A recent article in The Irish Independent warns women of the dangers of buying so-called abortion pills online, citing the bleeding, infection and other risks of the unsupervised use of these drugs, known as abortifacients. In my work as a certified obstetrics registered nurse and part-time analyst for LegitScript, this issue has recently caught my attention.
According to the World Health Organization, nearly half of abortions worldwide are unsafe, occurring without medical supervision. In the developed world, where most women have Internet access, about 6 percent of abortions (360,000) are unsafe. Perhaps the easiest, most discreet method of terminating a pregnancy autonomously is by ordering abortifacients via an online pharmacy. Websites like nice-a-beauty.com (registered through Joker.com and using the Internet service provider I Web Technologies) inaccurately market Misoprostol as recommended by the WHO, and provide links to sites such as eurodrugstore.eu (registered via Internet CZ, also using the ISP I Web Technologies), where consumers can buy "abortion drugs" with the click of a mouse. The website alinrx.com (registrar: OnlineInc; ISP: Ecatel Ltd.) boasts: "When you need to buy the abortion pill online without an online prescription, we are here to help."
Misoprostol (brand name Cytotec) is one of the most popular abortifacients offered online. In the clinical setting, I frequently administer this medication to induce labor, and therefore I understand the risks and the reasons why taking this drug should be done only under medical supervision. Originally developed as a gastric ulcer medication, Misoprostol does not have FDA approval as either an abortifacient or labor-inducing agent. Such uses are considered off-label, and therefore women must sign a waiver in order for physicians or midwives to legally induce labor using the drug. The American Congress of Obstetricians and Gynecologists has published multiple statements supporting the safe use of Misoprostol for uterine evacuation, but only if done under medical supervision.
Misoprostol is administered either orally or vaginally, and the prescribed dose varies greatly depending on a woman’s overall health, gynecological and obstetric history, gestation and status of pregnancy (whether the fetus is alive or has died in utero). If not carefully dosed and the woman not closely monitored for uterine activity, there is a risk of uterine rupture -- an obstetric emergency treated only by immediate surgery. A woman may be at a greater risk of uterine rupture or excessive bleeding if she has previously had a C-section or has chronic conditions such as (but not limited to) a clotting disorder.
The risks associated with self-induced abortion are not limited to medication side effects or the delivery of the fetus. There may be complications with delivery of the afterbirth, excessive bleeding, infection and harmful conditions related to the mother's blood type -- none of which these websites mention when advertising "abortion drugs, no prescription needed." Furthermore, if online pharmacies are illegally selling drugs for use without medical supervision, why should we trust the drugs' authenticity? The pills could have no, reduced or -- worse -- increased levels of active ingredients. It is nauseating to know that rogue online pharmacies are falsely marketing and selling abortifacients to consumers without a prescription, contributing to illegal abortions and the complications that may ensue, all for their own unlawful profit.