Attempts to Purchase Misoprostol Online in Indonesia: A Mystery Client Study Design
Abstract Introduction: Abortion is highly restricted in Indonesia; self-administered misoprostol can safely induce an abortion. Pharmacies, a common place to purchase misoprostol off-label in other parts of the world, are monitored in Indonesia so that they cannot function outside the law. Misoprostol is for sale online through in-country distributors. Such procurement offers a level of safety and anonymity to the buyer and seller. So as to understand online acquisition of misoprostol, we created a protocol to capture the most visible universe and of sellers, how they engaged with clients, and what women’s experiences were likely to be attempting to buy misoprostol from them. Methods and analysis: We carried out a mystery client methodology to replicate the experiences of women procuring misoprostol online. Our study consisted of five sections: (1) identify the universe of online sellers using the most common search terms, drawn from multiple platforms to capture diversity in interactions as well as products sold (2) remove sellers advertising on more than one site as determined by their telephone numbers (3) draw a roughly probability proportional to size sample (4) contact sellers as mystery clients through text/chat, depending on the platform and engage with them using one profile (marital status, age, and number of children) and (5) purchase drugs offered by the seller. Ethics and dissemination: Ethical considerations include that by purchasing abortion medications from these online sellers, its possible that we made it harder for women seeking to buy drugs from online sellers. Our engagement with these online sellers may have resulted in some of them feeling under scrutiny and possibly pausing their sales. Dissemination plans include depositing a preprint of the paper, sharing the protocol with other study teams who are interested in replicating the methodology in other locations, and sharing our data collection tools on SurveyCTO.