Over the past two decades, Colombia has seen several legal changes in access to abortion. Both surgical and medication abortions are now legally provided at free cost to patients regardless of their immigration or insurance status. Before 2006, Colombia had an absolute abortion ban. But, in February 2022, the Constitutional Court decriminalized abortion for up to 24 weeks with Ruling C-055. Abortions beyond 24 weeks are permitted under specific conditions such as risks to the patient’s health or life, fatal fetal anomalies, and cases of incest or rape.
Colombia’s Ministry of Health (MOH) guidelines outline the recommended dosage for abortion medications like mifepristone and misoprostol or misoprostol alone at different gestational stages. Some non-profit organizations introduced telemedicine services for medication abortion during the COVID-19 pandemic. As a result, 88-94% completion rates were reported for first-trimester abortions whereas 74-93% for second-trimester abortions. Successful self-management of abortions requires adequate support and evidence-based counseling throughout the process before, during, and after the procedure.
The current study aims to evaluate whether individuals purchasing abortion pills from online sellers in Colombia obtain accurate information, directions, and dosages as per the guidelines of Colombia’s MOH. This collaborative study was conducted by Fundación Oriéntame (a non-profit organization) and the Guttmacher Institute (a policy organization).
This study was carried out in Colombia between July 2023 and September 2023. The methodology involved 4 stages: 1) identifying the keywords related to online abortion pill purchases using Google Trends, 2) finding sellers through online platforms such as Facebook, websites, TikTok, and Instagram, 3) removing duplicates from sellers list with multiple profiles through various online platforms, and 4) gathering information from mystery clients who interacted with sellers including the buy and receive the medications. Sellers documented the information of mystery clients about abortion pills including doses, number of pills sold, cost, contraindications, and complications using a predesigned SurveyCTO questionnaire.
A total of 161 sellers were identified through online platforms, majorly from Facebook and websites. Lastly, 122 mystery clients were contacted by sellers, of which 61 inquiries were made at 8-12 weeks gestational age and 64 inquiries at 16-17 weeks gestational age. During the abortion process, symptoms like cramping and bleeding were reported in 84.6% of clients for the 8-12 weeks group and 66.7% for the 16-17 weeks group. About 25% of sellers confirmed that these symptoms were severe during the abortion process compared to the normal menstruation cycle, whereas 15.4% of sellers declared that these symptoms were similar to regular periods. In total, more than 20% of sellers declared that mystery clients might require medical care due to complications from the pills.
Moreover, a total of 45 purchases were made to mystery clients of which 27 were in the 8-12 weeks gestational age group and 18 in the 16-17 weeks gestational age group. It was estimated that the median price paid including delivery charges was COP$150,000 (US$36.79) for the 8–12 weeks group and COP$200,000 (US$49.06) for the 16–17 weeks group. More than 77% of all misoprostol packages are in a blister pack without any visible damage. This was notably more common in 94.1% of 16-17 weeks purchases than 8-12 weeks purchases. Around 24 blisters (60%) displayed the expiry date of medications.
For the 8–12 weeks group, 69.6% of clients received eight misoprostol pills, while 76.5% of clients in the 16–17 weeks group received 12 pills. However, only 82.6% of clients were recommended to take the dosage of abortion pills according to the guidelines of Colombia’s MOH. Furthermore, only 12.5% of sellers advised the clients not to take any analgesics during the abortion process, as it may affect the effectiveness of pills. It was found that the majority of sellers offered accurate guidance on how to administer the pills and also included unnecessary and contradictory information.
This study concluded that even as legal abortion becomes more accessible in Colombia, online sellers of abortion pills may continue. It is essential to provide accurate, Colombia-specific information about medication abortion, enabling individuals to better understand and utilize the available legal options.
Reference: Arango DA, Cartwright AF, Braccia A, et al. Seeking abortion medications online: experiences from a mystery client study in Colombia. BMJ Open. 2025;15:e086404. doi:10.1136/bmjopen-2024-086404
