A family physician explains how to handle self-managed abortion issues | Opinion
They include access, wait times and complications
By Grace Shih
“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.
Grace Shih is an associate professor of Family Medicine at the University of Washington. She wrote this piece for The Conversation, where it first appeared.
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