Women turn to home abortions as unregulated pill sites expand operations

Jane was living in rural New Mexico when she found out she was pregnant. She never wanted to have children or become pregnant and knew immediately that she wanted an abortion.

But while abortion remains legal in the state, she says she also didn’t want to take a chance with long clinic waiting lists or a sudden change in the law that would put her in limbo. She had volunteered at an abortion hotline years ago and knew that even before the Supreme Court’s decision to overturn Roe v. Wade, waiting periods and mandatory ultrasounds can cost extra time and money.

So instead, she turned to her closet, where she kept a pack of abortion pills bought online for $150 after a previous pregnancy scare.

Rather than a doctor, she relied on the advice of a few close friends and called the M+A Hotline, an anonymous helpline that counsels women who have had miscarriages and abortions.

“I wasn’t in a place where I could call a bunch of (clinics) and get a ‘no,'” said Jane, who agreed to tell her story on the condition that ABC wouldn’t use her real name. – or identifies the online pharmacy she used – due to privacy concerns and fear of criminal prosecution.

“I wanted certainties,” she added. “And I didn’t want to be pregnant.”

Less than five months after the fall of Roe v. Wade, the impact on women across the country has become nearly impossible to measure. Abortion access has become dramatically more restricted on paper – at least 14 states have stopped nearly all legal abortion services, including prescriptions for medical abortions. Data released this week estimates there have been 10,670 fewer legal abortions since the Supreme Court ruling.

But advocates say those numbers don’t tell the whole story. They believe that demand for abortion pills has exploded, even in states where abortion remains accessible due to legal uncertainty.

To meet this demand, online pill brokers buy generic versions of drugs in bulk from pharmacies in India, Russia, Mexico and Vietnam. The drugs are then illegally shipped to US consumers at a significant markup — 10 times the original cost or more — but still a fraction of the $400 to $500 price charged by many abortion clinics, advocates say.

The result in many cases is that online abortion medication appears to be a cheaper and easier option, even if it is unregulated in many cases.

“We’ve known for a long time — even when people have access to clinics — that some people may prefer other pathways for privacy, convenience, or cost,” said Elisa Wells, founder of the site. Plan C.’s online abortion, which helps people find services that will provide abortion medication.

Although an accurate count of self-managed abortions is nearly impossible, there is no doubt that it is increasing dramatically, she said.

“There’s a big market for these pills,” Wells said.

The Plan C website is displayed on a laptop computer in Brooklyn, NY on October 27, 2022.

Bloomberg via Getty Images, FILE

Mifepristone, also sold under the brand name Mifeprex, has been available in the United States for 22 years. It works by blocking the hormone progesterone needed to continue a pregnancy. It is usually prescribed with a second drug, misoprostol, which causes cramping and bleeding to empty the uterus.

According to Food and Drug Administration rules, only certified providers can prescribe mifepristone to someone less than 10 weeks pregnant. The person must be screened for potential health complications like bleeding disorders and ensure that they do not have an ectopic pregnancy, which requires immediate life-saving treatment.

Although state rules may be stricter or ban the drug outright, the FDA says mifepristone is safe enough to be offered via telehealth and mailed to a person’s home without seeing a doctor. in person – as long as it comes from one of two government-inspected manufacturers — Danco Laboratories and GenBioPro.

“You should not buy Mifeprex or its approved generic over the Internet because you will circumvent important safeguards designed to protect your health,” the FDA warns online.

Yet, as Americans in recent decades have crossed the Canada-US border to get cheaper insulin or flown to India for more affordable medical procedures, many post-Roe women seem to sidestep these warnings and state laws to get the abortion pill delivered to their doorstep. .

A research article published Tuesday in the medical journal JAMA found that the online site Aid Access – which offers women telehealth appointments and writes abortion prescriptions filled by a pharmacy in India and shipped to their homes – saw an increase in requests for pills from the United States. following the decision of the Supreme Court. Applications have increased the most in states with near-total bans, including Louisiana, Mississippi, Arkansas, Alabama and Oklahoma.

“The evidence we’ve seen shows us that when you ban or severely restrict abortion, you’re not doing anything to change the need for abortion. But what you seem to be doing is changing how and where people access services. care,” Dr. Abigail Aiken, a professor of public affairs at the University of Texas at Austin and one of the study’s co-authors, said in an interview with FiveThirtyEight.

Other online pharmacies seem to offer little to no medical evaluation, shipping the drug directly with few questions asked.

This leaves many people who have abortions with medical issues that they cannot always report to their doctor for fear of legal action. April Lockley, medical director of the M+A hotline, which answers medical questions about miscarriages and abortions but does not provide access to abortion drugs, said the line saw a surge in calls after Texas passed its ban on abortion and again after the Supreme Court. decision last summer. She said the hotline currently averages about 25 to 50 contacts per day.

It’s not immediately clear if the FDA has any of these online pharmacies on its radar, or if the agency has the bandwidth or appetite to pursue them. Although the agency wrote stern warning letters to Aid Access, no further enforcement action was made public.

Online medical abortion was an option that Texas resident Jessica Garza wanted to have on her radar last year when she found out she was six weeks pregnant.

Garza said she suffered from severe depression after the traumatic birth of her daughter six months prior. A stay-at-home mom, she arranged to travel to Louisiana, which at the time allowed surgical abortions.

At the clinic, Garza faced a long waiting list and state restrictions that required her to make the trip multiple times. She was 15 weeks before she could have an abortion – a wait she described as agonizing and traumatic.

“I believe that if I had been forced to carry this pregnancy to term, I don’t think I would have survived it. I was in such a bad place,” Garza said.

For Jane, she said she had no regrets about working outside the system.

“Even though I was worried about what I Googled and who I texted, physically going to a clinic felt more visible and legally risky,” she said.

With clinics, she says, “you have to cross borders and you have to cross picket lines. No thanks.”

About Terry Gongora

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