Though a recent study found American abortion rates have dropped to record lows, it is impossible to say how accurate the number is, since the majority of self-managed abortions go unreported. And as more states adopt restrictive abortion laws, the use of easily shipped black-market abortion pills has most likely risen.
The FDA-approved medication abortion administered in a clinic involves two pills, but those who use pills to terminate a pregnancy on their own are using just one. The first pill used in a clinical medication abortion is mifepristone, which blocks pregnancy-enabling hormones and is heavily regulated in the U.S. The second, misoprostol, causes uterine contractions. Because misoprostol was originally intended for treating ulcers, it is sold over the counter in some countries, including Mexico.
Due to the ease of obtaining misoprostol, a host of websites focused on shipping the pill from overseas to the U.S. have popped up in recent years, making it impossible to track how many people have managed their own abortions, according to the New York Times:
“‘When you say a self-managed abortion, people think about a coat hanger or a back-alley abortion,’ said Abigail R. A. Aiken of the University of Texas at Austin, who has studied the safety of self-managed abortions and the reasons women choose them. ‘The reality is we’re sitting here in 2019, and it’s not like that anymore. You can go online, and you can fill out a form, and you can get this safe and effective technology delivered to your home.’”
A website called Aid Access, which offers misoprostol through the mail, reported 21,000 requests for the pill last year, its first operating in the U.S. To further support the idea that many women are increasingly opting to handle their own abortions, a study of Texas women recently found that between two and four percent had attempted abortions outside the care of medical professionals. And another study, also in Texas, found that while abortion rates declined statewide after the state temporarily enforced stricter abortion laws, they declined most sharply along the border, where it is easier to get misoprostol.
In addition to restricted abortion access, the cost of abortion could also be a reason many choose to order the pill online. The Times estimates that in a clinic a medication abortion costs around $500 and is often not covered by health insurance. Ordering the pills online costs somewhere from $90 to $200.
Though it’s concerning that so many are aborting without the supervision of a medical professional, there is also not much evidence that self-managed medication abortions are more dangerous than clinical pill abortions. The success rate of both FDA-approved pills taken together is 98%, but misoprostol taken alone is successful around 80% of the time. A study in Ireland found only a small number of the people who ordered misoprostol through the mail developed bleeding or infections requiring follow-ups.
However, as lawmakers push abortion bans, many also seek to make even suspicion of abortion a crime. For example, under the Georgia ban, a miscarriage could be punishable by up to 30 years in prison. Leaving those seeking abortion with no other recourse but to buy illegal pills on the internet makes vulnerable people more likely to be subjected to harsh punishment for simply not wanting to be pregnant.