Social Media Is Rife with Tips on Accessing Abortion Pills: What's Real, What's Fake — and What's Safe?
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With the reversal of Roe v. Wade, abortion is illegal, or severely limited, in many states across the country. While people who live in these states can no longer obtain the medical procedure at a clinic, self-managed medication abortions may be an option.
Social media is suddenly full of influencers and experts offering advice on everything about getting and using abortion pills, from whether you can set up a mail forwarding address to a state where abortion is legal (yes), to whether, in an emergency, a doctor would be able to tell that you used the pills (no).
But first, the basics: Medication abortion consists of taking the drugs mifepristone and misoprostol a day or two apart to end early pregnancy.
"Mifepristone plus misoprostol is 95 to 98% effective at ending a pregnancy before 11 weeks," says Susan Yanow, consultant to international activist non-profit Women Help Women and the U.S. spokesperson for SAAS, Self-Managed Abortions; Safe & Supported. "People in the U.S. have been using pills to self-manage abortions since at least 2000, and even longer in the rest of the world."
The pills can be taken at home, eliminating the need to drive to a clinic, take extended time off of work or worry about child care.
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"For every abortion that has happened in a clinic in North America, Europe, India, or China, there have probably been 1,000 abortions with pills outside of the clinics," says Yanow.
How Does Medication Abortion Work?
While the process can vary, Yanow says the most common method involves a person swallowing one mifepristone, waiting 24 to 36 hours, and then taking 4 misoprostol. Mifespristone blocks progesterone, which causes changes in the uterine lining and detachment of the pregnancy, while misoprostol leads to contractions.
Cramping and contractions may begin about 1 to 4 hours after taking misoprostol, emptying the uterus, much like a miscarriage. Pain can be managed at home, usually with ibuprofin and heating pads, although experts recommend that a hospital be reachable within an hour in case of emergency. Most people finish passing the pregnancy within 4 to 5 hours of the onset of cramping, but some lingering cramping may continue for a day or two.
"What these pills do is cause a miscarriage, which happens anyway in 15 to 20% of all pregnancies," says Yanow. "So if somebody uses these pills and needs to go to a doctor, they would get the exact same treatment as if they were having a spontaneous miscarriage."
And that's what they should say, she emphasizes. The substances cannot be detected in the body because they metabolize quickly. "If they say they have used abortion pills, they could be criminalized."
Can You Get the Pills in a State Where Abortion is Banned?
A person who wants to terminate a pregnancy and cannot get to a clinic has several options. The first is telemedicine, during which a licensed clinician in the U.S. evaluates the patient and then mails the pills to a patient in their state. "That can only happen in states where abortion is legal and telemedicine is allowed," explains Yanow, adding that the provider or clinician is not allowed to treat somebody outside of their state.
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The nonprofit Aid Access connects people to doctors in states where abortion is legal, and can also connect people who live in states where abortion is not legal to European doctors who provide prescriptions for abortion medication. In U.S. states where telehealth abortion access is legal, the cost is $150 and pill arrive by mail within a few days, according to the Aid Access website. For U.S. states and other countries, European doctors work with a pharmacy in India that delivers pills in 1 to 3 weeks for $110. Aid Access also has a helpdesk and doctors who can respond to questions before, during and after a self-medicated abortion, according to the website.
Plan C offers a step-by-step guide to mail forwarding for people in states without abortion access. The group describes how a person obtains a virtual mailbox in a state that allows telehealth abortion services, gives that address to a clinician, and can then can have the mail forwarded to their true home address. Plan C also offers to help someone avoid clinicians entirely and get pills mailed through the Internet using overseas pharmacies. Plan C can help navigate this process. A quick search for online pharmacies showed a delivery time of 2 to 3 weeks for $200, with higher fees for expedited delivery.
It's important to note that while there is no guarantee about what you will get from online pharmacies since they are not regulated by the U.S. government, Plan C says they have tested the ones they list and that they are not scams. "But, we do not operate these sites and cannot guarantee they will be reliable in the future," the site says.
Still, there are other risks that people need to know. "It's best if they understand how to use digital security when they're ordering these pills," says Yanow. While there has been a surge of warnings about deleting period-tracking apps (Yanow recommends EUKI, which keeps data in your phone, not on the Internet or in the cloud), there are many other ways security and privacy can be compromised. A handful of people have been arrested or prosecuted for using abortion pills in the past, including a woman whose browser history was used as evidence. That case was dropped but, says Yanow, given the current political climate, prosecutions could rise.
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It is too early to know, for example, if state law enforcement will use IP addresses, search history location data or texts to track activity and potentially prosecute people, or what kind of data tech companies may be asked or subpoenaed to hand over.
What Is the Best Option?
One of the benefits of a telehealth appointment is that you can interact with counselors, says Katie Watson, a constitutional scholar and bioethicist at the Feinberg School of Medicine at Northwestern University. "So if you want to ask them about your symptoms — say, is this the right amount of bleeding — you get a response from someone who has knowledge," she explains.
She adds: "Getting the medication is part one, but knowing you have a phone number or email to reach out to if you have a question can give peace of mind, from a medical perspective."
With ordering from an overseas pharmacy: "You might be without an organization or a trained individual to contact," Watson says. "You really are by yourself — except for what you Google." Therefore, Watson says many people considering self-managed abortion will want to have the number on hand for a helpline staffed by clinicians like the Miscarriage and Abortion Hotline.
It's important to reiterate that medical complications are extremely rare, says Yanow.
"Since these pills were introduced in the U.S. in 2000, there have been 19 deaths," she says. "If these pills were not about women's autonomy, they would be in the vending machines in our bathrooms — that's how safe they are."
