As abortion access dwindles throughout the United States, forcing countless women in the South and Midwest to travel hundreds of miles to their nearest provider, so-called "DIY abortions" have resurfaced in the discussion about reproductive rights. Over 100,000 people in Texas are believed to have attempted to terminate their own pregnancies; in 2015 alone, there were more than 700,000 Google searched related to instructions on how to self-induce.
We're no longer living in the age of the back alley or the bloody coat hanger, both of which are symbols that inadvertently reinforce the cultural myth that abortions are inherently violent and risky. And while some desperate people lacking robust information could resort to dangerous options, many pregnant people today are choosing to surreptitiously use the abortion pill—a single drug or combination of medications that induce a miscarriage—at home.
According to a recent study published in The BMJ, "self-sourced" medical abortions administered outside of a clinic aren't a real threat; abortion pills, when used correctly, are safer than Tylenol. Still, however, laws that criminalize of pregnant people could put women in real danger. The legality of buying the abortion pill yourself and doing your own abortion is murky, and women throughout the country have been arrested on the suspicion of terminating their own pregnancies at home, or even for miscarrying under suspicious circumstances.
We know that American women are risking jail time to try and obtain the abortion pill for home use. What remains uncertain, however, is whether the pills available on unregulated drug-selling websites are real, or if sites purporting to sell the abortion pill are being honest with their customers.
This question led me and my collaborators at Plan C, an organization of abortion advocates, and Gynuity Health Projects, a reproductive health research organization, to look for, buy, and test the chemical makeup of abortion pills sold online in a first-of-its-kind study. Some of our colleagues surmised we'd be buying some very expensive sugar pills, while others were confident we'd find the real thing because the medications are manufactured for pennies in other countries. A quick Google search revealed plenty of places to either get medications or get scammed. We decided people desperate to access abortion should know which they might find. Last month, our findings were published in Contraception, a monthly peer-reviewed medical journal.
The legality of buying the abortion pill yourself and doing your own abortion is murky, and women throughout the country have been arrested on the suspicion of terminating their own pregnancies at home.
To conduct our study, we ordered a total of 20 mifepristone-misoprostol combination packs (considered the "gold standard" for medical abortion) and two misoprostol-only products (also an effective option, according to the World Health Organization), one or two from each of 20 sites. I and other mystery shoppers posed as young people seeking abortions and had the pills shipped to our homes. The median price of mifepristone-misoprostol products we bought was about $200 — $300 less than the average clinic-based abortion in the United States. Paying for the pills could get a little complicated: Options for payment included "E-Check" (a service that required a bank account and routing number), wire transfer, PayPal, Visa, MasterCard, Western Union or Bitcoin, and sites rarely offered more than two options. I refused to give my bank information, so I paid more Western Union fees than I would have liked to.
The median delivery took almost 10 business days, which is admittedly a long wait for abortion pills. Rush options were available and reliable (we chose them a few times) but more expensive. The pills came in subtle, unmarked envelopes. To our surprise, three quarters of them were postmarked within the United States. The other five were shipped from India, where all of the 20 drug products received were manufactured, according to their packaging. A few envelopes had pills hidden in secret pockets or taped to cell phone chargers sent, presumably, as alibis. Eight mifepristone-misoprostol kits had their foil packages pinpricked and folded around each pills. None of the packages came with instructions for use, but independently run sites like Safe 2 Choose and howtouseabortionpill.org are attempting to fill that void.
Throughout the research process, we began to realize that this collection of 20 websites may actually be the enterprise of only a few individual vendors. I ordered from different sites but then received confirmation emails from the same person at the same email address, and was delivered multiple packages marked with the same return addresses. Two orders I placed from two different sites were shipped in the same envelope. We ended up receiving all but two of our orders. We experienced a few troubling communications. One of our buyers received a confusing but ominous message from a vendor: "Please do not share this info with any other side because investigation team is searching the details for this type of medicine." Once a vendor told me that he never received the money that was charged to my credit card, and I had to strong-arm him into sending me the pills anyway.
Our lab test confirmed that all the pills were real. All of the mifepristone pills contained just about 200mg of mifepristone, just as much as the ones you get at Planned Parenthood. The WHO guidelines recommend as little 400mcg of misoprostol for medical abortion up to seven weeks after your last period, in conjunction with 200mg mifepristone, and three quarters of the packages had over 400mcg total in their pills, meaning they would likely be very effective. (The pills in the other five packages had less than that, meaning they could be less effective.) Interestingly, we found that the eight kits with pinpricks were the eight with the lowest misoprostol content. Misoprostol has been found to degrade when exposed to air, and damaged packaging could be a warning that enclosed pills may be less effective.
We can't know that every site selling abortion pills is legitimate, or even that these same sites will continue to send good products in the future. This snapshot reveals only that between December 2016 and March 2017, you could buy a real abortion on the internet, and the 20 packs we received contained the drugs we expected.
Abortion pills were supposed to be revolutionary: Not only would they increase access and options, they were going to change the way we thought about abortion, allowing people to take their reproductive autonomy into their own hands. Pills are simple to use by yourself if it's been less than 10 weeks since your last period, and they're also safe and ostensibly accessible. For many people who may prefer this option, or who may have no other choice, the risk of prison is the most dangerous part. But as long as reproductive autonomy remains inaccessible for people in certain zip codes or certain income brackets, self-induced abortion will persist in spite of this risk. As someone interested in autonomy for all, I feel it's important to simultaneously fight against the forces that endanger and incarcerate pregnant people and help work towards giving them the information necessary to make their own choices.