Self-managed abortion (SMA) refers to actions people take to end a pregnancy outside the formal health care system. There are a variety of reasons people choose to self-manage their abortions, and these reasons may vary based on regional contexts. For some people, medically delivered abortion care is no longer, or has never been, available in their community. Available options might be inaccessible or unacceptable, or the person might have a preference for self-managed care as a primary choice. The majority of SMAs are completed safely with misoprostol, either alone or with mifepristone. Rare medical complications should be managed as they would be in any case of spontaneous pregnancy loss. For many people, the greatest risk of harm related to SMA comes from the threat of criminalization. Many U.S. states have at least one law in place that could be misused to prosecute people attempting or assisting with SMA. Criminalization makes people less safe and harms the confidential patient–practitioner relationship. Obstetrician–gynecologists and other health care professionals should provide all people with compassionate, nonjudgmental medical care, including those presenting before, during, or after self-managing an abortion.