Garima Shrivastava considers how self-managed abortion in India unsettles simple ideas of access, drawing attention to the social, technological, and institutional conditions that shape experiences of abortion.
A young person, 19 years old, finds themselves pregnant after months in an abusive relationship. Terrified and isolated, they attempt to harm themselves in the hope that the pregnancy will end. When they finally reach a clinic, the experience is not one of care, but of judgement. Nurses mock their short hair and gender expression. They are questioned repeatedly and left without meaningful support. Yet, in that same space, another young person seeking an abortion quietly steps in to help, and together they sign each other’s consent forms.
This story comes from a participant in my PhD research on self-managed abortion (SMA) in India. I use the pseudonym Sahana to protect their anonymity. I begin with this story not to individualize abortion, but because it reveals something important about how SMA is lived and navigated in practice. Following the World Health Organization, I use SMA here to refer primarily to medication abortion taking place outside formal clinical supervision (WHO 2022). Sahana’s experience illustrates that SMA cannot be understood simply as a matter of legality or access. Instead, it is shaped through the conditions under which care, support, judgement, and stigma are encountered in daily life. This raises a broader question that runs through this piece: what becomes visible when SMA is understood not as an isolated act or individual choice, but as a process that takes shape through relationships, technologies, institutions, and everyday forms of care?
Beyond the clinic
Much of the public and policy discourse around abortion continues to be organized through the language of access. We ask whether abortion is legal, whether services are available, and what barriers prevent individuals from obtaining care. These are undeniably important questions. Yet they can also flatten the complexity of how abortion is navigated in practice, often assuming a relatively linear pathway where access either exists or is denied.
The realities of SMA in India complicate this framing. Estimates suggest that nearly 73% of abortions occur outside formal healthcare settings through self-managed medication abortion (Singh et al. 2018). This statistic unsettles dominant assumptions that abortion primarily occurs within clinics, under medical supervision. Instead, it directs our attention beyond the clinic, toward the everyday spaces, outside formal healthcare settings, through which abortion is negotiated.
This does not mean that medicine disappears outside of clinical spaces. Rather, SMA reveals how medical authority extends beyond the clinic, shaping abortion through dispersed forms of knowledge, care, and regulation. Abortion may take place at home or outside formal healthcare settings, yet it remains connected to broader medical systems in ways that continue to influence how it is experienced and navigated. SMA therefore highlights forms of care that exceed the clinic, while remaining deeply intertwined with medicine itself.
Yet India’s abortion landscape remains marked by contradiction. Although abortion is legally permitted under the Medical Termination of Pregnancy (MTP) Act, access to medication abortion continues to be shaped by provider discretion and broader social norms. As one participant in my research project explained, “Even if I know it’s legal, accessing it is still not easy. Many doctors simply don’t want to write the prescription.”
These tensions cannot be understood through law alone. For many abortion seekers, particularly those who are young or unmarried, abortion remains entangled with expectations surrounding sexuality, marriage, and social respectability. In this context, abortion stigma is often tied to broader moral norms surrounding female sexuality, where pregnancy outside marriage can become a marker of social transgression rather than simply a reproductive event. As a result, legal permission does not necessarily translate into meaningful access, and abortion continues to be negotiated through forms of scrutiny, judgement, and stigma that extend beyond the law itself.
Negotiating care
What these experiences reveal is that access is not simply granted or denied through law alone. Instead, SMA is continuously mediated through interactions between legal regulations, institutional practices, and broader social norms. One participant described how provider refusal shaped her attempts to obtain abortion pills despite meeting all legal requirements. What stood out in her account was not outright denial, but the uncertainty involved in navigating the healthcare system. The prescription itself became a site of power. Doctors acted not simply as medical providers, but as moral gatekeepers whose personal beliefs and anxieties shaped whether abortion became practically possible.
Another participant described a case involving a young, unmarried woman who visited a doctor seeking medication abortion pills. The doctor agreed to prescribe the pills, but only after asking her to write and sign a “confession,” stating that she had engaged in premarital sex and was seeking abortion because she could not continue the pregnancy. When the woman later presented the note at a pharmacy and realized it had been read, she panicked and ran away. What lingers in this account is not simply the presence of stigma, but how stigma becomes materialized through ordinary practices and objects. The confession note travels between clinic and pharmacy; it carries moral judgement across spaces. The note itself becomes part of the abortion experience, shaping fear, exposure, and withdrawal. Access is technically granted, but only through practices of surveillance and discipline that shape how SMA can be navigated.
Thinking about abortion through the framework of access alone fails to capture these complexities. Access suggests a relatively stable endpoint: either one receives care or one does not. But the experiences described above reveal SMA as an ongoing process, shaped by the relationships and circumstances through which abortion is navigated. Feminist new materialist approaches (Barad 2007) offer one way of thinking through these complexities. Rather than treating SMA as an individual decision, these approaches draw attention to the relationships through which abortion becomes possible in practice. By foregrounding these relationships, they help explain why legal access alone cannot fully account for how abortion is experienced and navigated.
Entanglements and digital life
The relational nature of SMA becomes especially visible online. Over the past decade, feminist organizations and sexual and reproductive health groups in India have increasingly used digital platforms to circulate abortion-related information beyond formal healthcare settings. These platforms have become important sites through which abortion knowledge, support, and visibility are negotiated, while also generating new forms of risk and vulnerability.
One participant in my research described how their organization faced immediate backlash after posting a testimonial video about abortion online. The hostility they encountered eventually led them to step back from discussing abortion publicly. This account highlights that digital platforms do more than circulate information; they actively shape the possibilities for public engagement. Visibility online can create opportunities for connection and support, but it can also expose individuals and organizations to forms of scrutiny that make sustained engagement difficult.
Another participant described being “afraid to even speak on the phone.” The statement is striking because phones are often imagined as technologies of connection. Yet, here, the phone becomes a reminder that communication is not always experienced as private or secure. The possibility of being overheard, monitored, or exposed shaped what could be discussed and what remained unsaid. These experiences invite a more critical engagement with digital technologies and their role in abortion access. Rather than presenting digital platforms as neutral tools, these experiences highlight how technologies are embedded within broader social relations and inequalities. The possibilities they create are therefore uneven, shaped by questions of privacy, visibility, and power, as much as by access to information itself.
Rethinking self-managed abortion
Importantly, the possibilities opened up by SMA are not evenly distributed. Whether it becomes a viable option depends on the social and material conditions through which abortion is navigated in everyday life. This is also why the language of “self-management” can sometimes feel misleading. The term risks equating autonomy with independence, as though abortion occurs outside relationships or systems of support. Yet the experiences discussed here suggest something quite different. Rather than being exercised in isolation, autonomy is often made possible through networks of care, trust, and support. SMA, then, is not simply an individual act but a deeply relational process.
Seen from this perspective, familiar debates about legality, safety, and access appear less straightforward. While these questions remain important, they cannot fully explain how abortion is lived in practice. In India, abortion is often negotiated within broader social expectations surrounding sexuality, family, and respectability, revealing that access is shaped as much by social conditions as by legal rights.
Rather than asking only whether abortion is accessible, we might instead ask what conditions make SMA possible, and for whom. SMA is not simply about ending a pregnancy outside the clinic. It is a process shaped through ongoing negotiations with institutions, social norms, and varying forms of support. Attending to these dynamics allows us to move beyond access as an endpoint and instead ask how self-managed abortion becomes possible in everyday life.
About the author
Garima Shrivastava is a PhD researcher at the Centre for Gender Research, Uppsala University, Sweden. Her research explores self-managed abortion in India, focusing on the intersections of law, technology, stigma, and care in shaping abortion experiences beyond formal healthcare settings. You can follow her on X @Garimas26 and LinkedIn.
References
Barad, Karen. 2007. Meeting the Universe Halfway: Quantum Physics and the Entanglement of Matter and Meaning. Duke University Press.
Singh, Susheela, Chander Shekhar, Rajib Acharya, et al. 2018. “The incidence of abortion and unintended pregnancy in India, 2015.” The Lancet Global Health 6 (1): e111–20. https://doi.org/10.1016/S2214-109X(17)30453-9.
World Health Organization (WHO). 2022. Abortion Care Guideline. World Health Organization. https://iris.who.int/server/api/core/bitstreams/59a704cc-4024-412a-97d9-55d86d139602/content.
