Imagine that you're pregnant, and don’t want to be. Imagine that you live in one of the six states with only one abortion clinic. Imagine that you don’t have much money, and traveling hundreds of miles to the nearest clinic would be prohibitively expensive. Imagine that the nearest state is one of the 27 that have a required waiting period for abortions, which would mean finding a hotel or a place to stay overnight. Imagine that staying somewhere overnight would mean taking multiple days off work at a job that pays you an hourly wage, meaning you would lose that money. Imagine that you don’t have a car.
According to decades of research, this set of circumstances applies to countless people across the country seeking abortion services. And considering that escalating attacks on abortion have created additional barriers to accessing the procedure over the last several years, it’s somewhat inevitable that people who need abortions are turning to the internet for help, not just for information about their nearest abortion clinic, or for money to cover the procedure, but, increasingly, to learn how to end their pregnancies themselves. And that even includes those who face fewer obstacles to abortion services: Some people would simply prefer to handle it on their own, in the comfort and privacy of their home, at their own convenience.
The number of online searches for self-managed abortion—the practice of self-inducing an abortion without the supervision of a medical professional—began to significantly increase in 2011, coinciding with an uptick in state-level abortion restrictions. The Guttmacher Institute found that American internet users conducted more than 200,000 Google searches for information about self-managed abortion over the course of just one month shortly after President Donald Trump took office.
These searches eventually lead users to one of the many websites currently selling abortion pills online. For somewhere between $95 and $360, retailers will send a pack of pills which, if containing the right drugs—mifepristone and misoprostol—and taken correctly, will end a pregnancy that's up to 10 weeks along. Mifepristone blocks the body’s production of progesterone, the hormone that prepares the uterus for pregnancy, and misoprostol causes contractions to empty the uterus, essentially causing a miscarriage—both of these drugs have been found to be safe and effective. But while buying things on the internet has always been easy, it hasn’t always been trustworthy.
So, is it safe to buy abortion pills online? And, given the Food and Drug Administration’s current restrictions on mifepristone, which require that it be administered in person in a doctor’s office or clinic, is it legal?
Are websites selling real abortion pills?
Yes, they are. Chloe Murtagh investigated the first question in 2017, when she tested abortion pills from 20 different sites. Murtagh, who was a program assistant at the reproductive health research organization Gynuity Health Projects at the time, wrote in a story for VICE that initially some of her colleagues suspected online abortion pill sellers were peddling “very expensive sugar pills” rather than mifepristone and misoprostol. But after conducting lab tests, her research team determined that all of the pills were real, and contained the same amount of mifepristone in them as the pills administered by clinics like Planned Parenthood. However, she did find that some pills contained lower doses of misoprostol, meaning they could be less effective—though not necessarily harmful.
Murtagh said her biggest concern was the shipping time on the pills, which took about 10 days to arrive. She said people considering buying pills online should be aware of the timeframe in which they need to take them—abortion pills are effective for those 10 weeks pregnant or less.
“I was most surprised and excited that every single pill we ended up receiving had at least some of the medication advertised,” Murtagh told VICE. “On the other hand, I was definitely concerned that some of the pills had less medication than expected, and probably more so, how long some of the packages took to arrive. Neither of those would necessarily threaten one’s health, but using ineffective pills and waiting a while for them is just lost time in a time-sensitive situation.”
Based on the research from Murtagh and her team, the reproductive health organization Plan C created a “report card” that grades online abortion pill retailers based on their pricing, shipping time, product quality, and physician oversight. The organization doesn’t make recommendations or advise people on whether they should manage their own abortions but founder Amy Merrill said she believes buying pills online to end a pregnancy is safe and effective if you know for sure that what you’ve bought is the real thing—and Plan C’s report card can help people verify that.
“I just keep coming back to the data about the safety of the method overall,” Merrill said. “It’s safer than Viagra to use this method of ending a pregnancy, and that includes people taking these pills from a clinic as well as ordering them online.”
There’s plenty of science and research backing Merrill up. The combo of mifepristone and misoprostol was first approved as an abortifacient in France and China in the late 1980s, and the World Health Organization has recommended it as a method for ending abortions since 2013. Earlier this month, the WHO updated its official guidance on the drugs, getting rid of the stipulation that once stated that using them required “close medical supervision.” Merrill said the guidance only buoys the mounting evidence that using abortion pills is a safe and effective method of ending a pregnancy.
Is self-managed abortion legal?
Medication abortion effectively induces a miscarriage, which means it typically involves cramping and bleeding, nausea, dizziness, diarrhea, and a mild fever. Some people can experience heavy and prolonged bleeding, or a fever that persists after taking the misoprostol pills, at which point doctors advise you go to the hospital. Advocates for those who manage their own abortions often advise patients to tell doctors they are simply experiencing a miscarriage—because while self-managing the procedure is unlikely to put people at risk for significant physical harm, experts say people considering ending their pregnancies on their own should be aware of the legal risks.
According to the reproductive justice legal group If/When/How, there are five states—Arizona, Delaware, Idaho, Oklahoma, and South Carolina—that still have laws on the books criminalizing self-managed abortion. (It was seven at the beginning of the year—New York and Nevada both recently repealed their criminal statutes ). Thirty-eight states have laws criminalizing harm to fetuses, which prosecutors could also apply to cases involving self-managed abortion.
Still, If/When/How’s lawyers say that the law is mostly on the pregnant person’s side: Since 2011, the group has uncovered just eight cases where someone has been charged with self-inducing an abortion, and the charges were thrown out in half of them.
“Any attempt to criminalize or control self-managed abortion is illegitimate and unconstitutional,” said Farah Diaz-Tello, senior counsel at If/When/How. “The charges usually end up getting dropped because the law doesn’t apply.”
If/When/How and other reproductive rights advocacy groups are putting pressure on states to lift any pre-Roe v Wade statutes criminalizing abortion, and escalating a campaign to get the FDA to lift the remaining restrictions on mifepristone and misopristol. Merrill argues that doing so would only make self-managed abortions even safer: Ideally, no one would have to rely on the internet as their only source of reproductive health care, and could attend to their reproductive health needs without fear of criminalization.
“We wish we didn’t even need to be having a conversation about this site or that site,” Merrill said, referring to online abortion pill sellers. “Lifting the restrictions moves it out of the shadows and into more normalized flows of commerce and telemedicine.”
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This article originally appeared on VICE US.