Medication abortions are a safe way to end pregnancy up to 12 weeks, according to the World Health Organization. In the traditional healthcare model, pregnancy is confirmed through urine, blood, or ultrasound tests before patients receive two medications to induce a miscarriage: mifepristone, which blocks the body from producing the hormone progesterone, and misoprostol right away or 48 hours later. The second medication causes cramping and bleeding to empty pregnancy tissue from the uterus.
According to the Guttmacher Institute, 19 states currently mandate that medical providers be physically present during the administration of abortion medication, which effectively makes telemedicine abortions unavailable in those places. The thing is, though, completing an abortion at home, otherwise known as a “self-managed abortion,” can be safe and effective.
A study published February 18, 2021, in BJOG: An International Journal of Obstetrics & Gynaecology found as much, measuring similarly high rates of effectiveness (98.2 percent versus 98.8 percent) between the outcome of medically induced abortions in patients who received an ultrasound and their first dose of medication in a clinic, versus those who received their care via telemedicine without confirmation of pregnancy. In addition, there were no reported changes in the number of serious adverse effects, which remained extremely low in both cases.
As access to clinical abortion care becomes harder to navigate, women are increasingly turning to the internet to get their abortion pills via telehealth providers or with the help of nonprofits such as Aid Access, which operates outside the formal U.S. healthcare system.
The steps for pursuing a self-managed abortion are as follows.
Steps for Buying Abortion Pills Online
- Confirm your pregnancy.
- Get online using a private connection.
- Visit a trustworthy abortion access website like Plan C or INeedanA.
- Optional but highly recommended: Complete a consultation to confirm eligibility for medication abortion.
- Determine costs and order from a vetted pharmacy.
- Wait 4 to 14 days for medication delivery.
Here is an in-depth guide to each step for buying safe and effective abortion pills online.
Step 1: Confirm You’re Pregnant
If you suspect you’re pregnant, get confirmation by taking an at-home pregnancy test or getting an ultrasound. The value of an ultrasound is that it can help rule out a rare but life-threatening complication called ectopic pregnancy, in which a fertilized egg implants itself outside the uterus.
Just 1 to 2 percent of pregnancies in the United States are ectopic, and a self-managed abortion is otherwise dependable. A study published in the August 2021 Obstetrics and Gynecology found that 95 percent of patients who had a self-managed abortion with telehealth consultation had a “complete abortion without intervention.”
Step 2: Get Online Using a Private Connection
If you live in a state where abortion is currently criminalized (or you simply want to keep your online activity private), it’s best to open a private window, use the privacy-protective search engine DuckDuckGo, or use the Tor web browser, which doesn’t save your search history. This enables anonymous activity on the internet that can’t be traced back to you. According to the Electronic Frontier Foundation, a nonprofit that defends freedom of speech and digital privacy, safe access to abortion information online is in jeopardy following the Supreme Court’s decision to overturn Roe v. Wade.
Securing your online activity is recommended, because your digital footprint could possibly become criminal evidence against you.
Step 3: Consult a Trustworthy Abortion Access Organization
Plan C is a nonprofit site that provides state-by-state information on how people in the United States can access abortion pills. There is also the site INeedanA, which hosts a localized directory for people seeking abortion care. Planned Parenthood, too, is a reliable source of reproductive health information, including on abortion pills and abortion access.
Providing reproductive justice information online is essential for people who may not be able to access this information elsewhere. “[Abortion pills] are a modern medical technology that can be safely provided via telemedicine,” says Elisa Wells, MPH, the cofounder and codirector of Plan C Pills.
“It should be made available to anybody who needs it and qualifies for it medically. It should be available in all 50 states,” she says. Unfortunately, “laws in certain states are not only restricting access to telemedicine abortion but also to abortion care in general. And there’s no reason from a medical perspective why this should be happening.”
Step 4 (Optional): Confirm You’re Eligible for the Abortion Pill via Consultation
Although it’s possible to skip this step and just order abortion pills directly from overseas pharmacies, going through a provider or organization that offers consultation can help you make more informed decisions.
After reading through a reputable online directory like Plan C, you will be advised if you are permitted to receive abortion pills by mail in your state. Answering questions about your medical history is generally all that is required. The very first question is how long it’s been since your last menstrual cycle, since abortion pills are recommended only up to 12 weeks of pregnancy.
In eligible states, a virtual consultation or simply a questionnaire may be all you need to do. If you’re going through a telehealth provider, clinicians are also available for support or follow-up questions so you can safely have an abortion “from the comfort of your own home,” says Wells.
RELATED: People Are Flocking to a Hotline With Their Miscarriage and Abortion Questions
If you live in a restrictive state, it may be possible to have a telehealth appointment in a neighboring state that does allow telehealth abortions. You would then set up a virtual mailbox in the adjacent state to receive your medication. These mailboxes cost about $50, and require sending a copy of your picture ID and another form of identification. The medications can then be sent by your telehealth provider to the virtual mailbox, and then forwarded to your home address.
It’s also possible to have abortion pills shipped to you through overseas organizations like Aid Access, which Plan C features on its site. You’ll have to complete a similar questionnaire to purchase medication this way.
Additional questions about your medical history may include:
- Do you have regular menstrual cycles?
- Have you ever had an ectopic or tubal pregnancy?
- Have you had sharp pains in the lower stomach in the last seven days?
- Have you had any vaginal bleeding or spotting in the last seven days?
- Do you have an IUD in place?
- What surgeries have you had?
- Do you have any bleeding disorders?
- Are you allergic to any medications?
- Do you currently take blood thinners or steroids?
Try to answer these questions as truthfully as possible to ensure an uncomplicated medication abortion without complications.
Step 5: Determine Abortion Pill Cost and Order From a Vetted Pharmacy
The cost of your abortion pills will vary according to the provider. While some telehealth providers accept insurance, if you live in a state where telehealth abortion or all abortion is restricted, you will have to pay out of pocket, with costs starting around $200.
Many providers and online pharmacies accept major credit cards, Venmo, or PayPal. (It’s important to note that these methods of payment are not anonymous, and some reproductive rights activists are making a case for other methods like the cryptocurrencies Monero or Zcash, which may provide an added layer of protection.)
If you cannot pay, some state providers offer financial assistance, as do organizations like Reprocare. In states where telehealth abortion is unavailable, Aid Access can provide financial aid.
If none of these options work for you, it’s still possible to get abortion pills by using online pharmacies outside the United States. For example, Plan C’s independent laboratory vets medications that can be picked up in person (for example, some Mexican pharmacies will ship to the Texas-Mexico border), delivered directly to your home from pharmacies in India, or obtained via a mail-forwarding service.
Step 6: Wait 4 to 14 Days for Abortion Pill Delivery
Expect to wait anywhere from 4 to 14 days for pills to be delivered to you. While some pharmacies and telehealth providers offer overnight or express shipping options, those who must wait for their medication to come from an international pharmacy should expect additional delays while packages clear customs. In addition, some telehealth providers may take several days to review intake forms or have availability for an appointment.
Providing patients with the option to receive abortion pills via telehealth is a new patient-centered mode of care that is convenient and safe. “Over the last two decades that abortion pills have been available in the United States, they have been overmedicalized and overregulated,” says Wells. “And many people love this form of access. It’s not the only form of access we need … but it is a modern and convenient way to access these pills.”
What Is Advanced Provision of Abortion Pills?
Some abortion rights activists also encourage “advance provision,” acquiring abortion medication for future use. Because access to abortion is at risk in many states and these medicines remain effective for up to two years, buying pills just in case, to have on hand if needed, can eliminate wait times and reduce stress. The activist, writer, and abortion doula Steph Black bought advance provision abortion pills online so she could offer advice to other women.
She says she went through the process on two separate occasions, once through a telehealth provider and another time through Aid Access. She found it to be relatively simple, although “there are parts of the website where it’s sort of hard to know which button to press,” she said. “You have to just read things carefully,” she added. “It’s very straightforward.”
Legal Risks of Using the Abortion Pill
It’s important to note that there could be legal consequences for self-managed abortion if the procedure is illegal in your state, according to Plan C. Between 2000 and 2020, more than 100,000 people in the United States completed an abortion in their own home. In that same time frame, about 60 people were prosecuted for carrying out or assisting in a self-managed abortion.
While states may not outright ban abortion medications — drug approvals are overseen by the U.S. Food and Drug Administration — state laws making abortion illegal could still put a person at small risk, which underscores the importance of using privacy-protecting strategies when getting online for information.