"ONE PROBLEM BECAME ANOTHER": A MIXED-METHODS STUDY OF IDENTIFICATION OF AND CARE FOR PATIENTS SEEKING ABORTION AFTER SEXUAL ASSAULT

Objectives: Almost 90% of United States counties lack an abortion provider. Given federal and state restrictions on abortion funding, many women lack true access to abortion. Some turn to online sources to obtain and self-administer abortion medications. This study explores online availability of medical abortion. Methods: Google was used to search for “mifepristone, ”“ misoprostol” and “medical abortion.” The top 100 hits and relevant sites reached from the hits were condensed into 90 unique sites. We evaluated each site for availability and cost of mifepristone and misoprostol as well as medical advice and gestational age recommendations for use. Results: Thirty-six of the 90 sites advertised or sold pharmaceuticals; 16 sold misoprostol, 3 sold mifepristone, and 3 sold kits containing both, costing $45–$60. The rest advertised pharmaceuticals but did not sell mifepristone or misoprostol. Twenty-two of the 36 sites advertising pharmaceuticals warned against using misoprostol during pregnancy. Five recommended gestational age limits for medical abortion: less than 9 weeks for three sites and during the first trimester for the others. Six sites gave appropriate warnings regarding bleeding, infection or failure. One Web site featured a “pharmacist” touting the products as “100% safe and effective” while warning that the medications are “not safe for use at home.” Conclusions: Deterrents such as waiting periods, funding restrictions and lack of nearby providers represent prohibitive barriers to abortion. As a result, some women seek abortion outside of clinical settings, even in the United States. Our research shows that medication abortion is available online but accompanied by advice of varying quality.