Angela had to dig through the lotion to find the pills. For a moment, she began to panic, worrying she’d been duped. But then her fingers felt the small pack hidden at the bottom of the container, and she pulled out a cache of double-bagged pills that she and her partner, Francisco*, had bought online for about $70.
She was seven weeks pregnant. At the time, both Angela and Francisco, who spoke to Rest of World on the condition that they be identified by pseudonyms to protect their identities, were students, barely able to scrounge up the money for an ultrasound. They were in a loving, long-term, committed relationship, but they were not ready to be parents.
Together, they decided that Angela would have an abortion.
But ending a pregnancy is illegal in the Philippines, where over 80 percent of the population identifies as Roman Catholic. The country is one of 23 that bans it under any circumstances. Any woman undergoing an abortion, along with anyone performing or facilitating the procedure, can face up to six years in prison.
Still, a widely cited 2013 study by the Guttmacher Institute estimated 610,000 illegal abortions were performed in the Philippines in 2012 alone. And how to access them, is an open secret.
“When people think of abortions in the Philippines, they think of a back alley,” Angela said in a phone interview in February. But for Angela and many women in the Philippines who are in need of abortion care, the place where they are able to access critical information and buy abortifacients is on the internet — on Facebook, on Twitter, or on one very well-known forum.
After confirming she was pregnant, Angela spent several weeks on what she called a “deep dive” into websites, Facebook, online forums, and academic journals, reading everything she could find about abortion options.
“I know that’s a privilege,” she said. “A lot of that has to do with class. I had the ability to do extensive research and understand it confidently. Not everyone has access to the internet or a smartphone.”
But for those in the know, information is easy to find online: Abortifacient sellers use social platforms as virtual storefronts.
Searching for the terms “Abortion Philippines,” “Cytotec Philippines,” and “Misoprostol Philippines” on Facebook turns up several closed groups and more than a dozen individual accounts advertising the abortifacient pill Cytotec (the brand name for misoprostol). Merchants say kits containing the pills necessary for women to self-administer a medical abortion can be delivered directly and discreetly, just as Angela’s were.
On their Facebook pages, sellers will post everything from their prices and contact information to screenshots of chats with former clients as proof of customer satisfaction. A few even outline the procedure, explaining which pills are included in the kit and the basics of how to take them. On their pages, sellers can be seen communicating with unseen clients about pick-up times or late payments.
Some of these same sellers also have Twitter accounts, often tagged with the words pampalaglag (abortion) or pamparegla (inducing a period).
Several sellers even advertise their ability to ship internationally to places, like the Gulf States and other Southeast Asian countries, that have a significant population of overseas Filipino workers, and where abortion may be prohibitively expensive or only available for health reasons.
Rest of World contacted a dozen sellers who had advertised their services on Facebook and Twitter. None responded to requests for interviews.
Beyond the sellers themselves, the internet can provide much-needed emotional support for women, many of whom face immense stigma in a country where frank discussions of sexuality are taboo and the Catholic Church has a powerful influence on government policies around reproductive health.
Camille Tijamo is the director of operations at Marie Stopes International, a provider of contraception and abortion services, in Cambodia, where abortion is legal. Tijamo, who is Filipina, says there is immense social pressure on women to see pregnancy — any pregnancy — as a positive thing.
“Every time a woman gets pregnant, you have to consider it as a blessing,” says Tijamo. “That’s the dictate from everyone, every time.”
In 2012, the Philippine government passed a landmark reproductive health bill aimed at making contraception more accessible and providing universal sexual and reproductive health education. Hospital care for women who had suffered complications from unsafe abortions was also legalized. But the law quickly met with resistance from Catholic groups and anti-abortion activists, leading to a Supreme Court challenge that ultimately delayed its full implementation.
According to the United Nations Fund for Population Assistance, widespread sexual education is still lacking, and it has contributed to the country’s rising rates of both HIV infection and teen pregnancy.
Despite uneven access to sexual and reproductive health education, a 2011 study co-authored by professor Jessica Gipson of the University of California, Los Angeles, found that young people knew about misoprostol and how to use it to terminate a pregnancy.
Tijamo says it often takes time for women in the Philippines even to consider abortions, because they are not seen as an option. “But when they decide [to get an abortion],” she continues, “what they do is get information online.”
As Angela went further down the internet rabbit hole, she found that in closed Facebook groups and on a notable forum women asked one another questions, offered support, and swapped stories of their own experiences.
One woman, posting under the username PrincessSofia, described her sadness and guilt after self-administering a successful medical abortion. Another user, Mylenebersabe, responded, “Omg. Don’t feel sorry sis .. you just did what you know what’s [sic] right.”
Another woman wrote about choosing to end her pregnancy because she was already struggling with a thyroid problem. In the same thread, a different woman responded shortly afterward, saying she was considering having an abortion because she faced the same issue and had been advised by her doctor not to get pregnant.
Amid this back-and-forth, midwives and sellers plug their services, offering guarantees of safety and effectiveness as well as phone numbers through which they could be contacted.
“I was lucky that I had a supportive partner,” Angela said. “But the forums are good for women who are going through it alone.”
Marevic Parcon, executive director of the Women’s Global Network for Reproductive Rights (WGNRR), says that she is not surprised that women are turning to social media to find help.
“In our own social media [accounts], we receive a lot — and I say a lot — of requests for abortions,” she said. “Sometimes it actually feels like, my God, I don’t know how to help these women.”
Instead, Parcon refers them to websites where they can get accurate information about pregnancy and reproductive health.
“Some of them are desperate, some of them are suicidal,” Parcon said of the people who contact WGNRR hoping to access abortion care. “But our hands are tied.”
In the end, Angela and Francisco settled on a supposedly reputable seller whom a friend had recommended and whose profile is widely advertised across forum posts and several Facebook and Twitter profiles.
Francisco communicated with the seller via Facebook and text message to coordinate the sale.
Like many sellers, the person Angela and Francisco contacted offered different kits at different prices and for different stages of pregnancy. The couple could choose between two: a 3,500-peso (roughly $70) kit, which the seller told them had 92 percent effectiveness, and a 5,000-peso ($100) one, which the seller said was 99 percent effective. Angela and Francisco chose the less expensive one and paid up front.
Around a week later — neither Francisco nor Angela can remember exactly how long— while Angela waited at a nearby cafe, a courier met Francisco at a preset location and dropped off the package.
The couple spent a sleepless night administering the procedure, following the step-by-step instructions the seller had sent them.
The next week, Angela took a pregnancy test to confirm she was no longer pregnant.
Angela’s story had a happy ending, relatively speaking. She received the pills she purchased, and they worked without making her sick or landing her in the hospital.
But other women have not been as lucky.
While platforms like internet forums, Twitter, and Facebook enable women to buy pills marketed as misoprostol, there’s no way to tell if these pills, or even the sellers themselves, are genuine.
One Facebook user attempted to out a seller who had scammed her, posting their number and usernames. “I was victimized [sic],” the post read, with commenters affirming the same thing had happened to them.
Dr. Junice Melgar, executive director of the Likhaan Center for Women’s Health, a Manila-based nonprofit that provides sexual and reproductive services largely to low-income women, told Rest of World that some of the sellers may be taking advantage of desperate women to make a profit.
Tijamo, who has worked with Filipinas who have traveled to Cambodia to receive abortions at Marie Stopes, told Rest of World of a client who flew to Phnom Penh after the pills she purchased from an online seller didn’t work.
“She showed me a picture of the medical abortion she bought online; it actually arrived inside a deck of cards,” said Tijamo, who knew immediately that something was wrong.
“[The pills] were just in the plastic,” Tijamo said. “There’s no packaging, the information [from the seller] is not even correct.”
Rest of World was able to find three sellers advertising medical abortion kits for those who are between four and six months pregnant. These violate World Health Organization (WHO) guidelines, which recommend that abortions after the first trimester be performed in a medical facility with a doctor present. (Planned Parenthood recommends that women who are more than eleven weeks pregnant receive surgical abortions.)
Amalia Puri Handayani works with Women on Web, which provides online consultations to women seeking medical abortions and, in cases where it is legal, arrange for a prescription to be called in or delivered. Handayani said that Women on Web abides by the WHO guidelines and does not prescribe medical abortion pills to women who are more than 10 weeks pregnant, a cutoff that factors in the estimated two weeks it takes for the prescriptions to be filled and shipped.
“A medical abortion can only be done at home safely until 12 weeks,” said Handayani, referring to the WHO guidelines.
For some women, the greater risk may be the pills themselves.
In Malaysia, where abortion is legal only in cases where it is deemed necessary to preserve a woman’s physical or mental health, five women died between 2015 and 2017 from abortion pills they had purchased online, according to the government.
Women on Waves, a Netherlands-based nonprofit that helps women obtain abortions and the sister organization to Women on Web, keeps a running list of fraudulent websites and sellers from all over the world, warning prospective purchasers that some merchants may take their money and never deliver, or sell them drugs that can make them sick.
The list features sellers operating everywhere from Latin America to Turkey.
“There’s no way to tell where [the pills] are coming from,” says Dr. Melgar of the risks of fake or harmful abortion pills.
But black market pills, even with these liabilities, may still be the safest option. In the Philippines, where the procedure is unregulated, abortifacients have fewer risks compared to back-alley abortions that may cause life-threatening infections or damage to vital organs — though those continue to take place.
“Before, women would self-induce by very desperate measures, like jumping from a window or having someone step on their abdomen,” Dr. Melgar told Rest of World.
Medical abortions have become increasingly popular globally. As the Covid-19 pandemic has strained healthcare infrastructure around the world, many women have turned to telemedicine abortions. In April alone, Women on Web received 16,663 emails requesting abortion pills by mail, over 1,000 more than the organization received in February, according to Handayani.
Even as many major urban areas of the Philippines went into strict lockdowns in an effort to contain the spread of the coronavirus, abortion sellers have continued to advertise on social media, assuring customers that their pills can still be delivered.
Rest of World reached out to Facebook and Twitter to ask if they were aware of the pills being sold on their platforms.
A representative from Twitter referred Rest of World to the company’s guidelines, which prohibits the sale of controlled or illegal goods on the platform.
Representatives for Facebook first asked for screenshots of particular sellers and groups, which Rest of World’s editorial policy did not allow us to provide. Subsequent calls and emails requesting comment on the company’s policies around buying and selling prescription and unregulated medications on the platform went unreturned.
The Philippines currently does not have a law that allows the government to regulate social platforms. But breaking an existing law while using a social platform could lead to additional charges and a longer sentence if a seller or buyer were ever convicted of a crime, according to V. Johann Espiritu, a lawyer who specializes in technology and new media.
But policing these platforms wouldn’t eliminate womens’ need for accurate health information and access to reproductive health care. Nor will it erase the stigma of terminating a pregnancy.
“Just because I am pro-choice and pro-abortion doesn’t mean that’s the first thing I’ll campaign for,” Angela told Rest of World. “Safe sexual education needs to come first.”
More than six months after her abortion, Angela has only spoken about the experience to three people other than Francisco. She hopes that, one day, they will be able to talk to their future children about it, the children she is still sure she wants to have — when she’s ready.
“If I can’t tell my story to my own daughter or son,” she said, “then it’s a betrayal of what we went through.”