Study: Abortion Pills Ordered Online Were Safe, But None Came With Instructions

This is the first study to test the potency of the pills themselves.

None of the abortion pills that the researchers ordered came with instructions on how to use the pills, leaving people to find instructions on their own. Shutterstock

New research shows that you can buy effective abortion pills online. This is a groundbreaking finding given that cost, travel, and onerous abortion restrictions often make in-clinic, first-trimester abortions inaccessible.

While other studies have documented that people generally don’t have trouble finding abortions pills online, this is the first to test the potency of the pills themselves. With reports of “fake drugs” on the market overseas, it’s studies like these that can help to dispel fact from myth about the quality of the pills people might order, even if the act of ordering them may not be legal.

In the study, published Tuesday in the peer-reviewed journal Contraception, researchers ordered abortion pills from 20 websites, none of which required a prescription. Once the pills arrived in their homes, researchers sent the pills to a lab in good standing with the FDA to test the pills’ chemical contents.

The lab confirmed that all of the mifepristone, one of the two drugs used during a medication abortion, was within 8 percent of the advertised—and World Health Organization-approved—effective amount. The other drug, misoprostol, varied more considerably in how much of it was present in the pills the researchers received. Despite this variation, the researchers determined that the misoprostol pills would still be effective in causing an abortion.

Medication abortions following the FDA-approved mifepristone/misoprostol regimen are provided up to ten weeks in pregnancy across the United States. The World Health Organization added mifepristone and misoprostol to its essential medications list in 2005, and also provides protocols for medication abortion past 12 weeks in pregnancy. If a person accesses a medication abortion in a clinic, they generally take the first pill (mifepristone) at the clinic, and then the second set of pills (misoprostol) at home 36 hours later. The abortion itself occurs at home, and then they generally follow up with a clinician in the clinic or by phone several weeks later. Some states are taking measures to expand access to medication abortion by allowing patients to access it via telemedicine, while others are curtailing access by prohibiting the use of telemedicine, which severely limits abortion access for people not able to get to a clinic.

There is limited data about who is most likely to self-manage their own abortion in the United States. Though this is a difficult population to study, some data shows that women born outside the United States might be more likely than U.S.-born women to prefer self-managing their own abortion, and in Texas in particular, recent data found that women were likely to consider self-managing their own abortion if they had difficulty obtaining reproductive health services in general. People who experience marginalization and discrimination, particularly related to race, immigration status, and class, may be more likely to seek an abortion outside the formal health system than other pregnant people, and even be criminalized for doing so.

“Access to abortion through the formal health-care system is very difficult for many women in the United States, and we know that some women are looking online to obtain abortion pills. The fact that our study found no evidence that the products we received were dangerous or ineffective is therefore certainly reassuring,” Dr. Elizabeth Raymond, senior medical associate at Gynuity Health Projects, said in a press release about the study.

Yet the study is not all good news for abortion access: None of the abortion pills that the researchers ordered came with instructions on how to use the pills, leaving people to find instructions on their own. There’s ample evidence that with proper information and support, people can successfully self-manage their own abortions; without instructions on how to take the pills, people won’t have information about correct dosage, timing, and how to tell if their abortion is complete. We know people can follow the instructions to take the pills on their own and even self-diagnose unlikely complications, but they need access to this information (from websites like Women Help Women) in order to use it.

Lack of instructions wasn’t the only concerning aspect of ordering abortion pills online. The cost of the pills ranged from $110 to $360 with shipping costs between $19.95 and $171. While this is certainly less than the average cost of an in-clinic medication abortion ($504, according to the Guttmacher Institute), this may still be cost-prohibitive for people struggling to make ends meet. More than one-third of the abortion pills didn’t arrive until after the advertised arrival date, a disconcerting event given that mifepristone and misoprostol are most effective when used before 12 weeks of pregnancy.

Despite these disadvantages, many people may still prefer self-managing their own abortions instead of going to a clinic for care. According to one study, some people prefer to avoid medical facilities all together due to negative prior experiences, or because they have concerns about confidentiality and simply prefer a more private abortion experience in their own home. A recent study found that women in Texas who attempted to self-manage their own abortion did so because of difficulty accessing abortion clinics due to age, financial barriers, and immigration status, or because abortion restrictions forced their local clinic to close.

People may turn to self-managed abortion because they have no other options, but they also may prefer to have an abortion in their own home, on their own terms. Thanks to this new study, we know that the pills people order online can be effective. Now legislators, advocates, and health professionals need to make sure they have access to accurate instructions and compassionate support to have a safe, effective abortion, whether they prefer that it be in a clinic or at home.

As Dr. Willie Parker explained in an emailed statement about the new study, “When a woman decides to end a pregnancy, she should be able to get the abortion care that bests meets her needs and circumstances. Unfortunately, the abortion pill, which is a safe and effective method of ending an early pregnancy, remains unnecessarily regulated and only available through registered health care providers,” Dr. Parker said. “This study shows that many of the medications for abortion being sold online are what they say they are, and that is reassuring.”