It was believed that the drugs, which have been shown to be highly effective and safe, would dramatically increase women’s access to abortion. But the excitement was premature. The approval of the pills came with tight restrictions on how they can be distributed – only in clinics, medical offices and hospitals, and only by or under the supervision of a doctor certified to prescribe them, and only to patients who have signed an FDA-approved patient agreement. Those restrictions, the FDA says, are to ensure the safe use of mifepristone.
After the FDA restrictions came state restrictions. In Arkansas, for example, a law was implemented in 2015 requiring providers to counsel patients that medical abortion may be reversed if a woman is given a high dose of progesterone after taking the pills. (There’s no science to back this claim.)
As restrictions on abortion increase, it’s no surprise that women are trying to find their own answers. In fact, Google data shows a surge in searches for the topic of self-induced abortion in the US in 2011 – the same year that marked a steep increase in anti-abortion legislation on a state level.
Increasingly, women are turning to the internet to procure the pills, like they are in many other parts of the world where abortion is illegal or highly restricted.
“How can it be that in a country like Ethiopia, which has poor health infrastructure, you can buy the pills for $5 and just use them?” says Elisa Wells, who in 2014, along with two colleagues, began the Plan C campaign, a website dedicated to giving American women reliable information about medical abortion. “The idea that women have better access to abortion there than women in the US is crazy,” she says.
Wells believes the online revolution could “upend” the system and break down barriers for women. “No longer do you have to find a clinic near you, which is disruptive to your normal life, or far away… you could just get it online and do it from the convenience of your home. You no longer have to walk through the gauntlet of protestors, who are so stigmatising – there’s no need for women to be subjected to that.”
Donna Harrison, from the American Association of Pro-Life Obstetricians and Gynaecologists, is firmly against women obtaining abortion pills online – or at all. She says it’s far more dangerous than surgical abortion, despite studies showing that both procedures, if done correctly, are incredibly safe.
For women looking to procure the pills online, the main concerns – aside for deciphering which websites are fakes – are legal. “We have seen in recent years women who’ve been arrested and sometimes convicted for seeking abortions outside the legal system,” says Elizabeth Nash from the Guttmacher Institute.
“We have to ensure that women can do this safely without the threat of legal prosecution. Ultimately what would be wonderful is if women could access healthcare when they need and not have to use a clandestine process.”
Two years after FDA approval in the US, India followed suit, allowing registered medical practitioners to provide medical abortion at up to seven weeks, in accredited facilities. In 2003 it extended the law to allow these providers to prescribe the drugs in other settings, meaning that women could get the pills over the counter with a prescription. The idea was to deter women from seeking unsafe abortions and ultimately reduce the harm and deaths that these can cause.
But again, the law may say one thing but it plays out differently on the ground. Research shows that over 70 per cent of sales of these drugs take place without prescription, and pharmacists often fail to explain to women how to take the pills or offer traditional medicine instead.
“Traditional or alternative drugs… often lead to complications or incomplete abortion. Often the clients are so poor that they can’t afford the combination of drugs and they don’t want to go to the hospital even if it’s free,” says Rajib Acharya, statistician and demographer at the Population Council in India, a research organisation focused on health issues.
And there remain other major barriers to the uptake of medical abortion, including cost, ignorance and stigma.
At the end of the day many women, Muttreja believes, will still seek out the quack down the road because they fear being seen at the pharmacy. “Do women actually have the courage to go to a pharmacy which is always [run by] a man and ask them to give her medical abortion tablets?” she asks.
Despite their vast physical distance apart and differences in language, culture and so much more, women like Sanathoi and Renee are both part of the story of the monumental challenges women face today: how to manage their bodies in a world where their sexual and reproductive health and rights are increasingly under attack.
Back in New Delhi, Vidya’s mother is slouched by her bed on a stool, sweat dripping down her forehead. Intermittent power cuts temporarily stop the rotting fans and make the already unbearable heat even worse.
“She has brought great shame on the family,” she says, shaking her head as the nurse stands by. Vidya has heard it all before; she doesn’t contradict her mother. In fact, she barely flinches. “Yes, I plan for marriage at the end of the year,” Vidya says, staring into the distance. Silently, she is wheeled off for the procedure.
*Some names have been changed.