On May 12, 2016, there was news at 07:36 AM in Nakhon Ratchasima about a baby found placed in a cloth bag left at the bus stop pavilion in front of the Michelin Center. It was a female infant wrapped up, with the umbilical cord still attached. The baby was crying well, strong, and was sent to Maharaj Hospital. Police investigated the scene and proceeded according to the law.
Such incidents occur repeatedly, reflecting that women facing unwanted pregnancies are unaware of service centers, hospitals, and clinics that provide counseling on options and pregnancy termination. This results in pregnancies progressing too far to terminate, leading to continued pregnancies and child abandonment. Meanwhile, there are very few doctors providing abortion services because it is a topic that society and most agencies tend to oppose.
Access to services for women is extremely difficult to meet doctors and nurses with up-to-date academic knowledge, safe medical abortion technology, and compliance with Article 305 and the Medical Council’s regulations. They must also be trained in providing counseling on options and pregnancy termination and be willing to serve women with unplanned pregnancies. Many women, therefore, have to search for abortion information on the internet.
Uncle Doctor listened to stories from these women about their experiences contacting to buy abortion pills from the internet, and their thoughts, feelings, and concerns. Let’s read.
A 20-year-old woman, assumed name “Tip,” is studying for a bachelor’s degree. Her boyfriend is 3 years younger and still studying as well. They used emergency contraceptive pills, monthly contraceptive pills, and condoms irregularly, about 80%, which led to her pregnancy. Her last period started on March 30, 2016. She took a urine test on May 5 and thought she was not ready to have a child because her boyfriend was still young and probably couldn’t raise a child, but her boyfriend wanted her to continue the pregnancy. Her close friend advised her to keep the child, fearing it would be sinful, but “Tip” decided to terminate the pregnancy and searched for “abortion” information on Google. She found the website “Sukhumvit12.com” with a contact number. She found that there were vaginal insertion abortion pills available for order, so she called on May 9.
Tip: “I want to buy insertion pills.”
Website: “How old are you?”
Tip: “I’m 20 years old.”
Website: “Then prepare to note the bank account number to transfer 3,260 baht.”
Tip: “What type of pills do I need?”
Website: “When was the first day of your last period?”
Tip: “The first day was March 30, 2016.”
Website: “You need to take 1 oral pill and use 4 insertion pills. After transferring the money, send an SMS to this number and provide your name and address so we can send the pills via EMS. You should receive them in about 3 days.
The phone conversation was brief and simple, without advising to check the pregnancy age, explaining the details of the pills, how to use them, the effects, when the abortion would occur, or post-abortion care. But Tip didn’t have time to think it over, quickly transferred the money, and waited until May 13, but still hadn’t received the pills. She and her friend called but got no answer. On May 14, the pills arrived, and Tip read the instructions, trying to understand how to use them herself. She didn’t quite understand the usage, wasn’t confident in their reliability, safety, or effectiveness. If the abortion didn’t occur or there were side effects or incomplete abortion, infection, would the website provide help, advice, or take responsibility? She thought about it and didn’t dare to use them. Her friend then advised her to see a doctor for help with the unplanned pregnancy. An ultrasound revealed an intrauterine pregnancy, not ectopic, at 6 weeks, and she was safe.
The website Tip contacted to buy abortion pills claimed to be from the “Population and Community Development Association,” but the correct website for the association is www.pda.or.th, and they do not sell abortion pills via mail because they cannot ensure quality and safety. Tip said the package indicated the sender’s address was in Nakhon Ratchasima.
Case 2
A 24-year-old woman with a 2-year-old child found her husband involved with another woman he met on Facebook. When she confronted him and asked him to choose, he chose the other woman and left, becoming unreachable. Her husband showed no interest in their child. She couldn’t remember the first day of her last period but noticed a missed period and a urine test confirmed pregnancy. She was using monthly contraceptive pills but sometimes forgot to take them. She was very stressed and consulted her mother, who said she couldn’t continue the pregnancy. She searched for abortion sources online and found a website offering pills by phone order and mail delivery, named “ClinicSWT.com,” claiming to be from the Family Planning Association of Thailand. The correct website is www.ppat.or.th, and they do not sell abortion pills by mail. When she called the website, the seller asked how many months pregnant she was and stated the price was 3,260 baht, including shipping. She was about to transfer the money, but a friend advised her to see a doctor instead. An ultrasound revealed a 7-week, 4-day pregnancy.
Another person ordered pills from “ClinicSWT.com,” received them but didn’t dare to use them. The package indicated it was sent from Chiang Mai. Both websites selling pills advised on the number of pills for 1-7 months of pregnancy, which is dangerous to let patients use and care for themselves because…
According to the World Health Organization’s guidelines on using abortion pills, patients must be closely monitored for safety in 3 stages.
- Pre-abortion stage: Patients will be asked about their menstrual history, medical conditions, drug allergies, other medications, physical examination, and pregnancy age with ultrasound to confirm intrauterine pregnancy, not ectopic. They will receive comprehensive counseling to understand and decide whether to have an abortion, choose a method, understand each method’s process, risks, safety, and success rate, and determine the safe gestational age for the procedure. They will also be informed about outpatient or inpatient procedures, contraindications, existing conditions like heart disease, anemia, current medications, uterine surgery history, and ectopic pregnancy.
- Abortion stage: Pills can be used safely up to 9 weeks or 63 days of pregnancy but must be under supervision. Patients must consult doctors about usage, side effects, and if unsuccessful, doctors must resolve it with suction within 1 week. For pregnancies over 12 weeks up to 24 weeks (beyond this, 6-7 months, abortion is not recommended due to maternal and fetal risks), hospitalization is required to prevent severe bleeding, retained placenta, severe infection, uterine rupture. Safe and effective dosages follow WHO-researched and recommended protocols, with different dosages for different gestational ages. The websites did not provide such guidance, raising concerns about drug efficacy, increasing the chance of incomplete abortion, retained placenta, and excessive bleeding requiring curettage due to using pills at advanced gestational ages.
A 2011 study on “Misoprostol Quality” by Peter E. Hall, a senior advisor at Concept Foundation, recommended rigorous quality checks before purchasing and selling “Misoprostol” abortion pills, known commercially as Cytotec or other names, produced by various factories and sold in Asia and Latin America. Many pills failed quality checks, with 4 out of 10 samples analyzed (214 samples) containing less than 90% Misoprostol. 50 samples were in substandard packaging, and after 1 year, they did not meet specifications. Even pills in recommended packaging showed 28% degradation. 14 samples contained no Misoprostol (empty pills), and 3 were defective (produced below quality but still sold in pharmacies, ineffective). Only 1 in 48 products passed quality checks with Misoprostol below standard. This data indicates that pills patients use may not be fully effective, risking incomplete abortion if quality is not confirmed. - Post-abortion stage: Patients must be monitored for complete abortion. If incomplete, suction may be necessary. Monitor bleeding duration; typically, pills used for pregnancies up to 9 weeks cause longer bleeding than suction (suction at 9 weeks), usually not exceeding 14 days. Check for abdominal pain, fever indicating pelvic infection, requiring diagnosis and treatment. Though less common than suction, caution is needed as severe infections leading to shock have been reported in the US (4 cases) and Canada (1 case). All patients using pills must confirm abortion completion and no retention through internal examination or ultrasound. If severe abdominal pain persists, check for ectopic pregnancy. Some cases involve both intrauterine and ectopic pregnancies. Women buying pills online without knowing they have ectopic pregnancies risk death. If pills fail, the fetus may have birth defects like sirenomelia. One case used Mifepristone, and five used Misoprostol.
Recently, on May 14, there was news from the Making Way Network, which helps women with unplanned pregnancies, about a 16-year-old who died from an abortion. She was 12-14 weeks pregnant and bought pills from Facebook to self-abort at home while her father and sister were away. Her boyfriend couldn’t come over, leaving her alone. She took 1 pill on April 24, dissolved 4 pills on April 25, and aborted a 1-2 inch embryo within 4 hours, but the placenta didn’t come out. She dissolved 2 more pills, developed a fever, and started bleeding. A neighbor took her to the hospital emergency room, where she was unconscious. Doctors performed curettage. She was hospitalized again for 4 days for infection treatment. Her sister found her unconscious with a high fever at home, sent her to the hospital, and she died there.
Therefore, providing pills to help women safely terminate pregnancies must include:
- Online history taking before dispensing pills
- Pregnancy age not exceeding 9 weeks (the gestational age for home use)
- Online consultation available throughout pill use
With love and care,
Dr. Ruangkit Sirikanchanakul, RSA Network Coordinator