A few months back, I received a direct message on Facebook Messenger from an unknown account, possibly a fake one. Normally I would just ignore such messages because more often than not they are from scammers, but not this time. The message sent was short, but still managed to make my heart stop for a while.

Please help, I want to buy abortion medicine.

I was shocked, then replied: Who told you I sell abortion pills? I’m a pharmacist, not an abortion pill seller.

The account owner, who called herself Nur, then sent me a screenshot of a post I wrote on Facebook recently, regarding mifepristone and misoprostol combination – two medications used for medical abortion that are unregistered in Malaysia. As a pharmacist passionate about sexual and reproductive health and rights, I often write about the subject of access to contraceptives and abortion in Malaysia on my personal Facebook profile for public education purposes. However, I have never stated anywhere that I sell those medications.

So do you sell them? She asked again. I’m 3 months pregnant. I don’t want this baby.

Oh no, I told myself. If I just let her be, she might go and seek other unreliable and unsafe methods to end her pregnancy. Would she contact one of those online illegal abortion pill sellers? Would she eat too much unripe pineapples in an attempt to induce miscarriage? Would she go and seek help from back-alley abortion providers who use non-sterile equipments, putting her at risk of infections?

I quickly replied: I don’t sell abortion pills, but if you need help, you can try to contact this NGO. I then gave her RRAAM’s hotline number, hoping that she would be able to access proper counselling and guidance from trained professionals of RRAAM. After thanking me, she quickly went offline.

I did not hear anything from Nur until now. Her Facebook account was already deleted. Since then, however, I received several other messages from people who would like to terminate their pregnancy. Most of them wanted to know where to find misoprostol and mifepristone combination for self-managed abortion. Some of them asked me regarding the trustworthiness of abortion pill sellers that they found on Twitter and Instagram. One person even sent me a link of an account on Twitter claiming to be a “doctor” selling authentic abortion pills, under the hashtags #pilgugur, #cytotec (Cytotec is a brand of misoprostol) and #pilcuci. 

Out of curiosity, I clicked on the link under incognito mode and found tweets of testimonies from “actual users”, complete with gory photos of aborted foetuses sent by them. Even more surprising, that was not the only account selling illegal misoprostol and mifepristone; upon clicking the #pilgugur hashtag I found over 30 similar Twitter accounts selling them, with similar tweets and similar claims. Photos of “successful” abortion, photos of the pills, screenshots of Whatsapp conversations with “customers” to show how they are trusted sellers, how they guide buyers from the start of the process until the end. It’s easy to see how so many people fall prey to these unscrupulous sellers, considering how convincing they are in marketing their products, and the fact that they profit off people’s desperation. If you’re facing an unwanted pregnancy and you don’t know any legal avenues to seek abortion safely and discreetly, where would you turn to other than Cytotec sellers who offer anonymous cash-on-delivery services?

Illegal sale of abortion pills is a serious problem, but the problem does not lie on the abortion pills per se. Medical abortion has been proven to be a safe and effective method of abortion for early pregnancies. In fact, the World Health Organisation (WHO) in its Clinical Practice Handbook for Safe Abortion states that this method can be used up to 24 weeks of pregnancy. For pregnancies less than 10 weeks of gestation, the medications can be self-administered at home under the guidance of health professionals, either via telemedicine or following initial consultation (with or without first dose administration) in healthcare facilities, as per the NICE guideline on abortion care. A person can therefore choose to undergo abortion in the privacy of their own home with this method. Complications arising from medical abortion are rare, with less than 0.4% of people undergoing the procedure in the first trimester experiencing serious complications requiring hospitalisation or blood transfusion. Rate of treatment failure is also very low, with fewer than 5% of them requiring surgical intervention for incomplete abortion. The WHO has already included mifepristone-misoprostol combination for medical abortion as part of its Model List of Essential Medicines since 2005, and has now moved it from its Complementary list to the Core list. Considering their high level of safety and efficacy as well as ease of use, mifepristone and misoprostol are essential tools in ensuring greater access to safe abortion. 

It is therefore baffling why these medications are not registered in Malaysia, thereby making their sale illegal even by registered healthcare professionals, an offence punishable under Section 12(1) of Sale of Drugs Act 1952. While abortion is legal in Malaysia under several circumstances according to Section 312 of the Penal Code, those who wish to terminate their pregnancy only have one legal option of abortion method i.e. surgical abortion. Surgical abortion is more invasive and has lesser privacy compared to medical abortion, which might put some people off – especially considering how taboo abortion is in Malaysia and being caught having one could be grounds for ostracisation. Because of this, some pregnant people have no choice but to resort to buying illegal pills online from anonymous sellers who do not have any medical background whatsoever, nor are they trained to handle possible complications arising from the use of their pills – which are either counterfeit medicines or authentic medicines given at the wrong dose. Some of them even fall prey to scammers who go missing as soon as they receive payment for the pills (which could be as much as RM600 per set).

Registering mifepristone and misoprostol will allow people to have access to them legally via healthcare professionals, enabling proper regulation, quality control and management of adverse events. At the same time, this will curb the sales of illegal pills since demand can be met legally. It is not a coincidence that since the deregistration of misoprostol in 2016, there has been a rise in the number of abortion pills sold illegally online, with a total of 24 raids conducted between 2016 and 2019 involved seizure of items worth RM 95,233. Clearly, making medical abortion illegal does not stop people from obtaining it – it only exposes people to unnecessary risks associated with unsafe, medically unsupervised abortion. Desperate people will resort to desperate means – just ask any of the folks in my Facebook Messenger inbox. 

In a way, I am grateful to have people like Nur mistaking me for an abortion pill seller and messaging me to obtain abortion pills because at least I can redirect them to safe avenues for abortion and stop them from seeking dangerous methods. But how many people out there who, instead of pleading for help from a registered pharmacist who has knowledge and awareness regarding safe abortion, decided to message a Pil Cuci ‘sis’ to obtain 8 dubious hexagon pills at the price of RM600? As long as mifepristone and misoprostol remain unregistered and legally inaccessible in Malaysia, we might not be able to see the end to illegal pill sellers. Take down one, and two more will crop up. It is just basic supply and demand. There will always be demand from people facing unwanted and unplanned pregnancies. Question is, who will fulfil this demand? A registered medical professional, or Dr. Pil Gugur COD By Hand?  M

Photo by Andrea Piacquadio from Pexels

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