Changes in beliefs about the safety of clinic-based abortion and self-managed abortion methods in the United States, pre- to post-Dobbs

OBJECTIVE: To estimate changes in beliefs about abortion safety among a representative sample of the U.S. population assigned female at birth (AFAB) before and after the Supreme Court's 2022 Dobbs decision. STUDY DESIGN: We administered two serial cross-sectional surveys to English- or Spanish-speaking AFAB members of a nationally representative panel (ages 15-49), pre-Dobbs (2021-2022; n = 6943) and post-Dobbs (2023; n = 3533). Respondents indicated their agreement (vs disagree/unsure) that "it is usually safe" to end a pregnancy via 1) an in-clinic abortion procedure; and using medication abortion pills obtained 2) at a clinic/doctor's office; or 3) outside the formal healthcare system (for example, from the internet, a friend, etc.). Using adjusted weighted logistic regression models, we assessed changes in safety beliefs pre- to post-Dobbs. RESULTS: From pre- to post-Dobbs, agreeing that each abortion method was "usually safe" increased: in-clinic procedural abortion: 57.8-64.1% (p < 0.001); medication abortion from a clinic/doctor's office: 52.2-59.6% (p < 0.001); and medication abortion obtained outside the formal healthcare system: 7.3-9.6% (p = 0.005). Agreement that each abortion method is usually safe increased significantly among respondents identifying as Democrat, with no history of abortion, and/or who support abortion legality (p < 0.05). CONCLUSION: While abortion restrictions in the U.S. increased, so did public perceptions that procedural and medication abortion are safe. However, about 40% still had concerns about the safety of abortions within the formal healthcare system and almost all (90%) continued to disagree or were unsure whether medication abortion obtained outside the formal healthcare system is safe. IMPLICATIONS: Major gaps exist in the U.S. public's knowledge about abortion safety. These findings suggest that continued education about the availability and safety of medication abortion is essential, particularly as abortion bans and regulatory threats to medication abortion within the formal healthcare system remain and attempts to self-manage increase.