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Online Access to Misoprostol for Self-Managed Abortion in Indonesia

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Online Access to Misoprostol for Self-Managed Abortion in Indonesia FACT SHEET Online Access to Misoprostol for Self-Managed Abortion in Indonesia Misoprostol, when used correctly, • The ability to purchase misopros- the gestational age provided by is a safe and effective method for tol for self-managed abortion from the buyer. inducing abortions, including those drug stores and websites with- that are self-managed. In Indonesia, out a prescription has led to law Outcomes of purchasing abortion the drug is typically obtained through enforcement efforts to shut down drugs online informal online vendors and it is illegal sales. As a result, most sales • The study’s buyers paid for 76 not possible for prospective buyers have moved to a fluid online mar- packets of abortion drugs but to assess the type and quantity of ketplace for abortion drugs. received only 64. drugs, nor the quality of information provided by a seller, until after a Availability of abortion • The average cost of each drug purchase is made. This fact sheet medications online packet was about 903,000 presents findings from a 2019 study • Buying misoprostol online through Indonesian rupiah (US$65). This conducted in Jakarta, Indonesia’s an informal vendor can be a dis- amount is roughly equal to one capital and largest city, on the creet and accessible way to obtain month’s income at minimum wage experience of purchasing abortion the medication. However, this in many rural and suburban dis- drugs, primarily misoprostol, online. option is not without risk; prices tricts in Indonesia. Data on information given by sellers are inflated, and potential buyers • Of the packets that arrived, 73% and drugs received were collected by have no means of verifying a sell- contained misoprostol. Almost trained buyers seeking drugs from 132 er’s legitimacy, trustworthiness or two-thirds (64%) of the packets online vendors. medical expertise. containing misoprostol had the Abortion access in Indonesia • Online sellers typically advertise correct dose. The minimum amount “packets” of drugs, rather than of the drug recommended by the • In Indonesia, abortion is legal only misoprostol alone. The advertised World Health Organization (WHO) in cases of rape (up to six weeks’ contents and prices for these to induce an abortion at six weeks’ gestation), in cases of severe fetal packets often vary according to gestation is 800 mcg. anomaly and in medical emergen- cies where the pregnancy poses a threat to the woman’s health and life. More than 80% of online drug sellers in Indonesia did not include complete information on the four expected physical effects* • Many women in Indonesia seek of abortion medication sent to a buyer abortion outside these legal parameters. In 2018, 1.7 million 13% abortions took place in the six all four eects 21% provinces of Java, Indonesia’s most no eects populous island. This figure corre- sponds to a rate of 43 abortions % of drug sellers per 1,000 women of reproductive 28% and age (15–49). three physical information eects oered • Misoprostol, often sold in Indonesia 26% under the brand name Cytotec one physical eect or Gastrul, can safely induce an abortion 75–90% of the time. In Indonesia, misoprostol is registered 13% two physical eects All four solely to treat gastric ulcers and can only be purchased legally with *Bleeding, cramping, nausea and diarrhea. Note: Percentages may not add to 100 because of rounding. a prescription. Three Two One Zero % of drug sellers • In the majority (87%) of packages Recommendations Source that contained misoprostol, the The information in this fact sheet can be found Buying from online vendors will likely in Moore A et al., Online abortion drug sales in medication arrived in proper pack- Indonesia: a quality of care assessment, Studies in continue to be a popular source aging, i.e., a sealed aluminum blis- Family Planning, 2020, 51(4):295–308, doi:10.1111/ for misoprostol in Indonesia—both sifp.12138. ter pack with no signs of damage because of the anonymity it affords or tampering. in a setting where abortion is legally Acknowledgments This fact sheet was made possible by UK Aid from • The majority of packets (92%) restricted and highly stigmatized, the UK Government and support from the Dutch contained at least three different and because the COVID-19 pandemic Ministry of Foreign Affairs. The views expressed do not necessarily reflect the positions and types of pills (e.g., pain medication, has driven people to seek online policies of the donors. herbal supplements and vitamins). alternatives for a variety of health Sixty-four percent of packets con- services. However, the study findings tained at least one type of pill that point to a high degree of uncertainty was not identifiable. in the reliability and quality of care from online abortion drug sellers. Instructions received from • Women’s rights groups and health drug sellers advocates should disseminate • The accuracy and completeness information widely on the correct of information provided to buyers usage of misoprostol for abortion varied widely. to help ensure users’ safety. • Twenty-one percent of sellers did • High-quality postabortion care not provide information about should be made widely available any of the four expected physi- to ensure that any complications cal effects of taking misoprostol resulting from incorrect misopros- (bleeding, cramping, nausea and tol use are treated promptly and diarrhea). Sixty-six percent men- correctly. tioned 1–3 of these effects, and • The Indonesian government fam- only 13% mentioned all four. ily planning program should help • None of the sellers mentioned the to reduce the need for abortion possibility of postabortion com- by better enabling people to pre- plications or what steps to take in vent unintended pregnancies. case of complications. Unintended pregnancy can be reduced by a number of interven- • According to WHO, misoprostol tions, including ensuring availability should be dissolved under the of a range of contraceptive meth- tongue or against the cheek, or ods and appropriate counseling on inserted into the vagina. Among Reconstra their use, and by offering compre- the sellers whose packages con- hensive sexuality education. http://reconstra.com/ tained misoprostol, 72% provided accurate information on how to • Safe abortion care should be avail- Menara Kadin, Regus administer the medication. able to the full extent of the law. Special Capital Region of Jakarta 12950 +62 21 529 00828 • Out of all drugs received, only [email protected] 21% contained at least the mini- mum dosage of misoprostol in the recommended packaging, along with instructions on optimal administration. Good reproductive health policy starts with credible research guttmacher.org 125 Maiden Lane New York, NY 10038 212.248.1111 [email protected] February 2021.
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