Pills and Poisons

President Vladimir Putin has praised the autonomous Tuva Republic, one of the poorest regions in Russia, for its high birth rates. Yet Tuva leads the Russian Federation in teen pregnancies and abortion rates. Girls and women buy mifepristone and misoprostol from online groups to circumvent the region's restrictive abortion laws — even at the cost of their lives. 

The only hospital allowed to provide abortions in Tuva is the Kyzyl Perinatal Center. Milana, a Kyzyl OB-GYN, whose name was changed to protect her, said, "Every department of gynecology is hell." The medic described how she sees "ten or more girls per day" who need to get their uteri scraped. Milana believes that counterfeit abortion pills purchased online are causing pregnant women to flock to the hospital doors with complications. The physician said, "When we call the police, they cry, they tell us about their difficult life, that their husband doesn't work and they have many children."

In recent years, multiple Russian regions have restricted pregnancy terminations in private clinics. Since August 2023, 19 regions banned "inducement to abortion." In Tatarstan, Karelia, and Chelyabinsk, officials pressured private practices to stop providing terminations. Since September 2024, mifepristone and misoprostol are listed as "drugs subject to quantitative accounting." Therefore, they are treated the same as narcotics and psychedelics, making it difficult to access emergency contraception that contains them in small doses. 

Journalists from the independent outlet Veter found women's online forums in which users asked for help with unwanted pregnancies. The group included posts promoting foreign abortion pills. One post read, "Girls, I want an answer to the question: Is there any harm in taking Chinese abortion pills?" Journalists contacted the pill sellers in the group. The price of miferoprostone was R5,000 ($65). Anonymous accounts also offered vacuum abortions in private clinics for R15000 ($194).

Gynecologists recommend that patients not take abortive pills without consulting a physician first. Incorrect dosages, poorly timed ingestion, and lack of informed supervisions of complications have had fatal consequences. In 2019, the body of a woman and her 24 week-old fetus were found in Tuva surrounded by bloodied menstrual hygiene products and packages of foreign-made misoprostol. 

Veter spoke to Sayana, another Tuvan woman whose name was changed for her protection. She decided to buy pills online because she did not want to do the tests and psychological exams required prior to a pregnancy termination in Russia. She did not consult a physician and was instead guided by a drug smuggler on how to take the medication. After taking the drug, Sayana experienced toxicosis. Her seller insisted she should not vomit, or the pills would be less effective. Sayana survived, but experienced complications in childbirth a year and a half later and had to resort to vacuum aspiration.

The founder of the Emergency Contraception Fund, Irina Fainman, said Tuva's mountainous geography and distance to other regions make it harder for women to access emergency contraception than in other parts of Russia. It is also easy for smugglers to bring pills from Kazakhstan, Kyrgyzstan, and China, which are right along Tuva's border.

OB-GYN Diana Lobzeva stressed that sex education is necessary to prevent pregnancies. However, authorities have not announced any plans to combat the clandestine abortion crisis.