The panic started as soon as Jayda took the test in early July. It came back positive, and a quick calculation suggested she was seven weeks pregnant. It was a bad time. Her mom had just died, and Florida, the state where she lived, had introduced restrictions in April that prohibited people from using telehealth appointments to access abortion pills. Jayda, who is in her late 20s and asked to be identified by a pseudonym to protect her privacy, tried to book an in-person appointment with Planned Parenthood, a nonprofit that provides sexual health care across the US. But the wait time was two weeks. “That seemed like a lifetime away,” she says.
Instead she turned to the unregulated world of websites selling abortion pills, or MTP kits—a combination of two medications, mifepristone and misoprostol, used to end pregnancies. As restrictions in US states have tightened, a cross-continental network of companies and nonprofits has sprung up to ship these pills to places where access is restricted. Some are motivated by ideology, others by profit and opportunism. But all fall into a legal gray area, where regulators appear unable or unwilling to assert authority.
Jayda found out about this network after frantic Googling lead her to a website called Plan C, which lists online pharmacies that ship abortion pills into US states. She poured over the options. “I was in a panic,” she says. “I wanted the pills as soon as possible and didn’t want to pay a fortune for them, but I also wanted them to be as legit as possible.”
One online pharmacy, AbortionRX, stood out. Stock images of grinning women illustrated the website’s homepage, and the text felt clunky, as if written by someone who wasn’t fluent in English. But AbortionRX promised to get the pills to Florida within eight days in exchange for $250. Women on Reddit had shared their positive experiences. “Website looks a little sketchy but they’re legit,” one post read. That was the reassurance Jayda needed. She clicked “order now” and paid.
AbortionRX’s web address was registered from Amsterdam, according to domain registrar data. The packaging suggested that the pills Jayda received included one 200 mg mifepristone tablet and four 200 mg misoprostol tablets, and had been manufactured by the Indian drug giant Zydus. They had been shipped from India to an unknown location in the US, where they sat waiting for a buyer. AbortionRX did not reply to multiple requests for comment, but when WIRED asked a customer service representative where the pills were shipped from, the person responded: “We ship US to US.” Jayda’s pills were posted in an unassuming small brown envelope with a California return address.
“We do not own this product and currently we are not marketing it in India or in any other geography,” a Zydus spokesperson said when asked about the company’s connection to abortion pills featuring Zydus branding.
“Most of the pills that we see are from Indian manufacturers,” says Elisa Wells, cofounder and codirector of Plan C. “They might be coming directly from those companies, but I suspect not. I suspect there’s somebody entrepreneurial who has set up this pharmacy site and is somehow buying pills in bulk and shipping them out.” Abortion pills in many countries can be bought off pharmacy shelves for around $5, she says.
One of those entrepreneurs is a man who goes by the alias Chris Jones. Jones, who declined to give his real name in case his operation becomes illegal, runs the website Medside24, which is also listed by Plan C. He started the business in Moscow before moving to Kazakhstan’s capital, Almaty, after Russia invaded Ukraine. All of the company’s clients are in the US, he says, and most of them are being referred from Plan C. Medside24 sells an average of 15 abortion kits a day at what Jones describes as a 50 percent profit margin.
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Where Medside24’s pills come from depends on availability, says Jones. Sometimes they’re from Russian manufacturers, sometimes Vietnamese. The pills Jones is currently shipping into the US are manufactured by the Vietnamese pharma company Stella. Jones says he gets the pills from a local abortion clinic, which orders them in bulk from a local importer.
It is the payment system behind the site that reflects the gray legal zone where these online pharmacies operate. In the last three months, Jones says Medside24 has begun accepting payments via money transfer service Zelle. But for years, the site only accepted Bitcoin. “You cannot just go to to a national bank and open up a merchant account and say I want to sell abortion pills,” says Jones.
The US Food and Drug Administration has expressed concern about these sites for years. In 2019 it sent an abuse complaint to the Barbados-based hosting company Rebel.com, asking the company to investigate “illegal activity” carried out by domain names it had registered such as AbortionRX, as well as other online pharmacies selling abortion pills. “The FDA has a policy that limits personal importation of drugs which would cover medication abortion, but historically the FDA really hasn’t done a whole lot of enforcement,” says Mary Ziegler, law professor at University of California Davis. “There is a sense that what these companies are doing isn’t legal, but there’s also a sense that no one is really going to do anything about it.”
Without official intervention, the job of checking these websites’ products has instead fallen to Plan C. Back in 2016, Plan C and nonprofit Gynuity Health Projects started buying abortion pills from 16 different sites and sending them to a lab to be verified. “All of the pills were real, and this was really astounding to people,” says Wells. “When we presented the research at the National Abortion Federation conference later that spring, there was a gasp in the room from all these abortion providers who couldn't believe that we could have just bought these abortion pills on the internet.”
Plan C hasn’t carried out any lab tests since then, says Wells, but the organization does remove pharmacies from its website if they receive complaints. “If we hear about a problem, we test the site using a mystery shopper model, where somebody purchases the pills and sees what comes in the mail, how much they cost, how long they take, whether there are customer service issues. And then we might remove a vendor based on that,” she says. When customers told Plan C that Medside24 was selling abortion kits with only three misoprostol pills instead of the recommended four, Plan C removed them from its directory. It was reinstated when it added the fourth pill. “This is now rectified,” says Jones.
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The FDA told WIRED it does not recommend purchasing mifepristone over the internet, because it means patients are “bypassing important safeguards designed to protect their health.” And women using these online pharmacies do complain of a lack of support once they have purchased the pills. When Jayda took the AbortionRX pills, there was less bleeding than she expected, making her panic that the medication hadn’t worked. Because she did not have anyone to advise her, she turned to a support group on Reddit. “Honestly, in a moment that felt so scary and where I felt very alone, without anyone to turn to, those women really helped me pull through and get a plan of action in place,” she says.
After five agonizing days, she got an in-person appointment at Planned Parenthood, which confirmed that the pills had ended her pregnancy. Jayda describes her experience with AbortionRX as good, but if she were to go through the process again she says she would use a mail-forwarding service, so that she could use a US-based virtual clinic such as Hey Jane. “It would have been great to be able to reach out to a designated person and tell them, ‘OK, this is what is happening.’”
Aid Access is one nonprofit that is out of the reach of US antiabortion authorities, but with the support system of a more official clinic. Run by Dutch physician Rebecca Gomperts—who says she also sources her pills from Indian pharmacies—the website’s delivery time is slower than some commercial services, taking between 14 and 21 days, according to Plan C. But because it offers financial support for people who might struggle to pay, Aid Access had been popular even before the Supreme Court overturned Roe v. Wade. Between 2018 and 2020, 75 percent of Aid Access clients said they were using the service because they couldn’t afford in-clinic care, according to one study published in The Lancet.
That same study, which collected survey responses from 2,797 people, also testified that Aid Access was safe. “We found that 96 percent of people were able to end their pregnancies alone, meaning that they did not need to go to a provider in-person for any extra assistance,” says Abigail Aiken, one of the study’s authors and a professor at the University of Texas. “Less than 1 percent of people reported treatment for what we would call a severe outcome, either a hemorrhage where they needed to have a blood transfusion or an infection that would require antibiotics to treat it.”
To Aiken, the international abortion pill market feels resilient because it is beyond the purview of any one country’s authorities. “If someone’s based outside of the country, it is unclear how to exactly force them to comply with the law in another jurisdiction,” she says. “It's not clear what folks who are very motivated to outlaw abortion can do in response to that.”
Plan C’s Wells also believes these supply chains are robust. “We do worry that routes of access could get cut off. But we are in the 21st century, in a global economy. And there are so many routes of entry into this country for products that we feel that it’s fairly unstoppable,” she says. “If one of these companies were to get shut down, another would pop up.”