Women in desperate situations may resort to purchasing abortion medication online. Mail-order medication offers privacy and possibly less cost. Furthermore, the internet can be perceived as a comfortable venue for young women. But what is the price to be paid for women seeking this type of abortion?
Mifepristone (Mifeprex) is a drug that attacks rapidly growing cells and blocks the effects of the hormone progesterone. When prescribed in early pregnancy, it causes the fetus and placenta to separate from the lining of the uterus. In the second step of the abortion procedure, Misoprostol tablets are given 3 to 7 days later to trigger contractions and expel the pregnancy from the uterus. The process may take a few hours or as long as a few days. A physical exam is given one to two weeks later to ensure that the abortion procedure is complete and to check for complications.
The U.S. Department of Health of Human Services requires that Mifeprex be ordered, prescribed and dispensed by or under the supervision of a healthcare provider who meets certain qualifications. Also Mifeprex may only be dispensed in clinics, medical offices, and hospitals by or under the supervision of a certified healthcare provider. However, websites are offering abortion medication with no prescription or medical supervision.
The FDA specifically warns consumers against purchasing abortion medication on-line, “You should not buy Mifeprex over the Internet because you will bypass important safeguards designed to protect your health (and the health of others). Mifeprex has special safety restrictions on how it is distributed to the public. Also, drugs purchased from foreign Internet sources are not the FDA-approved versions of the drugs, and they are not subject to FDA-regulated manufacturing controls or FDA inspection of manufacturing facilities.”
A recent study, published in Contraception September 2017, studied the feasibility of obtaining Mifepristone and Misoprostol from the internet.
In the study these medications were ordered on different websites without prescription or documentation. The results of this study are concerning.
Here are some of the findings:
- All 22 products ordered for the study contained an amount of medication less than labeled.
- None of the websites questioned any specific contraindications listed for Mifeprex, the brand of mifepristone approved for abortion by the US Food and Drug Administration.
- The cost was considerably less expensive than abortion clinic visits to obtain the drugs, ranging from $110-$360. The FDA states that a primary reason for seeking medication online is reduced cost.
- 15 of the products received were shipped from locations within the U.S. and five were shipped from locations in India.
- None of the 22 medications ordered came with any instructions regarding how much or when to take the medications. This is alarming because there is a particular order to giving the first and second medications with a specific number of hours between.
- Three of the 22 orders came with other products in the envelope that were not ordered such as cell phone charging cables or necklaces making it apparent they were not coming from a legitimate pharmacy.
- None of the websites questioned the gestation of the pregnancy. Nearly half of the products did not arrive until after the anticipated date. Medication abortion is only indicated for use up to 70 days (10 weeks) after the first day of the last period.
- The products received rarely were the same brand as those ordered.
- Some websites disappeared shortly after the order was placed.
- The security of the information provided to vendors, including financial information, was questionable and the authors of the study received fraud alerts and a notification from a vendor suggesting that an active investigation was ongoing.
Without prescreening for medical disorders prior to purchasing these medications, there is serious medical risk. Contraindications for Mifeprex include anemia, bleeding disorders, liver or kidney disease, seizure disorder, acute inflammatory bowel disease or use of an intrauterine device (IUD).  According to the manufacturer, abortion medication is not effective if a woman has an ectopic pregnancy. Without proper screening prior to taking Mifeprex, a woman may believe she ended her pregnancy following the intake of abortion medication but may have severe risk of a ruptured ectopic as the pregnancy continues to progress. An ectopic pregnancy may be severe and life-threatening.
With on-line purchasing of these medications there is no medical evaluation following the abortion. This leaves women who have ordered these medications to wonder if their symptoms are normal, if the abortion was complete, and if anything went wrong. Medical abortion risks include: allergic reaction, infection and sepsis (sometimes without fever), and prolonged heavy bleeding (which may indicate an incomplete abortion). All of these require immediate medical attention.
Women seeking to purchase medication abortion need to know that they may be purchasing a potentially substandard and falsified medical product being distributed by unregulated websites. And – they need to understand the risks of taking these medications without prescreening, medical supervision, or any follow-up assessment to assure the procedure is complete and to evaluate for complications.
Women who have started the Abortion Pill process also need to know that it can be reversed – if appropriate medical attention is sought quickly. They can call this 24/7 HOTLINE: (877) 558-0333 for a referral to a doctor near them who can help them.
- Medical Abortion Procedures. American Pregnancy Web site. http://americanpregnancy.org/unplanned-pregnancy/medical-abortions/. Published April 26, 2017. Accessed November 14, 2017.
- Mifeprex (mifepristone) Information. FDA Web site. https://www.fda.gov/Drugs/DrugSafety/ucm111323.htm. Published March 30, 2016. Accessed November 11, 2017.
- Murtagh Chloe, Wells Elisa, Raymond Elizabeth G., Coeytaux Francine, Winikoff Beverly, Exploring the Feasibility of Obtaining Mifepristone and Misoprostol from the Internet, Contraception (2017), doi: 10.1016/j.contraception.2017.09.016
- Abortion Pill. American Pregnancy Web site http://americanpregnancy.org/unplanned-pregnancy/abortion-pill/. Published June 12, 2017. Accessed November 9, 2017.
- Important Safety Information for Consumers. DancoWeb site. http://www.earlyoptionpill.com/for-health-professionals/important-safety-information-health-professionals/#. Accessed November 9, 2017.