Women in US forced to depend on online pharmacies, googled instructions as abortion clinics stay shut

Washington: One week after Sally realised she was pregnant, her home state Texas temporarily banned abortions, deeming them unnecessary elective procedures that were suspended because of the coronavirus crisis.

So, the 34-year-old, whose name has been changed for this story to protect her privacy, took matters into her own hands—something she never would have considered in the past.

Having split with her boyfriend, she decided to buy pills on the internet, and perform her own abortion at home.

It’s illegal, and certainly stressful, but more and more women—faced with difficult decisions during a time of national crisis—are going that route.

“It came in a little Manila envelope. And it was just a five-pack of pills. No instructions—nothing,” Sally told AFP from her home in Dallas.

Getting the pills was not easy. The first two sites she consulted were out of stock. After sending $250 to a third site and enduring several long days of waiting, the envelope arrived.

By then, it had been 10 weeks since her last period—the absolute limit in the United States for a medical abortion.

“I was so terrified,” she said.

She googled online to figure out how to use the pills for what is called a “self-managed” abortion.

She took the first pill—mifepristone, commonly known in the US as RU-486, which is used to stop the development of the pregnancy.

The four other pills were misoprostol, which triggers the actual abortion. And then Sally took painkillers.

After a night of “really bad” cramps, and bleeding that “shocked” her, everything went as expected. Sally went back to work the following day, “relieved” that the pills worked properly.

“I would have rather had medical supervision, for sure,” she says without hesitation.

Beyond the legal ramifications, how does one find websites where the pills are sold? How do you make sure you get them quickly?

Dozens of women like Sally are exchanging advice, tips and notes about their experiences in the abortion forum on the popular social network Reddit.

Soaring sales

A woman’s right to have an abortion is protected by the landmark US Supreme Court decision in Roe v Wade.

Even in normal times, that right has come under threat in some conservative-leaning US states. But several states sought to capitalize on the virus crisis to advance their campaigns.

There are also natural impediments to getting an abortion in a time of national crisis: the fear of getting infected at a clinic, the inability to leave home to get the procedure, or even financial distress due to sudden unemployment.

To help women buy their own pills online, the Plan C site lists eight online vendors, and ranks them in terms of price and speed of shipment.

The pills sold by those vendors have been tested and declared reliable in 2018.

One online retailer who asked not to be identified told AFP that sales in the US “increased by 150 percent in April compared to March.”

Visits to the Plan C website had doubled by late April as compared with a month before.

Plan C co-founder Elisa Wells said that while 900,000 abortions are performed each year in the United States, 40 percent of them medically, at least 10,000 are done “outside of the conventional medical establishment”—either via pills bought online or in Mexico.

What are the risks?

Abortions using mifepristone and misoprostol are safe, experts say. Complications that require medical intervention are rare.

“In the year 2020, in the United States, the real concerns about self-managed abortion aren’t physical but legal,” explains Jill Adams, the executive director of If/When/How, which puts women who want to abort on their own in touch with attorneys.

From mid-March through the end of that month, the association’s hotline received twice as many calls as usual.

Five US states—Arizona, Delaware, Idaho, Oklahoma and South Carolina—have laws that specifically ban self-managed abortion.

But women in other states are not really better protected: some local prosecutors use other laws to convict them, such as those forbidding the practice of medicine without a licence.

Some even charge women with child abuse, or drug-related offenses.

In late March, 21 states asked for the lifting of federal restrictions on sending mifepristone through the mail, saying it limits a woman’s use of telemedicine and forces women to “travel unnecessarily” despite stay-at-home orders.

To get around some of the US red tape, the websites offering abortion pills are operated from abroad.

Aid Access, which offers the least expensive abortion pills at $90 a dose, is the only one that has a medical supervisor, Dutch physician and activist Rebecca Gomperts.

For the past year, Gomperts has been locked in a battle with the US Food and Drug Administration, which demanded that she stop providing abortion services via telemedicine.

The pandemic has defeated her for the moment: she cannot get the pills she needs from India, which closed all of its airports.

Another online provider, which gets its supplies from Russia, told AFP that it expects to be out of stock for several weeks.

The only service that is authorized to send the pills—in 13 US states—is TelAbortion, which has been up and running since 2016, working with about 700 women.

In March and April, the number of women contacting TelAbortion doubled, as compared with the two previous months.