Fact Sheet: Online Sales of Mifeprex and Misoprostol for Self-Abortion

To view as PDF, see Fact Sheet: Online Sales of Mifeprex and Misoprostol for Self-Abortion

In March 2018, CLI reviewed sites on the worldwide web that offer the two-component abortion pill regimen, either as their business focus or as part of a larger online pharmacy. We found:

• At least 72 unique websites that sell either just Misoprostol (10) or both Misoprostol and Mifepristone (62) in MTP (medical termination of pregnancy) kits.
• The reviewed websites fall into two categories: abortion-pill focused websites (many of which also market a few other categories of products, such as “birth control” and/or “men’s health”) and online pharmacy websites that sell abortion pills among a wide range of other drugs. In total, CLI found 30 abortion-pill focused websites and 42 online pharmacy websites that sell the abortion pill.

When reviewing the first category of websites, CLI looked for the following information: mention of Food and Drug Administration (FDA) approval, limits on gestational age at which the regimen can be used, side effects listed, precautions listed, whether medical information is required of the purchaser, and prices. When reviewing the second category of websites, CLI looked for mention of FDA approval, limits on gestational age at which the regimen can be used, and prices.

FDA mentions

• Thirteen out of 30 abortion-pill-focused websites mention FDA approval (43%)
• Fifteen out of 42 online pharmacy websites mention FDA approval (36%)
• A total of 39% of the 72 websites mention the FDA

Of the websites that do not mention the FDA, at least three mention the World Health Organization. Additionally, one of the websites, telabortion.org, exists for an FDA-reviewed clinical study being conducted in Hawaii, Maine, Oregon, and Washington. Another website is for a pharmacy registered by the Medicines and Healthcare Products Regulatory Agency (MHRA) in the United Kingdom.

Gestational limits at which the regimen can be used (FDA approval for use of Mifeprex as an abortion regimen was extended to 10 weeks’ gestation in March 2016)[1]

• Seven weeks (8 websites)
• Nine weeks (25 websites)
• Ten weeks (11 websites)
• Twelve weeks (7 websites)
• Thirteen weeks (“up to 90 days,” 1 website)
• No gestational limit cited (20 websites)

Many of the 20 websites that do not cite any gestational limit sell Cytotec (Misoprostol) as a treatment for stomach ulcers without mentioning pregnancy or abortion. No protections against the off-label use of the drug exist, however, as there is either little or no medical oversight.

Side effects/precautions

With regard to side effects and precautions, every website (except for a few requiring doctor consultation/prescription) lists at least some. Some variation of the following list is typically displayed:

• (Heavy) bleeding
• Cramping
• Fatigue
• Headache
• Back/abdominal pain
• Vomiting
• Nausea
• Fever

There is little consistency from website to website as to what is listed. Some websites (approximately half) tell women to have access to a doctor in case they need it.

For precautions, there is also little consistency among the websites. Typically, a variation of the following list appears:

• Don’t drink alcohol or smoke
• Remove IUDs before using the drugs
• Don’t take in cases of ectopic pregnancy
• Don’t take if you have liver/kidney/heart disorders
• Don’t take if allergic to Mifepristone and Misoprostol
• Don’t breastfeed while using drugs

False and confusing language

Many websites use false, misleading, confusing, or awkward language to describe medical abortion. Below is a small sample:

• One website mentions a “pain-free” abortion but further down lists a number of clearly painful side effects
• One website says the drugs are “100% working”
• One website says it is “completely safe, effective, pain-free and infection-free”
• Daynighthealthcare247.com advertises a “harmless and successful” “early stage pregnancy execution”

Medical information required

Of the abortion-pill focused sites, only nine of the 30 ask for at least some medical information.

• Two claim to require prescriptions
• Two require an online consultation with a doctor
• Five have medical questionnaires, although for three of the five, the purchaser may simply leave the default answers in place to proceed with a purchase

Prices

The average prices on the abortion-pill-focused websites for MTP kits are as follows:

• One kit for $167
• Of the websites that sell 2 kits as a bundle, the average is $289
• Of the websites that sell 3 kits as a bundle, the average is $396
• Of the websites that sell 4 kits as a bundle, the average is $488
• Of the websites that sell 5 kits as a bundle, the average is $537

Additionally, at least one website sells up to nine kits in a bundle for $600.

On the online pharmacy websites, the averages are almost consistently $50 less than these.

Compared to pricing at Planned Parenthood centers in and around the Washington, D.C. area, the abortion-pill-focused websites sell MTP kits for a much lower price. Three Planned Parenthood locations list medication abortion at $475 and one lists it at $375, a difference of about $200-300.

♦

CLI’s review of 72 websites selling chemical abortion kits directly to consumers reveals a significant problem with medical standards oversight, potentially placing the health of many women at risk. Most of the abortion-focused websites do not require any medical background or prescription from the buyer and some sites do not note any limitation based on the gestational stage of pregnancy. That one person can buy 3, 4, 5, and, in some cases, even 9 abortion kits in one purchase – some hundreds of dollars less than those sold at an abortion center – raises major concerns about the possibility of stockpiling the abortion drugs and the reasons one might do so. With as many as 39 percent of these websites claiming to sell FDA-approved abortion drugs, the largely unregulated, easy-access availability of abortion pills on these websites is a situation warranting urgent attention beyond a statement of caution from the FDA.[2]

[1]https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm111323.htm

[2]https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm111323.htm