A study into women who seek abortion pills online in the face of strict laws against terminations has found that almost 95% safely ended their pregnancy without surgical intervention.
Experts say the study underscores the safety of medical abortion, and highlights that women who go on to experience symptoms of possible complications do follow advice to seek medical help at clinics or hospitals.
“This is abortion entirely outside the formal healthcare setting: it is an online telemedicine model, but this research shows that it can be both safe and highly effective,” said Abigail Aiken, assistant professor of public affairs at the University of Texas at Austin.
Worldwide about 43,000 women die each year as a result of not having access to safe and legal abortions.
Abortion in Ireland is currently legal only if a termination saves a woman’s life. In Northern Ireland abortion is also allowed if there is a permanent or serious risk to the woman’s mental or physical health.
However, the 1861 Offences Against the Person Act means that women can face life imprisonment for administering a drug to induce miscarriage, as the 1967 Abortion Act was not adopted in Northern Ireland.
Writing in the British Medical Journal, Aiken and an international team of researchers reveal how they probed the outcomes for women in Ireland and Northern Ireland who had sought the abortion drugs mifepristone and misoprostol through Women on Web – a digital community that provides medical consultations, abortion drugs and online support.
Of the 1,636 women who were sent the drugs between the start of 2010 and the end of 2012, the team were able to analyse self-reported data from 1,000 individuals who confirmed taking the pills. All were less than 10 weeks pregnant.
The results reveal that almost 95% of the women successfully ended their pregnancy without the need for surgical intervention. None of the women died, although seven women required a blood transfusion and 26 needed antibiotics.
Of the 93 women who experienced symptoms for which the advice was to seek medical attention, 95% did so, going to a hospital or clinic.
“When we talk about self-sought, self-induced abortion, people think about coat hangers or they think about tables in back alleys,” said Aiken. “But I think this research really shows that in 2017 self-sourced abortion is a network of people helping and supporting each other through what’s really a safe and effective process in the comfort of their own homes, and I think is a huge step forward in public health.”
But while Aiken said that previous research found that women in Ireland and Northern Ireland have welcomed being able to buy abortion pills online, she pointed out that the approach was far from the ideal solution for women wishing to end their pregnancy.
“I think that even though it is a positive thing for public health, it is not a positive thing for women’s lives because they still have to feel like criminals,” she said.
Aiken added that the study had limitations, not least that it relied – albeit through necessity – on self-reported information, and did not have data for more than 450 women who were sent the abortion medication but made no further contact with Women on Web.
Richy Thompson, director of public affairs and policy at the British Humanist Association, welcomed the study, but said covert online access to abortion pills wasn’t enough.
“That still doesn’t help women who have to access an abortion later on and so cannot use pills, and those women currently have to go to Britain in order to have an abortion and are charged up to £900 by the NHS,” he added. “Also, it does not remove from those women the risk of prosecution for having obtained abortion pills.”
Indeed, one ongoing case is that of a woman from Northern Ireland who was prosecuted for obtaining abortion pills for her daughter after a GP reported her to the police.
“Hopefully this research will only reinforce the need to end the legal injustice that women, while perhaps being able to access safe abortion pills in practice, nonetheless can face prosecution for doing so,” said Thompson.
Mara Clarke, founder of the Abortion Support Network, which helps women from Ireland, Northern Ireland and the Isle of Man travel to the UK for terminations, agreed. “More and more people contacting us are expressing fear of criminal prosecution,” she said, adding that women should beware of online scammers when searching for abortion pills.
While Clarke welcomed further evidence of the safety of the two drugs, she stressed that organisations such Women on Web and the Abortion Support Network are only a plaster on the problem facing women.
“Anything that helps women have terminations safely and encourages them to have terminations safely is ace in my book, but my end goal is for the abortion support network to be put out of business by law reform,” she said.