Self-Induced Abortion: Safety Concerns Regarding Misoprostol Information on The Internet

Introduction: While the prevalence of unwanted pregnancies is increasing, abortion is restricted in Indonesia. Misoprostol, a prostaglandin-E1 analogue, is commonly used off-label to induce labor. [1-2] Previous studies have revealed the practice of self-induced abortion by purchasing misoprostol online. [3-5] Objectives: This study aimed to explore the information provided online to customers regarding the off- label use of misoprostol. Methods: We searched Google with the key words "jual obat aborsi" (selling abortion drugs) and "jual obat penggugur kandungan" (selling drugs to abort pregnancy). The data were descriptively and qualitatively analyzed. Results: Thousands of websites were hinted at using the passwords. Interestingly, the domain names of the website contain official addresses such as xxx.go.id or xxx.ac.id. The seller's WhatsApp number, images of the aborted fetus, and customer testimonials were among the most prominent pieces of information. Most websites mentioned that the abortion drug is a prescribed medication, but they could purchase it here without a prescription. The dose of misoprostol "instructed" by the seller ranged from 2 to more than 16 tablets of misoprostol 400 mcg (Cytotec®, was no longer legally available in Indonesian markets), depending on the pregnancy age. Alongside misoprostol use, the sellers also provide Cyrux® (misoprostol 200 mcg, not registered yet in Indonesia) and analgesics (no information about the type of analgesics provided). The sellers mentioned the need for "high dose misoprostol" to ensure a completed abortion and warned their customers to take the "package" of abortion drugs as instructed. The recommended route of administration, as advised by the sellers, was sublingual. The reason for this route option was that it could be hidden from health professionals, and they might visit health care services for any possible complications without knowing that they just did a self-induced abortion. The terms "safe" and "no side effects" were frequently used in the website information. The efficacy of the abortion drugs was reflected in the terms "100% work" and "complete without curettage". Conclusion: This study revealed illicit internet sales and potentially harmful usage of off-label misoprostol as an abortion drug.