Seven years of legal limbo: How South Korea's abortion drug black market thrived

Seven years have passed since the Constitutional Court struck down South Korea's abortion ban, and the legislative and regulatory vacuum left in its wake has given rise to a black market for mifepristone, the oral abortion drug. Buyers and sellers have quietly built an underground trade, but the drugs changing hands carry no guarantee of identity or quality, and the transactions themselves violate pharmaceutical law.

The government has recently moved to formally introduce mifepristone, signaling that it is preparing to open a legal path to abortion after years of inaction. Experts say the move could ensure safe access for vulnerable groups, including teenagers, but caution that careful deliberation is still needed on the gestational limit at which the drug may be used.

Posts offering mifepristone for sale were easy to find on X and other social media platforms on Saturday. A simple keyword search was enough to surface listings.

One post offered a detailed transaction: "I am privately transferring 12 misoprostol tablets prescribed directly at a domestic obstetrics and gynecology clinic, for 20." The seller promoted their credibility by noting they had been a "long-term transferor for 24 years" and promised to share the prescription and exact dosage instructions after the deal was confirmed.

The post also included a buyer's review: "I reached out because I couldn't find anyone trustworthy selling mifepristone. I've bought the drug before." The seller also offered post-administration advice, suggesting the buyer begin testing on Sunday morning and check each day whether the line was fading, and recommending that the buyer visit a hospital "using abnormal bleeding as an excuse."

Traces of active trading were also visible across social media. Posts included messages such as "Selling mifepristone. Price 18.0, shipping included, urgent sale. Genuine product purchased directly overseas!" and "Mifepristone not selling — dropping the price to 150,000 won ($112). Authenticity can be verified."

The insistence on authenticity in these posts reflects a broader problem: the market is awash with counterfeit or unreliable mifepristone. In 2023, a seller identified only as A sourced mifepristone from an Indian online shopping platform and resold it domestically. By September 2024, A had completed 112 transactions totaling 19.03 million won in sales before being arrested for violating the Pharmaceutical Affairs Act.

There are also cases of sellers peddling outright fakes. In 2020, the Daejeon Metropolitan Police Agency arrested a group that had passed off Chinese-made counterfeit drugs as American mifepristone, in violation of the Pharmaceutical Affairs Act. The group purchased each set for 80,000 won through Chinese smugglers and resold them for 380,000 won. Using this scheme, they defrauded more than 300 people and accumulated 130 million won in criminal proceeds.

The black market appears to be growing. Data obtained from the Ministry of Food and Drug Safety by Rep. Jeon Jin-suk of the Democratic Party of Korea, a member of the National Assembly's Health and Welfare Committee, showed that illegal online sales, brokering and advertising of abortion drugs detected over the past five years totaled 3,189 cases.

The annual breakdown was 414 cases in 2021, 643 in 2022, 491 in 2023, 741 in 2024, 682 in 2025 and 218 through May 2026.

A researcher at the Korean Women's Development Institute said the increase reflected growing public awareness. "After the Constitutional Court's 2019 ruling that the abortion ban was unconstitutional, people came to know that medication abortion — not just surgical abortion — was an option," the researcher said.

The use of abortion medication remains illegal under current law. In practice, however, it has become a genuine option for women who need to end a pregnancy. A research team led by Kim Dong-sik, a doctor at the Korean Women's Development Institute, surveyed 640 women who had considered or undergone an abortion and found that 23.9 percent — 153 respondents — had used medication. Seven respondents said they had used both surgery and medication.

As demand grew amid the regulatory vacuum, the government moved to formalize the introduction of mifepristone. President Lee Jae Myung, speaking at a civil society roundtable held at Cheong Wa Dae on Sept. 4, said the Ministry of Health and Welfare and women's groups were in discussions on the matter. He said the plan called for the drug to be prescribed and dispensed in-hospital for the first two years, then to shift to hospital prescriptions filled at outside pharmacies after that.

Related ministries are reviewing domestic approval for mifepristone. The government is considering limiting prescriptions to early stages of pregnancy. If the process moves quickly, legal use of mifepristone in South Korea could become possible before the end of the year.

Kim said most women considering abortion are teenagers or in their 20s. "There is a need to legalize the drug within a regulated framework so that it can be taken safely, with a doctor's diagnosis and a pharmacist's guidance on proper use," he said.

Kim added that the medical community and women's groups hold differing views on the gestational limit for medication use. "Going forward, it will be necessary to narrow that gap and establish a clear standard for the weeks of pregnancy during which the drug may be used," he said.