Objectives: Recent research from Texas found that self-provided and non-clinical abortions are on the rise, largely due to abortion restrictions. Anecdotal evidence from other abortion advocates suggests that some people seek alternative abortion methods for other reasons. This is the first qualitative study with a geographically diverse North American sample to describe people’s preferences, motivations, and experiences with alternative abortion outside the formal healthcare system. Methods: Using community engagement and peer-to-peer sampling, researchers recruited 23 people who had recently used and/or provided alternative abortion methods in North America to contribute in-depth interviews. Researchers asked participants to describe specific influential, logistical, and experiential factors related to seeking and providing alternative abortion care. Transcripts were coded using in-vivo codes, and a community expert consulted on thematic analysis to construct a theoretical framework. Demographic data were also collected. Results: Participants were located across the US and Canada. Participants used a combination of methods early in the first trimester, with varying degrees of success. Most participants reported a prior in-clinic abortion, and those experiences factored into their decisions to seek alternative methods. The desire for privacy, control, and active participation in the process, were other key factors, as was gaining bodily knowledge and autonomy. Community-based abortion providers described providing safe and effective abortions, and cited several constraints of accessing in-clinic abortions as reasons people sought their services. Conclusions: People use and provide alternative abortion methods for a variety of reasons. This research can help advocates understand these emerging trends and inform future access to safe abortion care.