Arango Daniel Arango, Cartwright Alice F, Braccia Ava, Moore Ann, Vivas Maria M
Fundación Oriéntame, Bogotá, Colombia.
Guttmacher Institute, New York, New York, USA
BMJ Open. 2025 Jan 20;15(1):e086404. doi: 10.1136/bmjopen-2024-086404.
While Colombians gained broad legal access to abortion in 2022, people still lack knowledge about its availability and face variable quality of care at health facilities. This study sought to understand whether online sellers provide the instructions and medication dosages necessary for effective medication abortions.
The study design involved mystery clients contacting sellers identified across websites and social media platforms (Facebook, Instagram, and TikTok) to purchase abortion pills. Unique sellers were contacted with two profiles (first and second trimester pregnancy gestational ages). Mystery clients documented information received on physical effects, complications and how to take the pills from the sellers in a predesigned survey in SurveyCTO.
The study was conducted in Colombia from July to September 2023. We documented and described sellers' conversations with mystery clients and pills received. We identified 161 sellers across platforms, which resulted in 65 unique sellers after deduplication. We attempted to contact each unique seller twice.
Almost all sellers screened for gestational age using last menstrual period. Bleeding (84.6%) and cramping (66.7%) were the physical effects most commonly mentioned to mystery clients, although pain was mentioned to second trimester clients more often than first (40.5% vs 22.0%). Less than 17% of sellers highlighted possible complications that could require medical attention. Almost 90% of purchases were received (88.9%). All contained manufacturer-branded misoprostol and 77.5% were undamaged aluminium blister packages. While 82.6% of first trimester clients were instructed to take an initial misoprostol dosage in line with Colombia's Ministry of Health guidelines, all second trimester clients were told to take a dosage exceeding the recommended amount. Although most sellers provided appropriate information on administration routes for the pills, sellers also provided contradictory and unnecessary instructions.
Online sellers of abortion pills may persist even as legal abortion becomes more widely available in Colombia. While misoprostol was received from many of these sellers, they did not provide sufficient information about potential complications or accurate dosing instructions to second trimester clients. Accurate medication abortion information specific to Colombia should be made more accessible so that people can more easily navigate the new care landscape.
虽然哥伦比亚人在2022年获得了广泛的合法堕胎途径，但人们仍然缺乏关于堕胎可及性的知识，并且在医疗机构面临着参差不齐的护理质量。本研究旨在了解在线卖家是否提供有效药物流产所需的说明和药物剂量。
该研究设计包括神秘顾客联系在网站和社交媒体平台（脸书、照片墙和抖音）上识别出的卖家以购买堕胎药。用两个档案（孕早期和孕中期妊娠孕周）联系不同的卖家。神秘顾客在SurveyCTO中预先设计的调查中记录从卖家那里收到的关于身体反应、并发症以及如何服药的信息。
该研究于2023年7月至9月在哥伦比亚进行。我们记录并描述了卖家与神秘顾客的对话以及收到的药丸。我们在各平台识别出161个卖家，去重后有65个不同的卖家。我们试图联系每个不同的卖家两次。
几乎所有卖家都通过末次月经来筛查孕周。出血（84.6%）和抽筋（66.7%）是向神秘顾客提及最多的身体反应，不过孕中期顾客比孕早期顾客更常被提及疼痛（40.5%对22.0%）。不到17%的卖家强调了可能需要医疗关注的并发症。近90%的购买订单收到了货物（88.9%）。所有货物都含有厂家品牌的米索前列醇，77.5%是未损坏的铝箔泡罩包装。虽然82.6%的孕早期顾客被指示按照哥伦比亚卫生部的指南服用初始米索前列醇剂量，但所有孕中期顾客被告知服用的剂量超过了推荐量。尽管大多数卖家提供了关于药丸给药途径的适当信息，但卖家也提供了相互矛盾和不必要的说明。
即使在哥伦比亚合法堕胎变得更广泛可及的情况下，堕胎药的在线卖家可能仍然存在。虽然从许多这些卖家那里收到了米索前列醇，但他们没有向孕中期顾客提供关于潜在并发症的足够信息或准确的给药说明。应该让更易获取特定于哥伦比亚的准确药物流产信息，以便人们能够更轻松地应对新的护理局面。
