TY - JOUR T1 - Abortion attempts without clinical supervision among transgender, nonbinary and gender-expansive people in the United States JF - BMJ Sexual & Reproductive Health JO - BMJ Sex Reprod Health DO - 10.1136/bmjsrh-2020-200966 SP - bmjsrh-2020-200966 AU - Heidi Moseson AU - Laura Fix AU - Caitlin Gerdts AU - Sachiko Ragosta AU - Jen Hastings AU - Ari Stoeffler AU - Eli A Goldberg AU - Mitchell R Lunn AU - Annesa Flentje AU - Matthew R Capriotti AU - Micah E Lubensky AU - Juno Obedin-Maliver Y1 - 2021/03/04 UR - http://jfprhc.bmj.com/content/early/2021/03/03/bmjsrh-2020-200966.abstract N2 - Background Transgender, nonbinary and gender-expansive (TGE) people face barriers to abortion care and may consider abortion without clinical supervision.Methods In 2019, we recruited participants for an online survey about sexual and reproductive health. Eligible participants were TGE people assigned female or intersex at birth, 18 years and older, from across the United States, and recruited through The PRIDE Study or via online and in-person postings.Results Of 1694 TGE participants, 76 people (36% of those ever pregnant) reported considering trying to end a pregnancy on their own without clinical supervision, and a subset of these (n=40; 19% of those ever pregnant) reported attempting to do so. Methods fell into four broad categories: herbs (n=15, 38%), physical trauma (n=10, 25%), vitamin C (n=8, 20%) and substance use (n=7, 18%). Reasons given for abortion without clinical supervision ranged from perceived efficiency and desire for privacy, to structural issues including a lack of health insurance coverage, legal restrictions, denials of or mistreatment within clinical care, and cost.Conclusions These data highlight a high proportion of sampled TGE people who have attempted abortion without clinical supervision. This could reflect formidable barriers to facility-based abortion care as well as a strong desire for privacy and autonomy in the abortion process. Efforts are needed to connect TGE people with information on safe and effective methods of self-managed abortion and to dismantle barriers to clinical abortion care so that TGE people may freely choose a safe, effective abortion in either setting. ER -