After Roe v. Wade was overturned, some women were left with the option to buy abortion pills online, often shipped from abroad. However, a doctor warns that taking unregulated pills may pose serious health risks.
A recent study published in the JAMA Network reveals that requests for abortion pills via telemedicine in the US significantly increased. Before a draft of the US Supreme Court opinion on the abortion ban was leaked in May, an international abortion pill service Aid Access, received an average of 82.6 daily requests.
After Roe v. Wade, the landmark ruling that granted the right to abortion, was officially reversed in June, the organization received a daily average of 213.7 requests for abortion pills.
According to media reports, women are buying unregulated abortion pills from pharmacies in India, Russia, Kazakhstan, Vietnam, and other countries.
"The evidence that we've seen shows us that when you ban or severely restrict abortion, you don't do anything to change the need for abortion. But what you seem to do is change how and where people access care," said Dr. Abigail Aiken, a professor of public affairs at the University of Texas at Austin and one of the co-authors of the study said, in an interview for FiveThirtyEight.
How does medical abortion work?
Medical abortion consists of two prescription-only medications: mifepristone and misoprostol taken up to 48 hours apart. The US Food and Drug Administration (FDA) approved the use of mifepristone for early nonsurgical abortion in 2000.
In 2020, medication abortion accounted for 54% of US abortions, according to the preliminary data from the Guttmacher Institute's periodic census of all known abortion providers.
Nigar Sofiyeva, who holds an MD in obstetrics and gynecology and is currently doing her PhD training at the University of Bergen, says that buying unregulated abortion pills online is "very alarming" because of possible short-term and long-term complications.
She explains that mifepristone blocks a hormone called progesterone, which is necessary for the continuation of pregnancy. Meanwhile, misoprostol induces very severe uterine contractions, imitating pregnancy. The most common complication of taking misoprostol is bleeding.
"It can lead to uncontrollable bleeding that is so heavy that people cannot even reach the hospital. During my residency, I saw patients that would come and collapse in front of the ER," she said to Healthnews.
Sofiyeva says that after the regulated abortion, the ultrasound scan is done to confirm that the embryo is fully detached from the uterus walls and the endometrial cavity is empty. In other words, a complete abortion was done.
"If it is an unregulated or partial abortion, the remaining part of the embryo may cause an infection. It is in very close contact with blood vessels; therefore, the infection directly goes to the blood and may lead to sepsis and death," she says.
Infection can cause scarring of uterine tissue and damage the endometrial cavity. And that may lead to early-stage pregnancy loss or infertility in the future.
"If there is a scar on the uterine wall, there are no blood vessels. Therefore, there's no way for the embryo to be attached to the wall and get nutrients," Sofiyeva explains.
Who is at increased risk?
Sofiyeva says that for people with certain health conditions, taking unregulated abortion pills is even more dangerous. Among those conditions are hemophilia or other disorders in which blood does not clot properly, anemia, and heart and kidney problems. Taking particular medications, such as aspirin, that make blood thinner also elevates the risks.
"Some people may have undiagnosed conditions, so they don't know that they are much more prone to bleed," Sofiyeva says.
She points out that confirmation of pregnancy with a pregnancy test is insufficient. The ultrasound scan is necessary to rule out ectopic and molar pregnancy.
"In ectopic pregnancy, a fertilized egg implants itself outside the uterine cavity. It might happen in one of the fallopian tubes, abdominal cavity, or liver. In rare cases, it may happen in the spleen. When people take abortion pills and bleeding stops, they may assume they had an abortion when they did not."
In case of molar pregnancy happens, a fetus does not develop as it should. So when it detaches, the bleeding is even heavier, Sofiyeva explains.
Even regulated medical abortions may lead to complications. In a 2011 study from Finland that included 24,006 women who underwent medical abortion, 2.0% experienced an infection. Nearly one in seven (15.4%) was later diagnosed with bleeding, and one in ten 10.2% experienced an incomplete abortion.
In the US, 19 states require the clinician providing medication abortion to be physically present when the medication is administered, data collected by the Guttmacher Institute shows.
Many women, however, do not have much choice. According to the Mayo Clinic, symptoms that may require medical attention after a medical abortion include:
- Heavy bleeding — soaking two or more pads an hour for two hours.
- Severe abdominal or back pain.
- Fever lasting more than 24 hours.
- Foul-smelling vaginal discharge.
"When it is limited, people will go for much more aggressive methods," Sofiyeva, MD, says.
- JAMA Network. Requests for Self-managed Medication Abortion Provided Using Online Telemedicine in 30 US States Before and After the Dobbs v Jackson Women’s Health Organization Decision.
- National Library of Medicine. Comparison of rates of adverse events in adolescent and adult women undergoing medical abortion: population register based study.
- FiveThirtyEight. As States Banned Abortion, Thousands More Americans Got Pills Online Anyway.
- Guttmacher Institute. Medication Abortion Now Accounts for More Than Half of All US Abortions.
- Mayo Clinic. Medical Abortion.