MORE THAN 6,000 abortion pills have been seized in Ireland over the past 10 years.

The use of abortion pills in Ireland has become a major point in the debate on whether Ireland should liberalise its abortion laws: the chair of the Citizens’ Assembly said that in retrospect it should have spent more time discussing abortion pills.

Because abortion is illegal in Ireland (unless there’s a serious risk to the woman’s life) it’s difficult to get a clear picture of how often abortion pills are ordered online by Irish women from countries where they’re legal.

Hundreds of thousands of different types of drugs are seized each year by Revenue and then passed on for analysis by the Health Products Regulatory Authority (HPRA).

In relation to abortion pills, the vast majority of those seized contained misoprostol, while the rest contained mifepristone. These are medications that are legal in other countries to bring on labour or terminate pregnancies; scientific studies (example here) and the World Health Organisation (WHO) have said they are among the safest medical abortion options, and are “highly effective”.

(WHO is in favour of abortion with regard to women’s health, and states that “safe abortion services should be readily available and affordable to all women, including young women and adolescents, to the full extent of the law”.)

Source: Shutterstock

In response to queries from TheJournal.ie, the British Pregnancy Advisory Service (BPAS) agreed that combined use of those two drugs for medical abortion is “safe and effective”.

“Early medical abortion is performed by taking mifepristone and misoprostol, ideally 24 to 48 hours apart,” Clare Murphy, the BPAS director of external affairs said.

Mifepristone works by blocking the hormone progesterone, which is what sustains the pregnancy. Without progesterone, the lining of the uterus breaks down and the pregnancy cannot continue.

It is unusual for the pregnancy to pass after taking this pill alone however, so it is followed up by the misoprostol tablets, which are generally inserted high up in the vagina.

These cause the womb to contract so that the pregnancy is expelled. Women experience cramping and bleeding and generally pass the pregnancy within 4 or 5 hours.

In its report, the Oireachtas Committee on the Eighth Amendment recommended that abortion should be available to women up until 12 weeks, which would mostly involve medical abortion, or abortion caused by taking pills.

In response to a query from TheJournal.ie on how many abortion pills are seized each year in Ireland for the past decade, the HPRA gave the following figures:

2008: 48 tablets (34 contained misoprostol and 14 mifepristone)

48 tablets (34 contained misoprostol and 14 mifepristone) 2009: 1,216 tablets (1,118 contained misoprostol and 98 mifepristone)

1,216 tablets (1,118 contained misoprostol and 98 mifepristone) 2010: 671 tablets (643 contained misoprostol and 28 mifepristone)

671 tablets (643 contained misoprostol and 28 mifepristone) 2011: 635 tablets (620 contained misoprostol and 15 mifepristone)

635 tablets (620 contained misoprostol and 15 mifepristone) 2012: 487 tablets (471 contained misoprostol and 16 mifepristone)

487 tablets (471 contained misoprostol and 16 mifepristone) 2013: 438 tablets (424 contained misoprostol and 14 mifepristone)

438 tablets (424 contained misoprostol and 14 mifepristone) 2014: 1,017 tablets (972 contained misoprostol and 45 mifepristone)

1,017 tablets (972 contained misoprostol and 45 mifepristone) 2015: 850 tablets (739 contained misoprostol and 111 mifepristone)

850 tablets (739 contained misoprostol and 111 mifepristone) 2016: 536 tablets (436 contained misoprostol and 100 mifepristone)

The 2017 figures only account for up until May: 158 tablets detained, with 138 containing misoprostol and 20 mifepristone.

Source: Statista

Analysing the figures, the Murphy said that the reason why there’s a much higher number of misoprostol is because ”you need more misoprostol than mifepristone to induce a miscarriage”.

I believe that [telemedicine websites] will also send extra doses of misoprostol in case it doesn’t work the first time, but also women may simply be buying [more] misoprostol online.

Source: Photothek via Getty Images

One study which looked at the experiences of women on the island of Ireland who accessed medical abortions online said that between 1 January 2010 and 31 December 2015, 5,650 women requested abortion pills through the online telemedicine initiative Women on Web (the lead author of the Texas study, Dr Abigail Aiken, contributed to the Oireachtas Committee on the Eighth Amendment).

In that same timeframe, 4,098 abortion pills were seized in Ireland by Revenue.

The Assembly and Committee

The majority of the Citizens’ Assembly recommended that abortion without restriction should be allowed (64%). Of that group, 48% agreed that abortion without restriction should be lawful up to the 12th week of pregnancy only, and 44% said it should be allowed up to the 22nd week of pregnancy only. In cases of fatal foetal abnormality, it recommended terminations be permitted during any period of the pregnancy.

The Oireachtas Committee on the Eighth Amendment was then set up to review the Assembly’s recommendation, and in its first sitting, heard evidence from the chair of the Citizens’ Assembly, Judge Mary Laffoy.

When asked about any suggestions of what evidence the committee should examine, Laffoy told the committee she believed the use of abortion pills in Ireland was not discussed enough by the Assembly:

One thing I think we didn’t cover sufficiently, because the situation is changing, is abortion pills.

In the Committee’s subsequent hearing, Dr Abigail Aiken, an assistant professor at LBJ School of Public Affairs in Texas, gave evidence based on research she had conducted on Irish women who have accessed medical abortions.

She said that of the women who accessed abortion pills, the majority (54%) were using contraception when they became pregnant “and thus experienced a contraceptive failure”.

“At-home use of abortion medications obtained using online telemedicine has been demonstrated to be both highly effective and safe,” Aiken told the committee.

She also spoke of women who would be unable to travel or access online telemedicine and quoted one woman, Rebecca (39), who said that she was doing “everything they were warning you not to do” when pregnant:

I was walking up to 20km every day. I was doing sit ups, I was doing squats. I was doing anything I could possibly do to make this happen. I don’t think I ate for several days because I had read that if you have an extremely low calorie count and you’re taking high doses of Vitamin C that can cause a miscarriage.

Laffoy quoted research from the HSE which shows that there are “increasing numbers of women who are making contact with online abortion pill providers”.

In its submission to the Oireachtas Committee, the Irish Congress of General Practitioners (ICGPs) said that there seemed to be an increasing proportion of women who will purchase online hormonal abortifacient medications.

It said that “in these instances, it may or may not become known to their GP in subsequent consultations”.

Women who use abortion pills ordered online may fear presenting to

Irish health services if they develop problems.

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Studies on their use

Source: Dr Aiken

A survey conducted by Dr Aiken and questioned by the committee showed that women requesting abortions were of different ages, had differing pregnancy circumstances and various reasons for seeking abortions.

Among those that terminated their pregnancy, 97% felt they made the right choice and 98% would recommend it to others in a similar situation.

Women commonly reported serious mental stress caused by their pregnancies and their inability to afford travel abroad to access abortion. The feelings women most commonly reported after completing medical abortions were ‘relieved’ (70%) and ‘satisfied’ (36%), with 6.6% feeling low and 2.6% feeling disappointed.

In a survey published in the British Medical Journal, 1,000 women in Northern Ireland and the Republic who bought abortion pills online reported on the effects they had after taking the medication.

Almost 95% (947 women) reported that taking a combination of mifepristone and misoprostol ended their pregnancy, 0.7% required a blood transfusion, 2.6% required antibiotics, and overall 9.3% experienced symptoms potentially requiring medical attention. There were no deaths.

Source: Shutterstock/Cindy Goff

But there are dangers associated with ordering the pills online. A BPAS spokesperson outlined the side effects with taking mifepristone and misoprostol.

“The main side effects are the cramping and bleeding that follows, nausea, diarrhoea, headache and fever or chills are often experienced.

The main risks in fact are that it doesn’t work and there is a continuing pregnancy – although this happens in less than 1% of cases, or that some tissue is left behind – this happens in about 3% of cases. This means a woman will need to come back for an aspiration.

The risk of infection is low – 2 in 1,000 or 0.2% – and haemorrhage, or very heavy bleeding, also 2 in 1,000. The risk of death from medical abortion is 1 in 100,000, while the overall UK death rate in pregnancy, childbirth and the aftermath is 8.8 per 100,000, nearly 9 times higher.

“The overall risks are low – using these pills to induce an abortion is considerably safer than ongoing pregnancy and childbirth.”

She said that although the medication itself is safe and that some abortion pill websites offer aftercare, there are stigmas associated with ordering the pills that can influence women’s treatment or aftercare.

“The main concern is that in the rare event something does go wrong, women will feel scared to access help at home.

Undertaking this process alone without the reassurance of an immediate medical framework and in the context of doing something illegal can also be hugely stigmatising and stressful for women.

“If women are not ordering from Women on Web or Women Help Women, they are probably obtaining misoprostol on its own as this is widely sold as a stomach ulcer drug, so it is not subject to the same restrictions as mifepristone, which is licensed for abortion.