In the first half of 2012, women waiting at gynaecology clinics in Saudi Arabia were handed a questionnaire about a stomach medicine. Of the 678 who answered, 271 knew that misoprostol could end a pregnancy. Fifty said they had used it that way themselves.

That is one woman in fourteen, in a country where abortion needs a medical committee and a male guardian’s approval. The study’s author, at King Abdulaziz University in Jeddah, compared the figure with similar samples abroad: 2.2% in Brazil and 5% in the United States. Saudi women came out highest.

The knowledge travelled from woman to woman. Of the fifty who had used it, 41 knew another woman who had done the same, and 35 had a relative or friend working in medicine. They heard about it from people close to them, not from a doctor’s leaflet.

Two tea glasses and a phone on a low table, left behind after a conversation between friends.

A stomach pill, found by women in Brazil

Misoprostol was never meant for pregnancy. Searle sold it as Cytotec to protect the stomach of people on long courses of anti-inflammatory painkillers, and that is still the only use on the original label.

A strip of six-sided misoprostol tablets beside a folded leaflet.

Brazil approved it for ulcers in 1986. Within a few years Brazilian women had worked out what else it did, and the news spread the way it later spread in Saudi Arabia, from one woman to the next. The tablets needed no prescription at first and cost little. In its best year Brazil sold 581,003 units. Then the Ministry of Health restricted the drug in 1991, a newspaper campaign turned against it and a double-copy prescription rule arrived.

Regina Barbosa and Margareth Arilha studied Cytotec use in Brazil in 1992. The women valued three things: the price, the convenience and the privacy. Most still reported pain, and most had to go to hospital in the end to finish what the tablets had started. Gynaecologists in São Paulo’s public hospitals saw it from the other side. To them, Cytotec cases were easier than what had come before, because the women arrived with fewer of the injuries that other illegal methods left behind.

Clinics usually give misoprostol after a second drug, mifepristone. Where mifepristone is not available, women use misoprostol on its own, and the clinical guidance collected at misoprostol.org puts its success alone at 75 to 90% of cases. The ulcer tablet is the one that reaches the pharmacy shelf.

The 120 days

Classical Islamic jurists generally held abortion to be forbidden after ensoulment, the moment the soul enters the foetus. Some of them allowed abortion until 120 days after conception; others opposed it at any stage. The schools never agreed, and they still don’t. G. K. Shapiro’s review of the Islamic discourse in Health Policy and Planning found no direct scriptural prohibition of abortion. Jurisprudence discourages it, the review concludes, and scholars split on when it may be allowed and for what reasons. The least contested case is an abortion to save the woman’s life before 120 days.

Four month pages pinned in a row, the fourth half in shadow.

Modern law still uses the same number. When the UAE widened its abortion rules in 2024, Cabinet Resolution No. 44 allowed termination after rape or incest, on condition that the pregnancy is under 120 days.

A woman who takes misoprostol in the first weeks acts well inside that line, at home, with no committee to face.

What the law asks for

Shapiro counted 47 Muslim-majority countries. In 18 of them abortion is legal only to save the woman’s life. Ten allow it on request. Tunisia has allowed it since 1973, and Turkey allows it on request in the first trimester.

Across most of the Arab world, the route that exists runs through a doctor and a medical committee, sometimes a guardian too. The UAE’s 2024 reform widened the rules, and its conditions are strict: the rape or incest has to be reported to the public prosecution at once, the woman needs a year of residence, and a committee of three doctors, a psychiatrist among them, sits with a prosecution representative to decide.

None of that helps the woman who is unmarried, or married and done having children, or not ready. In 2017 the journalist Aya Abdel Rahman interviewed women across the region for Raseef22. Aziza, who became pregnant outside marriage, ended the pregnancy nine days after she found out. “I was afraid of my family and the conservative community in Upper Egypt,” she said. She chose a doctor known for abortions over tablets, because she was frightened of the tablets. She had planned on 5,000 Egyptian pounds and paid 7,000.

Why the tablet wins

A doctor costs money most women don’t have: Aziza’s 7,000 pounds compares with an Egyptian minimum wage of 1,200 a month at the time, which many salaries never reached. A doctor also knows your name. Khadija in Morocco told Raseef22 about doctors who demanded money under threat of reporting her. Habiba, in Egypt, went to a doctor she counted as a friend, and he made advances.

A tablet costs less, and nobody else has to know. In Egypt, the local misoprostol brand Misotac sold for 11 pounds a pack, about 60 US cents, until the government pulled it from pharmacies. After that it cost 50 pounds under the counter. In Saudi Arabia, the UAE, Qatar and Kuwait it moves on the black market, and anyone who searches for it finds the sellers at once: Facebook pages called “Cytotec200mcg Abortion Tablets For Sale In Dubai”, and Gulf phone numbers pasted into the open forums of university and research websites.

What happens next looks like a miscarriage. Planned Parenthood’s advice page says there is no test for abortion pills in the body, and the symptoms look the same as a miscarriage. A hospital treats an incomplete abortion the way it treats an incomplete miscarriage. A woman whose greatest fear is her family finding out weighs that above the price.

Where it goes wrong

In the accounts that end badly, the trouble comes from fear, guesswork and fake supply.

Samira told Raseef22 about a friend who could not find a doctor, went to unlicensed clinics and then swallowed a large dose of banned drugs at home. She bled heavily. “She was on the verge of death,” Samira said. She did not take her friend to hospital, because she was afraid they would be reported.

The Saudi study found a gap in knowledge. Every one of the fifty women who had used misoprostol believed it posed no risk to a pregnancy that continued, and 48 of them believed later pregnancies needed bigger doses. The study marks both answers as wrong. A pregnancy that continues after misoprostol can be harmed by it, and the Cytotec label lists birth defects among the risks.

Then there is the supply. Black-market tablets come with no quality control, and in Brazil, where this market is decades older, a single abortion’s worth of pills often costs hundreds of dollars from a seller met through WhatsApp.

Four things worth knowing

The World Health Organization’s position is calmer than the box: a medical abortion in the first 12 weeks can be safely self-managed outside a clinic. What makes the difference is practical.

  • Know how far along you are, and that the pregnancy is in the womb. An ectopic pregnancy will not end with tablets, and a scan settles both questions.
  • Get real tablets from a source you trust, with the maker’s packaging.
  • Go to hospital if you soak through more than two pads an hour, or have a fever over 38°C. The symptoms and the treatment are the same as for a miscarriage, and that is how a hospital will treat you.
  • If the bleeding never starts, or the pregnancy symptoms carry on, you may still be pregnant. A scan tells you.

The Cytotec page sets out the checks before it is used for an early miscarriage or abortion, and the miscarriage page explains what the process looks like.

Barbosa and Arilha closed their 1993 paper on Brazil by arguing that what they had seen made the case for legal abortion. In most of the 47 countries in Shapiro’s count the law still allows it only in narrow cases. The women in this story found their way around it, most of them with help from another woman who had done it before.