How To Navigate Self-Managed Abortion Issues Such As Access, Wait Times And Complications – A Family Physician Explains

Dr. Grace Shih, The Conversation,
Medicalabortion

Photo©fizkes/123rf

“Are these pills legit? If I send money, am I even going to get these pills?”

These are the kinds of questions people have when they are curious about ordering medication abortion pills online.

This process, often called “self-sourced medication abortion,” refers to an individual finding or sourcing medications to induce an abortion on their own, without going through their primary care provider, OB-GYN or other clinic like Planned Parenthood. Globally, abortion pills might be found without prescriptions at neighborhood pharmacies or by accessing local community networks. In the U.S., even prior to the fall of Roe v. Wade, someone could order abortion pills online.

As a family physician practicing in Washington, I expect that abortion care will remain legal in my state. Even so, in the setting of legal abortion, I have cared for people who are self-managing their abortion because they don’t have a nearby abortion provider, because they cannot get a timely appointment or because they want control of their abortion experience.

In a study done before Roe v. Wade was overturned, researchers estimated that 7% of U.S. women would attempt self-managed abortion in their lifetime. Research shows that when there are more restrictions around care, demand for online abortion pills increases.

For example, one study looked at requests to a common online source of abortion pills the week after enactment of Texas’ Senate Bill 8 – legislation that banned abortion after the detection of embryonic cardiac activity. That study found a mean daily increase of 1,180% over the baseline before the legislation took effect. We can only expect a larger surge given the new legal landscape in the post-Roe world.

As more people look to the internet to find abortion pills, what can they do to avoid getting scammed and stay safe? Here are some resources and common questions people have about the process.

How Do You Get Abortion Pills Online?

There are lots of places where you can get abortion pills online; however, not all sites have been vetted for legitimacy. One reliable “one-stop shop” is plancpills.org. This is a private advocacy organization that provides information on how to get pills. It does not mail the pills itself, but identifies the options that are available depending on someone’s location as well as basic information like the cost, delivery time, age restrictions and financial assistance availability. It’s like GoodRx for abortion pills.

What Are The Abortion Pills?

There are two medications that are commonly used for medication abortion: mifepristone and misoprostol. Mifepristone blocks the hormone progesterone and stops the pregnancy from continuing. Misoprostol is a prostaglandin – a compound that has hormone-like effects on the body – that helps soften and dilate the cervix to expel the pregnancy.

Some online abortion sites may offer the mifepristone pill with misoprostol pills, and others may only have misoprostol pills. Both options are safe and highly effective.

In the U.S., medication abortion is approved by the Food and Drug Administration as the combination of mifepristone with misoprostol. However, mifepristone can be difficult to obtain because of prescribing restrictions.

Misoprostol is more readily accessible and available over the counter in many countries. There are accepted protocols for both the mifepristone-plus-misoprostol abortion and the misoprostol-only abortion pills.

What If I Live In A State With Restricted Abortion Access?

You can still buy the pills in states with restricted abortion access, but it may take longer to get them and there may be some legal risks. There are several options for people living in states that have total bans on abortion, like Texas, Oklahoma, South Dakota, Missouri, Mississippi, Arkansas and Alabama.

One option is Aid Access, a private organization with clinicians inside and outside the United States. When requests are made by people living in states with abortion bans, prescriptions are written by non-U.S. physicians and pills are mailed from international sources. Because of this process, it takes longer – two to three weeks versus two to three days – to receive the abortion pills.

Another option is ordering directly from online pharmacies. This means no prescription is required since no clinicians are involved; the process can be quicker, but it also may cost more (say, $200 to $400 compared to $100).

Finally, some people use mail forwarding as a way to get abortion pills to restricted states. For legal questions, people can seek free, confidential help on the Repro Legal Helpline either online or at 844-868-2812.

Are The Online Pills Safe?

For the most part, yes. A 2017 study investigated the process of buying abortion pills from online sources, including verifying the chemical quality of the pills received. Most of the sources contained within 8% of the labeled active ingredient.

This study was conducted by researchers from Gynuity and Plan C, which are nonprofit organizations dedicated to abortion research and advocacy. Plan C Pills continues to check its sources, and only those that have been vetted and verified are included on its website.

In general, medication abortion is very safe. In fact, medication abortion pills are so safe and easy to use that a label prototype for over-the-counter medication abortion has been studied.

What Happens If You Have A Question Once You Have The Pills?

Depending on where you order the pills, you may have access to a clinician who works with the organization that mails out the pills. If no clinician is available or if you ordered directly from an online pharmacy, people can contact the M+A Hotline, which is a text/phone-based hotline staffed by volunteer licensed clinicians, or Self-Managed Abortion Safe & Supported, a global nonprofit where trained counselors answer questions through a secure web portal.

The bottom line is that self-managed medication abortion is medically safe, and there are many reliable resources available to help people through the process. As abortion restrictions increase in the U.S., abortion pills may become like any other internet commodity – just a click away.

Dr. Grace Shih is Associate Professor in the Department of Family Medicine at University of Washington. She is the Director of the WWAMI Region Family Medicine Residency Network, UW RHEDI Director, and Co-Director of the UWFM Reproductive Health and Advocacy Fellowship.

This article is reprinted from The Conversation under Creative Commons license.

5232 A Abortion Self Care

How To Buy Abortion Pills That Are Safe And Effective

10 Common Questions and Answers

Courtesy of Partners for Reproductive Justice

1. What Medication Can Be Used Safely For An Abortion With Pills?

Abortion with pills involves two medications: mifepristone and misoprostol. They can be used together — or misoprostol can be used alone — to empty the uterus safely and effectively by starting a process similar to a miscarriage. When misoprostol is used alone, it is slightly less effective but still very safe. This method is very common because mifepristone is not available in many places.

2. What Is The Difference Between Mifepristone And Misoprostol?

Mifepristone blocks the activity of progesterone (a hormone needed to maintain a pregnancy) in the uterus and softens the cervix so the pregnancy comes out more easily. Misoprostol makes the uterus contract and push out the pregnancy. This is similar to what happens when a person has a miscarriage.

When both medications are available, mifepristone is taken first, and then misoprostol is taken 1–2 days later. Mifepristone is always swallowed. Misoprostol is put in the mouth to dissolve, either in between the cheek and gum or under the tongue. Note: You don’t need to take misoprostol vaginally, and no one ever needs to insert it for you.

Mifepristone is only available in a limited number of countries around the world. Check here to see if it is available in your country: www.medab.org. Mifepristone is often packaged together with misoprostol and sold as a combined product just for abortion.

Misoprostol is more widely available around the world, less expensive than mifepristone, and easier to buy from pharmacies and medicine sellers. In addition to being used to induce an abortion, misoprostol is also used to treat ulcers and to prevent or treat heavy bleeding after childbirth, therefore it is generally easier to purchase without a prescription.

Misoprostol is the medication’s clinical name, but it is sold internationally under many different trade names, such as Cytotec, Misoclear, Misotac, Kontrac, and Isovent. You can find a full list of names here: www.womenonwaves.org.

3. What Do Abortion Pills Look Like?

Both mifepristone and misoprostol are sold in tablet or pill form. Misoprostol pills usually, but not always, have a unique six-sided shape. Mifepristone is usually a round, white pill. If someone is selling these medications in capsule form, they are not legitimate. (A capsule is a shell or container, usually made of gelatin, that contains a medication.)

4. What Does Mifepristone Combined With Misoprostol Look Like?

Where mifepristone is available, it is usually sold packaged together with misoprostol as a “combi-pack.” Combi-packs are rarely counterfeit and should look something like this.

5. What Is A “Blister Pack” And Why Is It Important?

A “blister pack” is a way of packaging medicines where individual pills are sealed in a “bubble” between two layers of material. The most common materials used for blister packs are cardboard, plastic and aluminum.

Misoprostol becomes less effective when the pills are exposed to heat and moisture. For that reason, misoprostol must be sealed in double-aluminum blister packs (aluminum on top and bottom), rather than cardboard or plastic. You are unlikely to find legitimate or effective misoprostol that is being kept in cardboard, plastic or as loose pills in a bottle.

A double-aluminum blister pack should look something like this. Be sure the aluminum is not opened on any side until you are ready to use the pills.

6. How Much Do The Pills Cost?

The cost of misoprostol varies around the world. But misoprostol is widely available, so it’s generally not very expensive. Manufacturers sell the pills to pharmacies for very little cost — less than $0.05 USD (5 cents) per pill. The highest sales price found in a recent study was $2 USD per pill.

Misoprostol is usually an affordable option for someone seeking an abortion. Of course, some pharmacists or medicine sellers may take advantage of people seeking misoprostol and try to charge too much for the pills. You can ask people you trust if they know how much the pills should cost where you live, or you can search the internet for local cost information. But remember: Misoprostol should not be expensive.

Pre-packaged combi-packs of mifepristone and misoprostol are only available in a limited number of countries (less than 30), and they are less likely to be sold without a prescription. If you live in a low- or middle-income country where combi-packs are available, the prices are likely controlled, and a combi-pack should cost less than $20 USD.

7. How Many Pills Do I Need To Buy?

If you have access to both mifepristone and misoprostol, you will need 1 mifepristone pill of 200mg and at least 4 misoprostol pills of 200mcg each. If you are 10–12 weeks pregnant, you may need to take 1 or 2 extra doses (4 or 8 extra pills) of misoprostol to finish the abortion process. If you have access to misoprostol only, you will need at least 12 misoprostol pills of 200mcg each if you are less than 13 weeks pregnant.

8. How Can I Know If The Pills Are Real And Not Counterfeit?

Even if you ask for abortion pills by name, such as misoprostol or mifepristone, some medicine sellers may try to sell you counterfeit pills that won’t work and may delay you from having an abortion. Safe, effective abortion pills should be:

  • The color white
  • Pills or tablets, NOT capsules
  • Packaged in an undamaged, double-aluminum blister pack, ideally
  • Sold to you by a pharmacy or medicine seller you trust
  • Not expired (an expiration date should be on the package)

9.  Can I Buy Abortion Pills Without A Prescription?

Mifepristone and misoprostol can be obtained from a health provider, from pharmacies and medicine sellers, and from the internet. Depending on what country you live in, a prescription may be required to buy mifepristone and misoprostol from a local pharmacy or medicine seller. But the two medications are often sold without a prescription. Misoprostol is typically much easier to buy because it is also used to treat ulcers and to prevent or stop heavy bleeding after childbirth. Mifepristone and misoprostol “combi-packs” and misoprostol alone can be bought from online pharmacies and organizations that support people to self-manage their abortions (see the list in question #10).

10. Where Can I Find More Information On Abortion With Pills?

Reliable, evidence-based information on how to safely self-manage an abortion with pills can be found on the websites of these organizations:

There are also these reliable mobile apps available in the Apple App Store and Google Play Store:

Ipas Partners for Reproductive Justice is an international reproductive justice organization solely focused on expanding access to abortion and contraception. We work on five continents with partners and governments to make abortion and contraception widely available, to connect people with vital reproductive health information so they can access services, and to advocate for legal, accessible abortion. Visit ipas.org

Find local holistic Women’s Health and Spirituality practitioners in the Spirit of Change online directory.

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