INDONESIA – Online abortion drug sales in Indonesia: a quality of care assessment

Ann M Moore, Jesse Philbin, Iwan Ariawan, Meiwita Budiharsana, Rachel Murro, Riznawaty Imma Aryanty, Akinrinola Bankole

Studies in Family Planning  20 October 2020  (Open access)

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 2019. Interactions were analyzed quantitatively and qualitatively, along with the contents of the packages. One hundred ten sellers were contacted, from whom mystery clients made 76 purchases and received 64 drug packages. Almost all sellers sold “packets” containing multiple drugs; 73 percent of packets contained misoprostol, and 47 percent contained at least 800 mcg of misoprostol. Thirty‐four packets contained insufficient drugs to complete an abortion. When compared to WHO standards, 87 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.

From the Background section
“So as to understand what women’s experiences are like trying to use misoprostol, we attempted to purchase misoprostol from brick‐and‐mortar drug shops in 2018 in Yogyakarta and Indramayu, and we found almost none of these shops were willing to sell our mystery clients misoprostol (3/327). Police crackdowns on the illegal sale of nonnarcotic drugs through brick‐and‐mortar drug stores in Indonesia have made drug shops fearful of selling misoprostol. While online sellers also exist, they too are on the radar of law enforcement. BPOM (Indonesia’s National Agency of Drug and Food Control) has engaged in various operations to shut down online sellers of illegal and counterfeit drugs including misoprostol.

“Therefore, it will come as no surprise that the online misoprostol marketplace is a fluid universe with sites shutting down and reopening under different domain names, some sellers leaving the market, and new ones joining, as sellers play cat and mouse with regulators (Pratima 2020). Since 2015, the Ministry of Communications and Information blocked 300,000 sites selling illegal drugs “which were mostly used for abortion,” following a report from BPOM (Pratima 2020). BPOM reported that in 2018 the Ministry of Communications and Information blocked or took down 2,217 websites selling drugs that require a prescription or are illegal in Indonesia, including sites that sold misoprostol for abortion purposes (Badan POM 2019), with another source citing that between 2017 and 2019 the Ministry of Communications and Information took down 96 sites advertising abortion drugs (Pratima 2020). With money to be made, it is likely that the sellers that are shut down will soon be replaced by others….”