Buying an abortion in the virtual world of Facebook

With 28 million Facebook users in Egypt, advertisers have clocked the social networking website as a powerful tool for promoting their products. 

The prospect of this unimpeded medium for self-publishing, coupled with the difficulties authorities face in catching anonymous online perpetrators, has made Facebook a lucrative platform on which illicit traders can stealthily promote illegal products and practices. 

Among the illicit products sold through Facebook now is abortion. 

Over the last few years, advertisers have scattered their promotion pages across the social network, claiming to perform "secret abortions" to anyone who will pay. 

Abortion remains illegal according to the Egyptian Penal Code, and individuals found guilty of attempting to terminate a pregnancy could face prison sentences of six months to three years. Doctors implicated in abortion cases could face imprisonment for up to 15 years. But the demand for the practice remains high, meaning that those looking to terminate an unwanted pregnancy must resort to illegal measures. Since the proliferation of the internet, this has come to take the form of a labyrinthine online market of illegal abortion services. 

Techniques advertised include Cytotec and Misotac pills for the early stages of pregnancy and operations for women beyond their first three-month phase.

Some of these groups offer a mobile number to contact them.

“We have Cytotec pills available at LE300. Anyone interested in buying them, please call us,” reads one announcement written on many abortion-related Facebook pages.

Cloak-and-dagger procedure 

"Doctor Abortion" is one of the frequently visited Facebook pages of this kind, run by an anonymous administrator and offering services to any client. “Without surgery, any one to three-month pregnant woman can undergo a self-administered abortion using pills at home," it promises. The page, or Facebook "group", claims to be able to terminate pregnancies as advanced as the forth month with no need for surgery. 

"Doctor Abortion" says their office is based in Cairo and that they do not have any other branches outside Egypt.

“Your pills can be delivered to any address in Egypt, the Arab world or further abroad. Send me a private message and I’ll answer instantly,” reads the advert. 

The page is subscribed to by a large number of Egyptians and some Facebook users from other Arab countries, with some subscribers inquiring publically on the webpage about the price of the pills, details of the procedures on offer and requests for an "urgent operation".

To find out more about the work of "Doctor Abortion", Egypt Independent made contact with the webpage in the guise of a woman wanting to terminate a pregnancy after having been refused by her doctor. 

The conversation revealed that the webpage is run by an intermediary who asks for various details about a client's pregnancy before putting her in touch with the doctor. 

Egypt Independent's reporter was asked a series questions, including whether this was her first pregnancy. “Don’t worry," she was told, "You’ll undergo an operation by a senior gynecologist in a [fully equipped] theatre. The price will depend on how many weeks pregnant you are — less than ten weeks will cost LE3,500, and up to 15 weeks will cost LE4,500,”  the administrator said.

"Dr Abortion" asked the reporter to have an ultrasound carried out to determine exactly how far along her pregnancy was. “I’ll tell you [further] details after you have the ultrasound done,” he said, not disclosing any information about the place or the name of the physician.

A dangerous trade

Five days ago, Egyptian media reported the death of a pregnant woman who had taken so-called "abortion pills" to end a problematic pregnancy. The woman was reported to have felt fatigued after taking the drugs, and was admitted to hospital in the governorate of Monufiya where she died later on.

Speaking to Egypt Independent, gynecologist Amr Hassan said that this medication works by inducing contractions of the uterus (typically felt in the form of painful cramps) after which the cervix opens and expels the embryo in the form of a bloody discharge.

In legal medical practice, explained Hassan, the pills are used to terminate pregnancies that would pose health risks to the mother or child. “We use this form of medication when a mother is suffering from cancer or a form of heart disease, or if she has miscarried”.

Article 29 of the Doctors' Ethical Code allows doctors to perform an abortion in such cases, backed up by a detailed report specifying the reasons for the decision and necessary health care to be administered after the procedure. In non-life-threatening cases, the expecting woman is required to obtain official letters of approval from two physicians. 

According to Hassan, abortion medication is available in few pharmacies because Cytotec has to be obtained from abroad and is very expensive — costing as much as LE8 per capsule and LE200 per blister pack. Misotac, he said, is a cheaper Egyptian alternative. Both drugs are sold only to patients with a prescription signed by a gynecologist.                                                      

“The wrong dosage of the medication may lead to severe bleeding and cause a uterine rupture, and possibly the women’s death,” he said. 

Hassan urged the Doctor’s Syndicate and Interior Ministry to carry out cyber crime investigations to crack down on the people selling illegal abortion drugs that threaten people’s health and condone indiscretion in the practice of abortion.  

Soaring popularity

Despite the medical and legal dangers associated with the practice, the figures on abortion rates in Egypt appear to be on the rise. 

A study conducted by the Population Council in collaboration with the Egyptian Fertility Society in 1998 found that the abortion rate in Egypt  had seen a surge in the years leading up to the publishing of the report. It was calculated that for every 100 babies born, 14.8 babies were aborted. 

Another study, conducted by the Cairo Institute on 1,300 women (both married and unmarried) revealed that one-third had attempted abortion, and of study participants from rural areas, 14 percent had administered abortion drugs to themselves at least once.

In the latest studies by the modern medical encyclopedia, it was discovered that 46 million abortions are currently performed worldwide each year, 20 million of which are considered to be unsafe. 

Apart from those seeking to terminate pregnancies out of wedlock, a common factor in the studies was that a considerable proportion of women seeking illegal abortions in Egypt are married. This raises questions about the rate of unwanted pregnancies within marriage and their causes.

The issue is a complex tangle of economic, social and religious causes, but in broad terms, factors such as poverty, insufficient contraception, lack of access to family planning and the traditional gender roles that assign wives to a submissive, non decision-making position have been identified. 

While an assortment of strategies have been adopted over the years to address the issue of unwanted pregnancy, (not least former President Mubarak's regimental contraception and family planning campaigns of the 1990's) there has been little dialogue about the legalization of abortion as a means of protecting women from the dangers associated with illicit abortions. 

The weighty influence of Islam and Orthodox Christianity on Egyptian society dominate the debate to a large extent. In 2010, the Islamic institute of jurisprudence, Dar al-Iftaa, issued a fatwa (ruling) stating that a child cannot be aborted after it has reached 120 days old  — the point when it is believed to possess a soul.  Prior to that point, a woman is permitted to undergo an abortion if her doctor deems the pregnancy a danger to her or the child's health.

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