Online Abortion Drug Sales in Indonesia: A Quality of Care Assessment

Abstract

This study sought to understand the experience of buying misoprostol online for pregnancy termination in Indonesia. We conducted a mystery client study August through October, . Interactions were analyzed quantitatively and qualitatively, along with the contents of the packages. One hundred ten sellers were contacted, from whom mystery clients made  purchases and received  drug packages. Almost all sellers sold "packets" containing multiple drugs;  percent of packets contained misoprostol, and  percent contained at least  mcg of misoprostol. Thirty-four packets contained insufficient drugs to complete an abortion. When compared to WHO standards,  percent of sellers imparted incomplete information about potential physical effects; no seller provided information about possible complications. Women buying misoprostol from informal online drugs sellers will be underprepared for understanding potential side effects and complications. Educational activities are needed to increase women's access to information about safe use of misoprostol as a harm reduction strategy. BACKGROUND Abortion is permitted in Indonesia only in medical emergencies where the pregnancy poses a threat to the woman's health and life, in cases of fetal impairment, or rape only up to 40 days gestation (Republic of Indonesia 2009). Nevertheless, every year millions of women in Indonesia seek an abortion, all of which occur outside of the formal healthcare system. A study in 2018 in Java, where close to 60 percent of Indonesia's population of 268 million people

Attempts to purchase misoprostol online in Indonesia: a mystery client study design

“…On the other hand, the clandestine nature of the service provision coupled with the fluidity of the online market creates new challenges for women seeking abortion. As evidence from the study based on this protocol suggests, challenges for women seeking misoprostol from online sources include not receiving drug already paid for, receiving incorrect drugs, and difficulty obtaining information on the drugs provided [ 7 ]. Of the 76 purchases made, 64 drug packages were received, 73% contained misoprostol, and 47% contained at least 800 mcg of misoprostol [ 7 ].…”

“…As evidence from the study based on this protocol suggests, challenges for women seeking misoprostol from online sources include not receiving drug already paid for, receiving incorrect drugs, and difficulty obtaining information on the drugs provided [7]. Of the 76 purchases made, 64 drug packages were received, 73% contained misoprostol, and 47% contained at least 800 mcg of misoprostol [7]. Future work in this area would benefit from testing the medications that the drug sellers sent to increase certainty about the active ingredients in unmarked/expired pills.…”

“… *Other reasons include: too expensive, seller required a prescription, seller made mystery client feel unsafe, seller requested an in-person meeting for cash payment [7] Source : From Ref [ 7 ], reproduced with permission from John Wiley & Sons …”

“…In all, we received drugs from 64 sellers in our sample. We describe the drugs received and information given by sellers in a separate paper [ 7 ].…”

Role of misoprostol 4 hourly versus 6 hourly in medical termination of pregnancy in 2nd trimester.

“…According to a study rate of abortion via vaginal route is 90% as compared to oral route 69%. 9 Few studies also recommend its use via sublingual route, with maximum efficacy. 10 Misoprostol is stable at room temperature and is effective with or without mifepristone.…”