Hegemonic medicine and self-managed abortion: reclaiming Latin American feminists’ contributions to knowledge and practice development

In this commentary, we challenge the narrative that presents self-managed medical abortion (SMA) as a recent "discovery" of Western biomedicine. Drawing on our lived experience and a literature review, we compare how different key concepts - autonomy, empowerment, person-centred care, privacy, confidentiality, and demedicalisation - are understood by the feminist SMA movement in Latin America, versus hegemonic medicine. We argue that, when the radical ideas of the feminist SMA movement are appropriated by mainstream health systems without proper recognition of their political foundations, they lose their original meaning and may fail to achieve the positive outcomes envisioned by activists. For instance, autonomy, privacy, and demedicalisation may result in individuals feeling unsupported, while person-centred care often means merely being treated without stigma or violence. Maintaining medical control over SMA restricts access, while neoliberal policies that promote "self-care" and the commodification of abortion pills enable states to evade responsibility with regard to abortion care. We advocate for integrating key concepts taken from SMA activism into formal health systems, while honouring their origins and political significance. This requires meaningful, horizontal collaborations between SMA activists and biomedical professionals, acknowledging that SMA activists are abortion experts, and should be treated as such.