In 2019 at least four people in northern Poland ordered abortion pills through an international feminist network but found their medicines destroyed when the packages arrived. They assumed customs agents had opened the packages, removed the pills from the blister packs, and crushed them before repackaging and sending them on. It is not a crime to order abortion pills online for shipping to Poland, so customs agents had no legal basis for impounding or damaging the medicines. Abortion-seekers and their supporters saw the destruction of the pills as intimidation amidst increasingly hostile and aggressive anti-abortion policing.
Poland's abortion underground is shaped by fears of two sporadic, unpredictable things: fake abortion pills and police crackdowns. Here I explore the relations between the two.1 Rumours circulate about women who buy fake abortion pills online, and police occasionally pursue individuals facilitating abortions, which is a crime in Poland. Only intermittently do either the fake pills or the real police materialise. They nonetheless have a profound impact on Poland's abortion underground and on how abortion-seekers navigate paths to clandestine abortion. To understand this, I here use the concept of ‘fake-talk’ (Hornberger and Hodges 2023). Fake-talk as a framework points us to claims about fakeness and their social, political, and economic effects (ibid.: 9–10). The purpose is to determine not the truth value of these claims but how they express ‘otherwise inexpressible predicaments and anxieties’ (ibid.: 16). I adopt this framing not because there is persuasive evidence that Poland is awash in fake drugs but because the possibility of fake drugs (and fake doctors, fake clinics, etc.) shapes how people navigate pathways to abortion.
Using this framework, I offer a taxonomy of fakeness in the Polish abortion underground. The absence of formal, trustworthy institutions to regulate abortion pills and providers generates fears of fake medicines, fake abortion providers, and police interventions. Fake-talk does different things for different actors: (1) for abortion-seekers trying to source medication abortion through informal markets, fake-talk helps explain why abortion pills sold online are not always effective, and it expresses the uncertainty that comes with navigating an online market in abortion pills; (2) for vendors selling abortion pills, fake-talk helps distinguish their products from those of their competitors, justify high prices for uncertain products, and generate doubt about competitor sites; (3) for abortion-seekers and networks assisting them, fake-talk helps rationalise ambiguous relationships with doctors, regarded as suspect authorities who will help (for a fee) in some cases but obstruct in others. I develop each of these uses of fake-talk in turn. Abortion pill products circulating in Poland consistently slip between the categories of real and fake, licit and illicit, legal and illegal. But fears about fake pills indicate more about the socio-political context than about the pharmaceutical contents of medications. Fake-talk in Poland helps us see strategies people use to self-manage healthcare in the absence of public provision, in a context where criminalisation of abortion-related activities is sporadic but ever present. This article draws on interviews carried out between 2018 and 2021 with Polish people living inside Poland and abroad.
Anti-Abortion Policing in Poland
Anti-abortion policing in Poland sets the context for self-managed abortion. This happens in two ways: through state policing by agents who (occasionally) enforce restrictive laws, and through the effects of anti-abortion norms and beliefs shaping how and where people obtain clandestine abortions. Anthropologists of policing see policing as an artifice built on top of ‘prior forms of moral order’ (Martin 2018: 135). This resonates with feminist critiques of state governance and police institutions, which have historically criminalised women's efforts to control their own sexuality and reproduction (Chesney-Lind and Hadi 2017). Before legal structures and police cast abortion, contraception, and other forms of sexual autonomy as criminal, patriarchal norms treated them as defiance of the moral order. Criminal laws against abortion enshrine the idea that abortion-seekers and providers are morally deviant and dangerous to society (Cook 2014). Some forms of sexual and reproductive autonomy are more widely accepted today, but abortion is exceptionalised and singled out for penalties and restrictions not applied to other treatments of similar safety. The ‘rules are different’ for abortion (Corbin 2014: 1179).
Only a few jurisdictions have decriminalised abortion. It remains criminalised in most countries, even where some abortions can be legally obtained. Criminalisation is built atop the moral order of abortion stigmatisation. This is evident in a persistent stigma even where abortion is legal (Kumar et al. 2009) and in research showing that stigma is compounded in countries where abortion is criminalised and difficult to obtain (Shellenberg et al. 2011). Criminalisation and stigmatisation reinforce each other, Anuradha Kumar shows: ‘The fact that access to abortion is so limited, that few providers are trained and prepared to provide safe abortion care, and that abortion laws are part of criminal codes in many countries could all be causes of abortion stigma. Or, they could be consequences of abortion stigma’ (2013: e330). That criminalisation and stigmatisation reinforce each other helps us understand how abortion is policed. Despite widespread criminalisation in law, action to arrest, detain, and prosecute individual abortion-seekers is relatively rare. Criminalisation is common, but policing is sporadic. According to scholars of abortion in legally restrictive contexts, not only is the crime of abortion hard to prove in evidentiary terms that would stand up in court (Kimball 2020; Mishtal 2015) but also anti-abortion states have little interest in detecting and prosecuting all instances of illegal abortion. States prefer ‘strategic ignorance’, whereby they choose not to collect data on, investigate, or prosecute the majority of illegal abortions (Freeman and Rodriguez 2022; Sheldon 2018). Not acquiring knowledge about clandestine abortion relieves states of pressure to act against people who flout the law, or obligation to reform laws that have lost legitimacy.
Anti-abortion policing can therefore proceed through quiet, targeted acts of intimidation, as in the case of the crushed abortion pills, so that criminalisation and stigma incentivise people to manage abortions through ‘concealment, secrecy and shame’ (Cullen and Korolczuk 2019: 8). Poland illustrates this dynamic: many abortions are criminalised, yet few come to the attention of police or the courts. Nonetheless, the anti-abortion climate means that social sanctions pose a greater threat than police do, informally policing abortion by compounding social stigma.
Poland had legal, subsidised abortion as a socialist state before it dramatically restricted abortion after the democratic transition (Gal and Kligman 2000; Kramer 2009). It implemented a highly restrictive anti-abortion law in 1993, and further restrictions in 2020. In practice, it has a complete abortion ban. People generally access abortion through two pathways. Those earlier in pregnancy tend to self-manage abortions with pills obtained through the internet or transnational activist networks. Those further along in pregnancy who cannot safely self-manage with medication abortion tend to travel to neighbouring countries for legal surgical abortion in a clinical setting.
The legal context for self-managed abortion is essential to understanding these pathways. Polish law does not criminalise people ending their own pregnancies. It criminalises anyone who terminates someone else's.2 This reflects how abortion was obtained in Poland at the time when the restrictive law was passed. When abortion was surgical, criminalising anyone who provided an abortion effectively criminalised all abortions. Today, the prevalence of self-managed abortion with pills, which allows people to be their own abortion providers, makes the distinction between the pregnant person and the provider anachronistic. Nor does Polish law prohibit importing abortion pills. It is not a crime to bring medications into Poland for personal use—in person or through the internet—even if these medications are not sold inside Poland. A lawyer from a reproductive rights nongovernmental organisation (NGO) explained that abortion pills can therefore be legally brought into Poland by the person who will use them. However, sex educators and abortion rights campaigners told me that stigma and poor sex education mean that many people are unaware that self-managing your own abortion cannot be treated as a crime.
Anti-abortion policing in Poland is irregular. People having abortions cannot be criminalised, so police and prosecutors instead pursue those who help them: doctors, family, friends, activists, pill vendors. Actual abortion-related prosecution is rare. Ninety per cent of cases registered never proceed to prosecution, and no public data exists on conviction rates for cases that do (Krajewska 2022). Nonetheless, fear of criminalisation persists and profoundly shapes the experiences of Polish abortion-seekers. Since 2015, when the hardline anti-abortion Law and Justice party took power, investigations and registered cases for abortion-related crimes have increased (ibid.). The time period between 2001 and 2014 saw an average of thirteen convictions per year (Mijatović 2019). In 2018 alone there were thirty-two convictions.3 Investigations and prosecutions of online pill vendors have also increased (Dudek 2020). In 2023, the activist Justyna Wydrzyńska was tried for assisting an abortion—the first time Polish authorities prosecuted an activist under abortion law. Wydrzyńska attempted to mail pills to an abortion-seeker. These were intercepted and never used, but Wydrzyńska was convicted and sentenced to eight months’ community service (Chrzczonowicz 2023; Kość 2023).
Despite the force of stigma and possible criminal penalties, an estimated eighty thousand to two hundred thousand Poles obtain abortions annually, some in foreign clinics but many in Poland with pills obtained online (Mijatović 2019). Criminalisation does not lead to widespread policing, but the spectre of the latter generates pathways which people must navigate in secret. This is where the fear of the fake arises.
Policing creates incentives for finding fakes, as the articles in this special issue show. The menace of fakes prompts the need for more policing. Studies from South Africa, Zimbabwe, and India show this through research on police and regulatory agencies tasked with finding the fake and accomplishing this in creative ways that sometimes involve constructing the conditions under which ordinary materials can be construed as fakes (Hodges this volume; Hornberger and Hodges this volume; Kufakurinani this volume; Thakur 2023). My account of fake-talk in Poland shows something different. Polish police do not target fake abortion pills, because these are not criminalised. What they police is the act of abortion when it occurs in a particular place (inside Polish borders) and in a particular way (with assistance from people besides the abortion-seeker). Fake-talk about medication abortion pills does not provide policing with a raison d’être as it does in other settings.
Instead, fake-talk helps people navigate the Polish abortion underground that flourishes under criminalisation. Anti-abortion policing is sporadic, but its spectre and the ever-present possibility of social sanction pushes people into an underground characterised by uncertainty. In that context fake-talk does three things: it shapes how people understand pills and vendors in a vast online marketplace; it helps vendors distinguish themselves from competitors; and it explains, for abortion-seekers and supporters, the ambiguities and risks faced with doctors, who are sometimes allies, sometimes enemies, and sometimes profiteers.
Searching for an ‘Original Set’: Fake-Talk as an Explanation for Ineffective Medicines
In 2008, a women's rights NGO reported on the state of abortion in Poland. It explained that restrictive laws had generated a thriving ‘black market’ with ‘huge profits’ and abundant scams, where vendors exploited women by selling costly ‘pills of unknown origin, dangerous to health’ (Nowicka 2008: 29–30). On internet forums, the NGO's warnings are echoed in peer-to-peer information and advice about how to avoid both fraudulent pills and police attention. On these forums rumours circulate about people who were sold fake pills. Users direct one another to suppliers they believe will offer an ‘original set’ of pills, meaning authentic mifepristone and misoprostol, and warn against vendors with reputations for selling ineffective products (Mishtal 2017).
Stories about ‘fake’ pills focus on the absence of successful abortion. Rumours circulate about rogue vendors who try to pass off paracetamol as mifepristone or misoprostol, at a hefty price, leaving people poorer and out of time. I do not suggest Poland's market in abortion pills is free of fraudulent or mislabelled products. People could well sell mislabelled medications that are in demand but inaccessible. But my interest lies in the effects of fake-talk around these.
Conversations between activists and pill-users, plus online conversations among pill-users themselves, illustrate how abortion pills become real or fake. People who ended their pregnancies successfully testify about the products of a particular site. People who attempted abortion unsuccessfully warn of fake pills sold by particular vendors. Often these warnings include the claim that vendors advertised mifepristone but only provided misoprostol. Misoprostol is likely, but not guaranteed, to induce abortion. Warsaw-based activist Aga described a typical call with someone sold mislabelled but potentially functional pills:
[The caller says] ‘I took mifepristone!’
[And I say] ‘What did it look like? OK, you didn't take mifepristone…’.
Sometimes we have this after we warn people, saying: look, these are the webpages who are just sending misoprostol. It's just misoprostol, and not mifepristone, but it's not poison.
How do we make sense of this misunderstanding? A medication abortion usually involves two drugs: mifepristone, followed by misoprostol. Mifepristone blocks hormones sustaining pregnancy. Misoprostol induces contractions, expelling the pregnancy. Mifepristone and misoprostol together are most effective, but misoprostol on its own is effective too, easier to obtain, and widely used by itself. The protocol for a first-trimester abortion with mifepristone and misoprostol uses five pills: one of mifepristone (200 milligrams) plus four of misoprostol (200 micrograms each). These are frequently packaged together as a ‘combi-pack kit’. A misoprostol-only regime calls for twelve misoprostol pills (200 micrograms each, taken four at a time at intervals of three hours). What determines usage is the availability of misoprostol. If easily (or illicitly) bought in pharmacies, as across Latin America, misoprostol-only regimes dominate (Drovetta 2015). Mifepristone is not approved for sale in Poland, and misoprostol is available with prescription only, so neither medication is easily bought.
Poles obtain medication abortion online through two routes. First, they can obtain pills from transnational networks like Women Help Women and Women on Web, both based outside Poland. These groups facilitate the shipment of abortion pill packs from distributors in India. Mifepristone-plus-misoprostol combi-pack kits are cheaply and widely available in India, and they are legally manufactured and exported from there. After placing an order with Women Help Women or Women on Web, an abortion-seeker can expect the pills shipped directly.
The second route is a marketplace of online Polish pill vendors who serve only the Polish market. These vendors sell an unusual product, differing from the typical combi-pack kit. Polish vendors frequently advertise a regime known as the ‘1 + 12 set’, consisting of one mifepristone plus twelve misoprostol pills. This product purportedly combines mifepristone-plus-misoprostol and misoprostol-only regimes. Vendors tell users to take the mifepristone, wait twenty-four hours, then proceed with the misoprostol: four pills every three hours for a total of twelve. Such a system is unique to Polish online vendors, for an important reason: according to reports from activists and users, many such vendors do not actually sell mifepristone but misoprostol only. They do so because mifepristone is difficult to obtain in Poland while misoprostol is more easily available. Moreover, taking twelve misoprostol is highly likely to induce an abortion, so vendors can market the product at a higher price, and effectively promise the same result as mifepristone, while in fact selling something else.
A misoprostol-only regime is less effective than mifepristone-plus-misoprostol, but if used correctly, it is likely to work. According to a 2019 meta-analysis, taking at least twelve 200mcg misoprostol pills over a 48-hour period has an 87 per cent likelihood of terminating a pregnancy in the first trimester (Raymond et al. 2019). However, without knowing whether your pills are mifepristone-plus-misoprostol or misoprostol-only, correct administration and successful abortion are less likely. For some people misoprostol by itself is effective, while for others it does not work because they do not know how to use it.
Lacking formal channels to obtain medicines, or authorities who regulate pills’ journeys, abortion-seekers often contact activist groups to authenticate the pills they sourced online. Activists receiving such requests say they ask for photographs of the packaging or pills. The pills are distinguishable by shape and, depending on these shapes, users might need to administer them differently, as long as they can identify the pills ahead of time.
As in the foregoing exchange—‘It's not mifepristone, but it's not poison’—activists I spoke with often associated online vendors with mislabelled products. But they stopped short of forum users’ claims that such vendors sold fake pills because they saw rumours concerning fakeness as another form of anti-abortion misinformation. The fear of the fake shapes how pill-users navigate the online marketplace, but fake-talk around vendors carries risks.
The claim that people are buying ‘misoprostol…but not poison’ stakes out a particular position in feminist debates over self-managed abortion. Feminists in Poland are divided over their attitudes to medicalisation and formal regimes to govern abortion (Chełstowska and Ignaciuk 2023). Some want an improved medico-legal framework for channelling abortion into clinics and hospitals. Others are wary, believing that medicalisation gives too much power to authorities whose regulations for allowing some abortions will inevitably disallow others (Assis and Erdman 2022; Jelinska and Yanow 2018). This maps onto wider debates about self-managed abortion in informal settings and without formal medical support (Erdman et al. 2018). Abortion rights advocates are divided over informality: is self-managed abortion with pills a stop-gap, until legal reform lets medical institutions direct abortion care, or is it a liberatory way to organise services, potentially preferable to medicalisation? The lens of fake-talk shows that feminists who worry about fake abortion pills tend to choose the former answer; feminists sceptical of fake-talk (and the stigma it generates), the latter.
Dodging the ‘Fraudster’: Fake-Talk as an Advantage in the Marketplace
Fake-talk around abortion pills in Poland is not limited to users who doubt the quality of purchases. It also flourishes among online vendors who use the discourse around fake pills to mark their own products as authentic and their competitors’ not. In 2020 a website trading as 9Tygodni (9Weeks) issued this warning to customers:
Most abortion pill sites are created by scammers who want to make money in an easy and fraudulent way…. After making the payment [to them], you can be 100 per cent sure that someone on the other side is rubbing their hands with satisfaction, because they have enriched themselves with a few hundred złotys in a simple manner, while you can wait in vain for any contact and even more so for the parcel to be sent.4
9Tygodni offered further tips on identifying a scam, including: the site does not list a phone number, only an email address; it allows payment in Bitcoin only; or it offers a ‘complete and original set’ of abortion pills for less than 500zł ($112). Finally, it warned, if another website uses text and images like 9Tygodni's, this marks it as an ‘amateur’ copying from a ‘reliable seller’. Abortion-seekers find themselves in a hall of mirrors, navigating warnings about fraudsters whose websites are fraudulent because they resemble those of self-proclaimed non-fraudsters (including warnings about other fraudsters). To differentiate the real from the fake becomes nearly impossible. Polish activists, meanwhile, accused 9Tygodni of being predatory. On social media, buyers from 9Tygodni reported not receiving their pills, receiving false mifepristone, and being blackmailed when requesting a refund.
Pill vendors engage in fake-talk to lend credibility to their sites, in a marketplace of many competitors selling apparently similar products at similar prices. Allegations of fraud surround many of them but are easy for vendors to circumvent. Websites often disappear and re-appear under new names and URLs. With each new vendor (or new iteration of an existing vendor), sites take steps to establish authenticity. They do this in relation to rival sites (as in the foregoing warnings) and to familiar institutions in abortion provision.
Several Polish vendors present themselves as the web presence for brick-and-mortar clinics in the Netherlands. Some list a street address in Utrecht which is the genuine address of the Vrelinghuis clinic. The clinic is not affiliated to these websites and itself posts a disclaimer about them. Claiming to be the online presence for this clinic allows vendors to establish the quality of their products but also allows them to make claims about their legal status. One site (wrongly) claims it is permitted to sell genuine mifepristone and misoprostol to Poles because it represents a clinic in the Netherlands where such medications are legal. Another site, trading as ‘Tabletka Poronna’ (‘Abortion Pill’), also lists its address at the site of the Vrelinghuis clinic and offers Poles the option to read about ‘our friendly clinic in the Netherlands’, linking to a news item in the Polish press about abortion travel to Utrecht. Having established that travelling to the Netherlands for surgical abortion is a possibility, the site suggests another option: ‘Currently, a much cheaper method of abortion is available in Poland, using early-morning [sic] pills until the 9th week. You can order secure tablets on our website with 48 hours delivery’. Polish media often report on abortion travel to the Netherlands and Germany, making that familiar to abortion-seekers on these websites. Vendors also play on associations between particular countries and abortion travel from Poland because these pathways have been in regular use in the decades since abortion was restricted.
Abortion travel pathways matter to fake-talk because when Poland outlawed most abortions in 1993, a market in abortion travel emerged. Abortion travel services ranged from referral agencies linking abortion-seekers with clinics abroad to full-service companies arranging bus trips to clinics in bordering countries. By the mid-1990s at least twenty companies operated, annually facilitating more than sixteen thousand abortions abroad (Ciaputa 2019). These services dwindled after some agencies were prosecuted and people in them were jailed. As organised travel services declined, abortion travel shifted towards self-organised arrangements and to private clinics in countries south and west of Poland (Ciaputa 2019). Pathways for abortion travel from Poland have historically been shaped by class and geography, and these patterns continue. Wealthier women travelled to the Netherlands, Germany, Belgium, or Austria, where abortion services were thought better but cost more. People in the south or east of Poland, or who could not afford to travel west, went to the Czech Republic, Slovakia, or Ukraine (before 2022). There are border-city clinics serving the Polish market with Polish-language phonelines, websites, and in some cases travel services from major cities to clinics and back. This abortion geography provides the context for pill vendors selling in Poland.
The uneven geography in which abortion-seekers and activists determine fakeness or authenticity also plays out for pills themselves. For many who order pills through international feminist networks, the pills will arrive from India. This is the cheapest, easiest route, because mifepristone and misoprostol manufactured in India are inexpensive and straightforward to export. Nonetheless, fake-talk around Asian pharmaceuticals in European media also shapes abortion-seekers’ views of Indian drugs, heightening suspicions that medicines are fraudulent (Hodges and Garnett 2020). Activists who help obtain pills explain the attitudes they see among abortion-seekers: ‘[They ask us], “Why is it from India or China”? And we have to say that it's cheaper outside the European Union. But they ask, “Why India? Why not from the United States”? [Laughing] Because it's always better. Good part of the world, bad part of the world’.
Abortion pills follow different pathways, depending on their origin and the identity of the group facilitating shipment. Dutch abortion clinics do not send pills abroad, but feminist activists in the Netherlands do facilitate shipments from Indian distributors to Polish customers. Polish online vendors situate themselves in the wider geography of abortion travel by claiming connection with Dutch clinics and Dutch activists. The vendor behind 9Tygodni misidentified itself as a Dutch organisation called Women on Earth, which purports to ship pills from the Netherlands. This is presumably to attract people who have heard about Women on Web or Women Help Women, both of which are in the Netherlands and ship pills to Poland. Polish vendors claiming to be Dutch clinics collapse the fine distinctions, but these distinctions are also lost in international media coverage. An American broadcaster recently had to issue a correction for stating that activists in Austria and Germany directly mail pills from their homes into Poland, when in fact they help abortion-seekers obtain pills from India via Women Help Women (Shapiro et al. 2022).
Abortion-seekers buying pills from online vendors face the risk of fake or ineffective pills as well as the possibility that sites are under police surveillance. The proliferation of Polish vendors has attracted attention from police who occasionally, but sporadically, intervene in the market (Dudek 2020). Vendors face legal risks, and some have been convicted. People buying pills to end their own pregnancies do not commit any crime, but they have been swept up in police action against vendors. An activist in Warsaw described a helpline call she took from a woman whom police twice called because her phone number was in the client database of a vendor police had raided. The police said the woman's case would end up in court. Unaware of the legal intricacies, she was deeply frightened. Later, a female officer took her aside and said that even if she had used the pills, she would not have committed a crime under the law.
In a fake-talk reading of this incident, we see how policing of self-managed abortion blurs the lines between legal and illegal, licit and illicit. Pill vendors selling misbranded or unapproved products might face legal risk, but no one buying those products for themselves can be charged. Pills illegal to sell are legal to buy, and use, though only in certain circumstances. This illicit but legal product carries criminal associations because of the secrecy and fears of fraud that shape its market, but self-managed abortion is not a crime. Nonetheless, police power to distort these categories and leverage anti-abortion stigma can intimidate abortion-seekers.
Real Doctors, Fake Pills? Fake-Talk as Explanation for Untrustworthy Institutions
Fear of the fake makes people suspicious of online vendors because so many portray themselves as reliable but reportedly sell faulty products. Facing this risk, some people buy abortion pills from doctors who sell them informally. Others pay for a referral from a Polish doctor to a clinic abroad. Online, abortion-seekers might struggle to distinguish the real from the fake, but the same problem faces those buying possibly fake pills from real doctors. Poles seeking an abortion find it plausible that doctors offer clandestine business related to abortion, because Polish doctors have a long history of providing abortion in the shadow of the formal system.
Facing enormous demand for abortion in a climate of criminalisation and stigma, doctors easily profit by selling abortion pills or medications promoted as such. A Polish employee at an abortion clinic in Vienna reports that she regularly sees Polish patients come there after unsuccessfully using pills bought online. In one instance she could verify that faulty pills had been sold by a practicing Polish gynaecologist: the patient ‘paid for tablets twice, 1200zł [$310] each time’ but they did not cause an abortion. When the patient reported the failure, the gynaecologist ‘told her that she just needed to buy another set!’ Facing buying a third round and not aborting, the patient went to Austria where she paid at least six hundred euros.
Doctors in the underground abortion economy also charge patients for referrals to foreign clinics, although these amount to little more than selling publicly available contact information. Another Polish translator who had worked in the Vienna clinic describes the case of two Polish women referred by a gynaecologist in a border city in the south of Poland:
He was giving women a piece of paper with our clinic's name and email address under the table. He charged 400zł [$100] for that. And then, we had two women from [that city] in a row…. I called him later, because I felt that his charging those women for nothing was completely unacceptable. He started shouting at me that I shouldn't call him, because anyone could be listening to his phone.
At various times in Polish history, abortion has been publicly available and legal, privately available and legal, or privately available and illegal. Private providers have emerged charging high prices to offer a stigmatised service discretely (Mishtal 2015). Despite anti-abortion conservatism in the profession, Polish doctors have historically had, and still have, economic incentives to provide clandestine abortions. Agata Chełstowska (2011) calls this ‘turning sin into gold’: though stigmatised and criminalised, abortion in Poland is also thoroughly commercialised.
To study pill vendors, I worked with a Polish-speaking researcher, Zosia, to contact sellers advertising online on classified ad sites and public forums. Zosia called the advertised phone numbers for twenty vendors, posing as a six-weeks pregnant woman in Łódź seeking pills. She asked the vendors questions any abortion-seeker finding their number online would. She did not ask about their identities or addresses. One of these calls reached a man describing himself as a practicing doctor in central Poland. He told Zosia she had to travel to his office for collection:
Do you want to come by train or car? We need to arrange it in advance, as I have my hospital practice and quite a lot of work in surgery…. I still need you to go to a gynaecologist in Łódź to confirm the pregnancy and tell you exactly how many weeks you are. If they want to start a pregnancy card—usually they don't do it during the first visit, but they might—don't panic. When everything is over, I will tell you exactly what to say to them, so it looks like a natural miscarriage.
A pregnancy card is used by doctors to monitor visits, tests, and interventions during pregnancy. The doctor assumed Zosia would be worried because this would create an official record with her local doctor and thus raise eyebrows next time she returned, no longer pregnant. When Zosia asked about payment, the doctor said he charged 1500zł [$380]—cash only—for the pills. But he explained that the quality of the products justified the high price:
You will find adverts out there for 300–400zł [$75–$100]. The internet is full of ridiculous advertisements from people who know nothing! You will see the ‘1 + 12’ nonsense. I had patients who did that and then the tablets were not genuine. I had to help them. I charge more, but I will be in contact with you the whole time and you can feel safe with me.
When the doctor warned about the ‘1 + 12 set’, he was referring to the kind of online vendors addressed earlier. His use of fake-talk allowed him to tout the quality of his products to Zosia, and to justify his higher price, while assuring her about his motives: ‘I am not doing this for the money, believe me. I have enough work, but to be able to help long-term I need to charge, as it costs me as well. And I have too much to lose here’.
A doctor facilitating an illegal abortion faces legal risk, though convictions in such cases are rare. Police must catch an abortion provider ‘in the act’ for it to be counted as a crime, and this proves a difficult standard for police to meet in practice (Mishtal 2015). Abortion providers who are convicted usually face fines and/or temporary bans on practicing, only occasionally receiving suspended prison sentences (Krajewska 2021, 2022). Professionally, however, they might face career-ending ostracism. The Polish medical profession is highly conservative and publicly associated with support for anti-abortion laws, even advocating more restrictive interpretations than required (Cullen and Korolczuk 2019). Polish doctors report a fear of being associated even with legal abortion. They fear loss of career opportunities, ostracism by colleagues, or public denunciation from the pulpit, as has happened to doctors named as abortion providers (De Zordo and Mishtal 2011). Surveys of Polish doctors show the post-1993 generation holds more conservative anti-abortion views and tends to see clandestine providers as profiteers, rather than advocates for patients (STER 2018). Anti-abortion laws generate and reinforce anti-abortion stigma against those who seek it, as well as those who provide it.
Doctors’ pronouncements of anti-abortion views do not always mean they refuse to provide abortions. Studies of Polish abortion pathways have found that many doctors operate different systems for dealing with requests: refusing abortions in the public system but providing them for a fee after-hours at private clinics (Caytas 2013; Chełstowska 2011; Ciaputa 2019; Mishtal 2015). As one activist said to me: ‘The abortion underground is part of a national hypocrisy. It's fine, as long as we don't talk about it!’ Many interlocutors articulated this sense of hypocrisy when sharing local rumours in their hometowns: the anti-abortion doctor who provided abortions for a fee, the right-wing politician who paid for his daughter to have an abortion in Germany, or the Catholic clergyman who was known to have a secret family nearby. For my interlocutors, saying one thing about abortion and doing another was a fact of Polish public life that also explained its flourishing abortion underground and the uncertainties abortion-seekers navigate in the absence of formal institutions to regulate or authenticate abortion medicines and providers. Abortion-seekers are left to distinguish real doctors selling fake pills from fake doctors selling real pills, and everything between. Situated in the context of Polish abortion history and geography, the categories themselves become blurry.
Conclusion: Neither Mifepristone, Nor Poison
Here I have developed a taxonomy of fake-talk in the Polish abortion underground. Fake-talk results from the ambient fear of criminalisation in a context where the legal status of abortion is complex and anti-abortion policing is unpredictable. Anti-abortion laws might be enforced by legal authorities or anti-abortion social norms might be enacted in daily life. Sometimes both. Regardless, official channels for obtaining safe abortion do not exist, so abortion-seekers pursue self-managed and cross-border routes.
Fake-talk shapes how people understand the quality and authenticity of products ordered online, vendors from whom they buy, and doctors they ask for assistance. In each case judgements of real or fake are complex products of social, geographical, and medical factors. As with much discourse around fake medicines, evidence of fakeness is hard to come by. Indeed, determining if an abortion pill is fake might lie ‘beyond pharmaceutical ways of knowing’ (Hornberger and Hodges 2023: 4). It might instead come from people's perceptions of the pathways they took to obtain medications. Claims about fakeness result from the prevailing sense of uncertainty, lack of trust, and sense of vulnerability to exploitation that Polish abortion-seekers face. At the same time, claims of fakeness are themselves obstacles to navigating a safe self-managed abortion: the warning that a mislabelled misoprostol pill is ‘not mifepristone, but not poison’ reminds us that the efficacy of abortion pills is determined by many factors that exceed typical ways of understanding the difference between real and fake drugs.
I conclude with two points showing why fake-talk matters outside this empirical context. First, claims about fake abortion pills speak to the social construction of pharmaceuticals. Claims about real and fake are as determined by what is outside the drug as what is inside it (Hardon and Sanabria 2017; Thakur 2023). A product can be judged fake from its packaging, documentation, or route of travel—none of which speak to its chemical properties. Pharmaceuticals follow complex ‘logistic regimes’ (Quet et al. 2018: 488) shaped by technologies, regulatory rules, political relationships, economic factors, and health concerns. These regimes determine where pharmaceuticals move, how they are transported, how they are governed, and how they are economically valued (ibid.), as well as how and when they are identified as genuine or fraudulent.
Where different logistic regimes overlap, they can create friction between different conceptions of legality, licitness, and authenticity, blurring the status of materials as they circulate (Gregson and Crang 2017; van Schendel and Abraham 2005). Depending on the geography and logistics of its journey, the same medicine ‘can be legal or illegal, cheap or expensive, considered efficient or dangerous’, and so on (Quet 2017: 157). These categories can be difficult to parse because the language used to discuss pharmaceutical products often collapses important distinctions: labels like falsified, fake, counterfeit, substandard can be applied to medications, depending on how they are produced, tested, labelled, packaged, stored, or traded (Hornberger 2018). Abortion pills vividly illustrate this point. Legally produced in one place, good-quality generic pills can nonetheless become tagged as fake on crossing a border, by virtue of being unapproved. Although abortion pills circulate through familiar logistic regimes that make them accessible informally (and inside states where they are criminalised), their social meaning remains complex and contested. Where people engage in illegal activities, they may reject the state's categorisation of those as ‘criminal’ and develop their own notions of the licit and illicit (van Schendel and Abraham 2005: 23–25). They nonetheless confront uncertainty, ambiguity, and stigma when undertaking those clandestine activities.
Second, a fake-talk framework helps us understand abortion discourses outside Poland. Fear of the fake shapes the narratives abortion advocates use to advocate for reform. For example, the figure of the rogue abortion provider came to stand in as rationale for preserving legal abortion in the United States: without legal abortion available in medical facilities, women would again fall victim to the figure historian Rickie Solinger terms the ‘Back Street Butcher’ (2001). The problem, Solinger argues, is that this was a fiction. It did not represent how people obtained illegal abortions. Dangerous illegal abortions tended to be self-induced, whereas illegal abortion providers were often trained people acting in secret but in relative safety. Deaths from unsafe abortion are indeed more common where abortion is illegal, but this is often driven by self-induced abortion with dangerous methods, rather than the actions of predatory rogue providers (Singh et al. 2018). The figure of the Back Street Butcher is important not because it is accurate but because it provides an argument for keeping abortion legal.
A parallel to the Back Street Butcher has emerged in debates about self-managed abortion with pills. The spectres of fake pills and dangerous online vendors now appear in pro-abortion campaigning, as rationales for bringing abortion into clinical settings. Pro-abortion discourses in Ireland and the United States express similar sentiments that legal abortion is important to protect abortion-seekers from the dangers of pills bought online (Belfrage and Freeman 2023; Calkin 2023). They use fake-talk in campaigns to reform abortion laws and open pathways to safe clinical care. Laudable as the goal might be, the pro-abortion narratives dabbling in fake-talk are often reductive and reinforce dubious distinctions about what makes some pills good and others bad. They risk misrepresenting the quality of products available online (Murtagh et al. 2018), the safety of self-managed abortion with medication sourced online (Aiken et al. 2022), and the potentially transformative effects of de-medicalised modes of abortion provision (Assis and Erdman 2022). Fear of the fake generates its own political momentum and forecloses new ways of thinking about self-managed care.
Acknowledgements
I am grateful to the ‘What's at Stake in the Fake’ project team for their insightful feedback on several drafts of this article. All remaining errors are mine. This research was funded by a Leverhulme Early Career Fellowship (ECF-2017-698).
Notes
I draw on research conducted between 2018 and 2021, both inside and outside Poland, in national and transnational networks including abortion activists and providers, pill vendors, members of civil society, and online fora.
Criminal Code of the Republic of Poland 1997 [English version]. OSCE Legislation Online. Article 152. §2. https://legislationline.org/sites/default/files/documents/6a/Poland_CC_1997_en.pdf.
This figure is compiled from analysis of reports from the Polish Council of Ministers, 2006–2021. Report on the Implementation of the Law of 1993 on Family Planning and Termination of Pregnancy. 2006–2021 editions, available at http://orka.sejm.gov.pl/.
https://www.9tygodni.pl, last accessed on 11 February 2022, link no longer active.
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