At Home Medical Abortions

Women Are Buying the Abortion Pill Online

Home Medical Abortions
Buying Abortion Pills Online. Photo © 2015 Dawn Stacey

In more than 70 countries where abortion is restricted, hundreds of women are now seeking the services provided through Women on Web’s “I need an abortion” project to purchase the medications necessary to perform at home medical abortions. Upon going to this website, women are asked to complete a 25 question consultation to determine if they are the proper candidate for an at home medical abortion.

After the consultation, it is asked that the woman make a donation of at least 70 to 90 euros (equivalent to around $80-$100 in US dollars) – depending on the country where she lives. A licensed doctor then reviews her answers, and if she qualifies, mifepristone (RU486) and misoprostol are shipped to her home. The abortion medications are accompanied by instructions about how to use these drugs, what to expect, and when to seek assistance from a doctor. There is also a helpline to contact if a woman has any additional questions about any step in the process.

The use of mifepristone and misoprostol will typically cause a non-surgical termination of an early pregnancy. Women on Web claims that their site helps women "gain access to a safe abortion with pills in order to reduce the number of deaths due to unsafe abortions." Further, research supports that a medical abortion can be safely performed at home as long as a woman has good information and has access to emergency medical care (in the rare case that there are complications).

Before ordering the abortion pills, the website suggests that you should have already taken a pregnancy test and preferably an ultrasound to confirm that you are pregnant. 

You can only buy at home medical abortion pills from the "I need an abortion" project if:

  • You are less than 9 weeks pregnant (63 days).
  • You don’t have any contraindications (which include: have an IUD, bleeding disorders, chronic adrenal failure, undergoing long-term corticosteroid therapy, and/or or if you have an allergy to mifepristone or misoprostol).
  • You have no severe illnesses.
  • You do not have somebody forcing you to end your pregnancy.
  • You live in a country where access to safe abortion is restricted.

The website presents credible research that claims that medical abortion has been shown to be effective through the first trimester (12 weeks pregnant) and will allow qualifying women to purchase the abortion pill if they are less than 63 days pregnant (9 weeks along). In the United States, RU486 has only been FDA-approved for women up to 7 weeks pregnant (or up to 49 days after your last menstrual period). With that being said, women from the US are not eligible to purchase these medical abortion pills since access to abortion is not restricted.

Critics of the services provided by this site claim that it may be encouraging women, from countries were abortion is illegal, to break the law.

However, customs regulations in most countries allow for people to have medication sent to them for personal use as long as it is in small quantities. Mifepristone and misoprostol are also on the World Health Organization’s (WHO) list of essential medicines, they are not classified as narcotics, contraband, or controlled substances. The WHO defines heath as, “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Women on Web believes that all women faced with an unwanted pregnancy and no reasonable access to safe abortion care qualify for the provision of care under the life and health exemptions of restrictive abortion laws. 

Critics also express concerns that women may experience serious medical complications if they are buying these medications from poorly managed internet sites that do not provide women with appropriate medical information and challenge the reliability of online consultations. Yet, these abortion medications are non-addicting and have a low risk for complications. Typically, only two to three out of every 100 women who have medical abortions will need to go to a local doctor/hospital to receive further medical care (such as vacuum aspiration). This risk is equal to the number or people who require medical care for an allergic reaction to penicillin use. Women on Web explains that the website uses the online consultation to ask the proper questions in order to receive all the information required for the doctor to determine if a woman can a safely have a home medical abortion. Just as during a face-to-face, in person consultation, the doctor is depending that you are providing honest information. Screening women for contraindications on the internet is not that different from talking to them in person, and both approaches rely on the woman’s honesty.

Realistically, we know that abortion is one of the most safely performed medical interventions. The “I need an abortion” project seeks to help women around the world get a safe medical abortion and to reduce mortality due to unsafe abortion. Every year, approximately 42 million women choose to have an abortion for all kinds of reasons. In countries where safe abortion is not accessible, around 20 million women seek unsafe abortion services… leading to about 47,000 unnecessary deaths a year. Online abortion services like this can help to make medical abortions much safer for women who do not have access to safe abortion services.

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Sources:

Gomperts RJ, Jelinska K, Davies S, Gemzell-Danielsson K, & Kleiverda G. "Using telemedicine for termination of pregnancy with mifepristone and misoprostol in settings where there is no access to safe services." BJOG. 2008 Aug;115(9): 1171-5; discussion 1175-8. Accessed via private subscription

Harper C, Ellertson C, & Winikoff B. "Could American women use mifepristone-misoprostol pills safely with less medical supervision?" Contraception. 2002; 65: 133-142. Accessed via private subscription.

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