simple random sample of 10% of posts was obtained from those shared from May 2, 2022 through December 23, 2022 (n = 523).

Results

Among the analyzed posts, 111 described experiences with SMA. Four themes emerged during the analysis. First, some posters noted concerns and questions related to online ordering and receiving mailed medication abortion, including shipping delays, cost, and discreet packaging. The second theme was related to concerns and questions about the SMA process, such as when and how to take medication, bleeding amount, and abortion completion. The final two themes were related to seeking support/advice for SMA and sharing SMA experiences, with community members seeking and sharing support to combat isolation while self‐managing.

Discussion

R/abortion is an important resource for some people self‐managing abortions. This study provided key insights into areas that are commonly discussed, which can inform the provision of practical support for SMA.

1. Introduction

Medication abortion has become the predominant method of abortion in the United States [1]. The COVID‐19 pandemic accelerated the proliferation of medication abortion use [2, 3]. In an attempt to maintain safety for patients and providers, following a lawsuit by the American Civil Liberties Union (ACLU), a federal district court issued a preliminary injunction that blocked the US Food and Drug Administration (FDA) from enforcing its in‐person requirement for medication abortion in July 2020 [4]. The preliminary injunction resulted in an official modification to the risk evaluation and mitigation strategy (REMs) for mifepristone in January 2023, which allowed access to medication abortion in retail pharmacies and by mail order when prescribed by healthcare providers [5]. The Guttmacher Institute calculated that medication abortion accounted for 63% of abortions facilitated by the formal healthcare system (estimate does not include self‐managed abortion [SMA] or abortion medication mailed to people in states with total abortion bans) in 2023, a 19% increase from 2020 and a 62% increase from 2017 [1, 6].

The increased availability of medication abortion is critical given the US Supreme Court's 2022 decision Dobbs v. Jackson Women's Health Organization (Dobbs) [7], which gave states the authority to determine the legality of abortion and the circumstances under which it can be provided; essentially overturning the 1973 Roe v. Wade decision in which the Supreme Court ruled that the US Constitution protected the right to abortion [8]. The Dobbs decision was leaked on May 2, 2022, in a breach of the Supreme Court, and the decision was issued on June 24, 2022. The period following the leak and subsequent decision was marked by confusion, fear, and a rapidly changing legal landscape; by November 2022, 14 US states had banned (i.e., made illegal in most cases) or heavily restricted (i.e., set limits based on earlier pregnancy duration) [6, 9]. By May 2023, 22 states had banned or restricted abortion [10]. Consequently, the Dobbs ruling accelerated the pre‐existing trend toward obtaining medication abortions and self‐managing abortions outside of the formal healthcare system in the United States (US) [2]. The largest increases in the use of medication abortion since Dobbs have been observed in states that implemented total bans [2], with research showing that limiting abortion within the formal healthcare system is associated with more SMA [2, 11].

For this research, we define SMA as a medication abortion carried out outside of a clinical setting with individuals self‐administering medications at home. Our definition includes SMA using medications obtained through online telemedicine, in addition to self‐sourcing medications in other ways, given the increase in requests for SMA through online telemedicine following Dobbs [2]. Aid Access was the first online telemedicine service to offer medication abortion in the US in 2018 [12, 13]. Aiken et al. found that clinic access barriers were the most commonly cited reason for requesting self‐managed medication abortion using telemedicine services [13]. Beginning in July 2020, Aid Access utilized a dual approach. In states permitting telemedicine abortion, US clinicians prescribe the medication. For states where this was illegal, the pills are shipped from India [14]. The Aid Access experience has been described as aligning with SMA models [15]. At the same time, telemedicine providers of medication abortion proliferated since the Dobbs decision, and an individual self‐managing a medication abortion can source pills through a US‐based or international website that sells abortion pills or, less commonly, through a community network. In some situations, telemedicine has resulted in self‐managed medication abortion where the provider may be embedded in the formal healthcare system [7].

Although SMA has emerged as a provisional solution to declining abortion access in the US, it has long been a preferred method for many pregnant individuals worldwide, utilizing a range of techniques, including medications, herbs, and physical interventions [3, 16, 17]. There is little evidence supporting the safety and efficacy of nonmedication methods [17], but substantial data demonstrate that medication abortion with mifepristone and misoprostol or misoprostol used alone is safe and effective when delivered in clinical settings and when used for SMA [7, 18, 19]. Despite legal challenges of medication for abortion, it remains available in US pharmacies and by mail through telemedicine and shield laws, which provide protections for doctors in states where abortion is legal to mail abortion medications to patients living in states with abortion bans [7, 20, 21]. Although shield laws do not offer legal protection to individuals seeking medication abortion, they enable a system of care wherein telemedicine providers are integrated into the formal healthcare infrastructure. Certain states, including Arizona and North Carolina, have implemented prohibitions on the mailing of medication abortion in response to the expansion of telemedicine services for abortion care [7]. Before the introduction of shield laws, Aid Access was the only telemedicine provider for people in states where telemedicine abortion services were legally prohibited [7]. Prescribed medications were filled by an Indian pharmacy and could take up to 3 weeks to arrive in the US [2, 13, 22].

As people self‐manage their abortions in the US, some of them also turn to resources providing alternatives to traditional in‐person care—many of which are online—for information, support, and services [11, 13, 23, 24]. Reddit is one social networking site where online communities have formed around health topics, including abortion. Reddit is a publicly available social networking site with a discussion forum format that allows users to create and join communities (“subreddits”) around a specific topic. Reddit posts have a generous character count limit (40,000‐character limit), unlike many other social media platforms. The pseudonymous nature of the platform is also unique, allowing users to discuss stigmatized and even illegal topics more freely than they might with clinicians, peers, or even on other social networking sites [25, 26, 27]. R/abortion is a subreddit, or mini forum, within Reddit dedicated to providing support and advice to people seeking or having an abortion. While seeking medical information and support on the internet is not a new phenomenon [28], the subreddit r/abortion has experienced significant growth during the writing of this paper, reaching 46,000 members in February 2024. With 62,000 members in January 2025, r/abortion provides real‐time community support and vetted information to its users [29]. As a result, it has served as an important resource for SMA even before Dobbs, with research showing that users posted a range of questions, from logistical to clinical to emotional, as well as sharing and seeking personal abortion experiences [24, 30].

Previous studies have explored social support and information seeking related to stigmatized health behaviors, such as drug use, on Reddit and demonstrated the potential opportunities of online communities in addressing gaps in more traditional in‐person models of care [31, 32]. Research analyzing content related to abortion on Reddit and r/abortion is an area of growing interest. Jacques et al. previously analyzed Reddit posts to document the effects of COVID‐19 pandemic restrictions on US abortion seekers and to explore abortion method decision‐making [24, 33]. The research illuminated how the COVID‐19 pandemic limited abortion access in the United States and the consequences of sudden changes in abortion service delivery. Higgins et al. documented cost‐related barriers, including considerations of SMA due to cost barriers, among US abortion seekers as described in Reddit posts [34]. In a systematic search of over 7000 posts to r/abortion between March and December 2020, Lewis and Messing identified 460 posts about ordering abortion pills online in their preliminary results (only abstract available) the most common reasons for ordering pills online were perceived inaccessibility, cost of in‐person services, privacy, and convenience [30]. Some common themes the authors identified in posts were concerns with the legitimacy of online pill providers, shipping timelines, and usage instructions. These past studies all used pre‐Dobbs data, yet provided insights into the role of online communities, specifically Reddit, in navigating barriers to abortion access. In a more recent study of posts on r/abortion in the month following the Dobbs decision, John and Martin determined that Dobbs caused confusion and panic, and subsequent informational and emotional needs among abortion seekers in the r/abortion community [35]. A study by Valdez et al. found Reddit abortion forum users are generally willing to express their views openly, such as sharing personal abortion experiences, reflecting on how their perspectives have evolved, and actively seeking information [36]. They found that r/abortion primarily functioned as a source of information and outreach.

As a growing number of states ban or severely limit access to abortion, more people will likely turn to SMA, as well as r/abortion, to navigate restrictive laws and barriers to access [37]. Reddit provides valuable insights into the diverse range of viewpoints and experiences related to the topic of abortion. The subreddit constitutes a unique online resource, with a growing community of users and increasing research interest. We implemented a larger research project to investigate how r/abortion functions in a post‐Dobbs landscape. R/abortion, as an exemplary abortion‐supportive online community, presents both a case study of the ways an online abortion community was used and a window into the abortion‐related experiences of community members during this time. Our research interest centered on content shared within the Reddit community and how it may have been shaped by changing legislation. The research project used a parallel multi‐method approach to describe use of r/abortion during 2022, with particular interest in the emerging challenges to abortion access shared as people sought abortion in the increasingly restricted policy environment. Results from several sub‐analyses of this larger project have been published and highlight abortion delays in receiving abortion care and subsequent challenges in waiting [38]; access barriers to abortion care [39]; and a need for more support and different support, particularly surrounding medication abortion [40].

The purpose of this study is to analyze r/abortion data after the Dobbs leak and the decision to explore SMA access and user experiences among the Reddit community. We are particularly interested in how r/abortion users describe their SMA experiences and what questions and concerns they pose to the online community. Analyzing user inquiries and concerns on r/abortion is crucial for effectively supporting individuals seeking information and resources on SMA in the post‐Dobbs landscape. This will deepen our understanding of the challenges individuals face in accessing abortion information and services.

2. Methods

2.1. Identifying SMA in Posts to R/Abortion

For this research, we focused on SMA using medication abortion outside of a clinical setting. We included self‐sourcing of medications, as well as medication abortions obtained using telemedicine and mailed medication and shipment from pharmacies through online organizations such as Aid Access, which proliferated post‐Dobbs [7]. We took an inclusive approach to defining SMA for this project aligned with the International Medical Advisory Panel's definition of self‐administration of medication abortion as a part of abortion “self‐care.” [41] Posts that described self‐administration and management of medication abortion but did not specify how they sourced the medications were included in the study. We did not include the provision of medication abortion which involves providing mifepristone in the clinic and sending people home with misoprostol. The mention of clinical support in a post did not serve as an exclusion criterion for our analysis, given the acknowledged potential for individuals self‐managing abortions to receive support from healthcare providers at various points in their experience [37]. However, no posts included in the analysis overtly mentioned clinical supervision or support. While many posts clearly described SMA, it was less obvious in other posts, and these cases were discussed among the coding team to ensure a range of experiences that also fit into our definition of SMA.

2.2. Reddit and the R/Abortion Community

Reddit is a popular social networking site used by approximately one‐quarter of US adults in 2022, with an average of 48 million monthly active users [42]. Within Reddit, user‐generated content is aggregated and dispersed across millions of user‐created and monitored message boards on specific subjects (or subreddits; “r/subject”), to which users can subscribe as members. On Reddit, each subreddit has its own community page, which presents the community overview, rules, and top posts in a content feed. Each subreddit is governed by a set of moderators elected from within the community, who set subreddit‐specific guidelines for posting content, review posts to ensure that those guidelines are being met, and have the option to delete non‐compliant posts and ban deviant users.

As described above, the “r/abortion” subreddit is an active subreddit community formed to “offer support and advice to people who are seeking or have had an abortion.” R/abortion is actively moderated by the Online Abortion Resource Squad (OARS), a group that trains volunteers and works to offer consistent, quality information and support to people coming to r/abortion [29]. The group of moderators working with OARS also actively enforces the r/abortion community rules, which respond to current challenges and priorities for moderators and the community.

2.3. Data Collection

Reddit post data were collected between October 2022 and February 2023 using PushShift's Reddit Application Programming Interface (API) and Reddit's Official API, platforms available to researchers that collected and archived Reddit data [43]. The data collection approach was informed by other research which similarly studied how Reddit was used for health concerns [44, 45] and is described in detail in Pleasants et al. [38] This study was part of a larger project that first obtained complete data from the r/abortion subreddit following the Dobbs leak and decision in 2022. The data collection period spanned October 2022 to February 2023, with data pulled at two time points—the first providing a partial sample through October to facilitate exploratory analysis, and the second in February to provide a complete dataset. Following the acquisition of the complete dataset, posts were excluded from the analysis if they had been removed, deleted by the user, consisted solely of an image, comprised solely of a link, or contained fewer than 30 characters. In preparation for the qualitative analysis, a random selection of 10% of posts from each monthly period was conducted utilizing Python's “random.sample” function. This 10% month‐stratified random sample of posts sought to provide an even representation of posts shared to r/abortion across the study period (May 2, 2022 to December 24, 2022). This resulted in an analytical sample of 523 posts. All usernames and Reddit's submission IDs were removed.

Monthly periods were defined as starting on the 24th of each month and ending on the 23rd of the following month, from May 24, 2022 to December 24, 2022, except the initial period, which began on May 2, 2022, following the leak of the Dobbs decision. We included the period following the Dobbs leak for several reasons. First, while the Dobbs leak did not change federal law, it contributed to substantial uncertainty and fear about reproductive healthcare in the United States, particularly for people living in more restrictive settings [46]. Second, we also know that with the leak, Oklahoma moved to ban abortion in May 2022, further contributing to an environment of restriction and uncertainty for people seeking to access abortion [47]. Lastly, Poliak et al. found that online searches for abortion medications increased by 162% in the 72‐hour period following the leaked Dobbs ruling in May 2022, with the volume of online searches positively associated with reproductive restrictions in the state [48]. During coding, posts shared by someone living outside of the United States based on their self‐described location (i.e., Canada), healthcare system (i.e., National Health Service [NHS]), or abortion access experience in a legal context different from the United States at the time of their post (e.g., mifepristone is illegal where they live) were excluded from the qualitative sample and replaced.

The collection and analysis of these data were exempted from review by the OPHS at the University of California, Berkeley (CPHS #2022‐08‐15585).

2.4. Analysis

For the larger research project, we employed a hybrid inductive and deductive thematic coding approach, accounting for the existing research describing abortion access experiences while also prioritizing the development of new and notable codes during the coding process [49]. The initial codebook was tested and revised by coding a small sample of posts (~10% from 2 months). The revised codebook was applied to all posts, and coding was recorded in MAXQDA [50, 51]. Open double coding was done for 10% of posts to facilitate reliability and consistency. The codebook was refined throughout the coding process, with the coding team meeting weekly to discuss inconsistencies in coding until an agreement was reached by researchers (K.W., E.P., E.A., E.D., L.P.).

For the sub‐analysis presented in this paper, we read through all posts (not comments) coded as SMA several times, taking notes on initial observations, ideas, and questions. We identified recurring themes from the notes and coded segments based on the identified themes—namely, sourcing of medication and related logistics, sharing experiences during SMA, and seeking support or information about SMA from the r/abortion community. Following categorization, further analysis involved summarizing findings and extracting additional subcategories within themes.

“Composite quotes” were created to represent the narratives included in this analysis. Although the data were publicly accessible, there were still ethical concerns regarding confidentiality and privacy [52, 53]. The recommended approach when dealing with Reddit data involves implementing a “heavy disguise” process accompanied by rigorous testing to generate representative narratives while protecting the privacy of the community members [54, 55]. While all analyses were conducted using complete text from submissions, we employed an “ethical fabrication” method to create representative narratives that were vetted through Google, Reddit, and a plagiarism detection tool (duplichecker.com) to ensure that the composite quotes could not be linked back to any of the original posts used in this analysis. These “composite quotes” aim to reflect and convey the narratives shared in the r/abortion community without creating any additional risk for community members.

3. Results

From the 5220 posts shared in r/abortion between May 2, 2022 and December 23, 2022, 523 were sampled for qualitative analysis. Out of this sample, 111 posts described experiences with SMA. Four themes emerged during the qualitative data analysis and are described below: (1) concerns and questions related to ordering and receiving medication abortion; (2) concerns and questions related to the SMA process; (3) seeking support/advice for SMA; and (4) sharing SMA experience(s).

3.1. Thematic Analysis

3.1.1. Concerns and Questions Related to Ordering and Receiving Medication Abortion

Almost all of the people noted that they ordered abortion medications through websites, with Aid Access being the most commonly named source among those who named a platform. Some people posted on r/abortion to share that they had just ordered pills, while others used the r/abortion community to report concerns or challenges with the ordering process. Many people noted concerns with the shipping process, including the length of time to ship and delays in shipping, particularly if the medication was coming from overseas and customs would be involved in the delivery process. They shared stories like the following:

I ordered from Aid Access but I'm worried it won't get here in time. It's been in customs for days now. I heard that's normal, but I'm just worried that I will be past ten weeks when I get it. (Composite quote)

The cost of procuring medication abortion came up less frequently and typically became a larger concern when expedited shipping was needed. Other posters shared stories about upfront costs making it difficult to order and, in some cases, not currently having the funds, which delayed their SMA process, as with posts like this:

I'm almost 6 weeks pregnant and I'm ready to order from Aid Access but I don't get paid until next month. I can't afford to pay for them until then, but I'll be over 8 weeks by then and I'm worried that the pills will get here too late for me to use them. (Composite quote)

Some posters were concerned about discreet packaging and whether or not they would need to sign for the package. Several posters shared concerns related to the legality of abortion in their state and the potential risks of receiving abortion medications in a state where abortion was banned, sharing posts like:

I live in a state where abortion is banned. I want to buy pills from Aid Access, but could I get into any legal trouble for ordering from them? What should I do? (Composite quote)

3.1.2. Concerns and Questions Related to Using Medication Abortion

Many people shared questions and concerns during the medication abortion process. Common concerns were related to when and how to take misoprostol pills and what to expect during the process, with posts like:

I ordered 2 mifepristone and 8 misoprostol, because that's what the site recommended. I'm trying to figure out how to take the pills and how much, but there's a lot of information. I'm almost 10 weeks and don't know how much I should take, but I don't want to take too much. I know to take the first pill orally and I want to take the 4 vaginally, but some places said you can put them in your cheek. Which one works better? Do I just put them into my vagina as far as I can reach? (Composite quote)

People often shared concerns about too much bleeding or too little bleeding, generally sharing that their bleeding experience was not what they expected with stories like the following:

I dissolved my miso pills in my cheek earlier tonight but I've only had light bleeding. I had a couple of tiny clots and intense cramping. The clots were all just squishy blood. I'm worried that this isn't working. Have other people had the same experience? (Composite quote)

Most commonly, concerns about bleeding were tied to concerns about medication abortion safety, efficacy, and abortion completion.

I finished taking my pills 6 h ago and I'm really scared. I haven't experienced any bleeding yet and barely felt any cramping. Does this mean it's not working? How am I supposed to know when it's done? I really don't want to go through all of this again. (Composite quote)

Almost none of the posts mentioned receiving clinical care as part of SMA, and many of the questions and concerns shared reflected limited access to or understanding of important clinical information related to MA use.

Can someone give me some guidance on what I can and cannot do during the process? Can I take PMS (premenstrual syndrome) medication or other pain killers? Is there anything I can't eat or drink, or any exercise I should or shouldn't do? I'm nervous about going through this process on my own and need more info. (Composite quote)

3.2. Seeking Community Support for SMA

Besides a venue to have questions answered, r/abortion seemed to serve as an important community of support for those self‐managing an abortion. Some posters were more explicit in asking for support; for example, “I'm starting SMA, can anyone talk?,” while others just asked for words of support and encouragement during their SMA with posts like:

I'm starting my medication abortion today. This is the only place where I can talk about it. I would really like to talk to someone who's done it. (Composite quote)

Some people mentioned they were completely alone and had not told anyone about their SMA.

I'm doing my medication abortion alone today and I could really use some support. I wish I could ask for advice or have someone there with me, but I can't tell my family. I'm also scared because if something bad happens, there won't be any doctors around that can help. I've never been through this before and I'm dealing with it all on my own. (Composite quote)

3.3.

I spent so much time looking through stories on here before I took my pills. I just took my four miso earlier today and am so anxious about this. I hope it's ok that I keep coming back and posting. And thank you to everyone who has responded to me! You are all my heroes. (Composite quote)

4. Discussion

Our analysis found that people shared and requested information about SMA in posts on r/abortion following the Dobbs leak in 2022. As abortion access continues to deteriorate in the US, the internet will likely continue to grow in importance as a resource for those seeking information and services. Using real‐time internet search data, Gupta et al. found that after the Dobbs decision was leaked, internet searches for abortion‐related terms increased by 42% more in states with immediately effective abortion bans than in states that had more abortion protections [46]. The authors surmised that increased internet‐based searches for information on reproductive care after the Dobbs decision may be an early indicator of future gaps in reproductive health care access in the US. John and Martin analyzed r/abortion posts and comments that expressed informational or emotional needs in the first month after the Dobbs decision. Their analysis identified a need for legal and medical information among posters, as well as logistical support related to accessing medication abortion, traveling out of state, and financing abortion care [35]. Although our study did not explicitly investigate access to information during SMA, the inquiries and concerns identified during our analyses suggest potential constraints on information accessibility. An alternative explanation is that individuals may have favored the personalized support offered by r/abortion over readily available information sources.

Our study highlights absent medical information and emotional support for some people self‐managing abortion, as documented in their posts on r/abortion. Lewis and Messing explored Reddit users seeking and sharing information about purchasing abortion pills online before the Dobbs decision [30]. Their preliminary research has shown that the subreddit r/abortion serves as a valuable resource for individuals navigating uncertain situations related to accessing abortion, particularly when considering online pill sources outside of traditional healthcare. Our findings validate this research while providing a more in‐depth analysis of the significance of r/abortion as a platform for individuals seeking self‐managed medication abortion support and information, especially in the post‐Dobbs era. Our study highlights Reddit's dual function as both an information hub and a community for social support. Community queries frequently indicated a limited understanding of the medication abortion process, particularly regarding expectations and management strategies. Preliminary data from surveys of Aid Access clients in Florida, Indiana, and Louisiana found that even though nearly all respondents indicated prior knowledge of correct medication use, anticipated side effects, and complication recognition related to SMA, approximately one‐third reported experiencing anxieties [56]. A significant proportion of these concerns revolved around the authenticity and effectiveness of the medications obtained.

Our analysis revealed common concerns related to dosage and administration routes of medication, amount of bleeding, and confirmation of abortion completion. The medical information sought highlights gaps in support systems for those undergoing SMA following the Dobbs decision. R/abortion aims to address these gaps by providing 24/7 moderation services facilitated by trained volunteers who offer accurate and supportive responses [35, 57].

The gaps in medical information and support identified in our study also suggest that while SMA may be safe and effective, it may not always meet individual expectations and lead to a satisfactory experience. Our findings support the preliminary results from a survey of Aid Access clients, which found approximately half of respondents received either information or emotional support during or after their self‐managed medication abortion [56]. Most of the respondents in this study were supported by a family member or friend, while some received support from medication abortion providers, the Miscarriage and Abortion Hotline, or other healthcare providers [22]. With increasing legal restrictions, individuals self‐managing abortions may have limited access to in‐person support networks, potentially compromising their ability to access informed and supported abortion experiences. The absence of medical information and support can be filled by online resources like r/abortion for some people, but for others, virtual resources may not suffice during SMA. In their analysis of posts and comments on r/abortion in the 1 month after Dobbs, John and Martin found that while posters received accurate information and resources, emotional needs were not always addressed [35]. Yet a key finding of our study was the prominent role of community and peer support within the r/abortion subreddit. The subreddit served as a forum for individuals to share their experiences with SMA and receive essential social support, a crucial factor given the stigmatization and isolation frequently experienced by individuals undergoing abortions [58]. Abortion can be an isolating experience, and the presence of support and a sense of belonging may contribute to a more positive and less isolating experience.

While social networks can fill a gap in connecting people to existing resources and providing space for sharing personal stories, other strategies are needed to ensure all people, not just Reddit users, have access to accurate information and emotional support. There are diverse resources outside the formal healthcare system to support people self‐managing their abortions, including hotlines clinically staffed, websites, emotional support services, and legal services [19, 59] and future research should assess how well people are connected to these existing resources. The restrictive legal environment has created an opening for the spread of misinformation and disinformation about abortion, making it even more crucial for individuals to access accurate and reliable information. As Pagoto et al. described, a coordinated research agenda on the abortion infodemic is necessary to address the evolving misinformation landscape and ensure people can access abortion care [60]. Individuals seeking abortion care now need to navigate complex legal landscapes, including understanding the laws in their state and neighboring states, identifying safe travel routes, and finding reliable sources of information that are not subject to legal scrutiny. From online communities like r/abortion to virtual models of care offered through hotlines and telemedicine services, there is a clear and urgent need for creative solutions to ensure individuals have the necessary tools and support to safely and effectively manage their abortions. Accompaniment models from Latin America, which incorporate the provision of information on medication abortion and support for the person, either in person or virtually, during the abortion process, may also provide an important framework for adaptation in the US context as more people self‐manage abortions by choice or necessity [61]. Abortion doulas, accompaniers, and other trained practitioners who may be well suited to provide desired emotional support in addition to navigating the medical facets of abortion experiences will also be critical as more people need to self‐manage their abortions [40].

This leads to another important point. Aid Access was overwhelmingly the most mentioned platform for accessing medication abortion online in our study. Other platforms were mentioned, especially when discussing the need for expedited medication abortion, but it was abundantly clear that Aid Access is a critical resource in the current abortion access landscape. Requests to Aid Access for abortion pills increased from 82.6 requests daily during the baseline period before the Dobbs decision leak to 137.1 and 213.7 daily requests after the leak and after the formal ruling, respectively. All states saw increased requests, but the greatest increase was in states that implemented total abortion bans [2]. Aid Access provides limited real‐time support, directing clients to FAQs on their site with outside, vetted resources for additional information and problem‐solving [62]. Meanwhile, online platforms for ordering medication abortion have proliferated since the Dobbs leak [7], and the quality of information and support provided likely varies. Additionally, people who face barriers to accessing and understanding health information, including abortion information, are often marginalized due to poverty, race, geography, and/or age [63, 64]. Given Reddit's anonymous nature, we do not know the demographics of those posting, but we recommend targeting SMA information and support to reach more vulnerable populations.

The anonymous nature of r/abortion seems to be an appealing feature for those engaging in the community. The Dobbs decision has dramatically shifted the legal landscape surrounding abortion in the US, creating a complex and evolving environment for information seeking. The legal challenges impact the abortion information environment, but may also affect the role of r/abortion. For example, the sharing of personal information related to abortion within online communities, including r/abortion, carries increased legal risks in states with restrictive abortion laws. Individuals may fear that their online activity could be used against them in legal proceedings. Ensuring the privacy and security of users within the community is paramount. This may involve implementing stronger privacy measures, providing guidance on safe online communication practices, and addressing concerns about data security. The legal landscape surrounding abortion is constantly evolving and the role of online communities like r/abortion is likely to continue to evolve in response to these changing legal realities. While our research illuminates the diverse needs of individuals seeking abortion care in this new legal context, more research is needed to identify how online communities like r/abortion can best meet those needs while mitigating legal risks related to data privacy, provider liability, and “aid and abatement” laws.

Our study was not without limitations. Only a specific population of people engages with Reddit and the r/abortion community; thus, this study does not represent the entire population of people considering and using SMA during the study period. Additionally, our analysis only included a subset of r/abortion data, limiting our understanding of SMA experiences to this subset, for which we do not have demographic information due to the pseudo‐anonymous nature of Reddit. The user‐generated data resulted in variability in content and quality across posts, making it difficult to have a systematic understanding of the use of SMA in this community during our study period. Similarly, it can be difficult to determine what was SMA based on what was shared in user‐generated posts. Our process for determining SMA in posts presents limitations and likely resulted in an underrepresentation of SMA in our data, as we coded SMA conservatively in an effort to not infer self‐management. However, SMA is also inconsistently defined across the literature [65], so this limitation is also reflective of the larger discussions around defining and studying SMA. Finally, our analysis was only of posts in r/abortion, not comments. Our analysis of posts allowed us to explore various aspects of SMA experiences, questions, and concerns, which provided an understanding of people's SMA‐related information and support needs, which led them to r/abortion. As comments are used to respond directly to posts and where interactions within r/abortion are recorded, our focus on narratives in posts limits our conclusions regarding the impacts and utility of the support and information received by the person through the comments on their post. Further exploration should cover comments, providing a holistic view of the information and support exchange. Despite these limitations, by employing a hybrid thematic qualitative analysis of r/abortion data, we were able to integrate past research while allowing for inductive insights throughout the coding process. Utilizing Reddit data allowed us to analyze user‐generated abortion content, which enabled nuanced insights based on users' unstructured narratives of their abortion experience moderated in a peer‐oriented environment.

5. Conclusion

R/abortion is an important resource for some people self‐managing abortions outside of the formal healthcare setting. The community can play a vital role in combating misinformation and disinformation about abortion by providing reliable information among users. By analyzing how people posted about SMA on r/abortion, this study provided key insights into areas that are commonly discussed in the virtual community, which included a range of topics such as concerns about ordering and shipping abortion pills, medical questions that arose during SMA, and general community support for people self‐managing abortions. Our findings are a call to action to ensure timely and accurate information and support are available, not only in online spaces but also beyond the internet, to meet the diverse needs surrounding SMA. Researchers, healthcare providers, and support organizations must strive to gain a deeper understanding of the concerns and needs of people self‐managing abortions. This knowledge is critical for ensuring that these needs are met and that SMA remains safe. As self‐management becomes an increasingly common pathway to abortion access in the US post‐Dobbs, addressing these needs is imperative for providing safe and satisfactory abortion experiences.