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In 2006, abortion in Colombia was decriminalised under certain circumstances. Yet some women continue to avail themselves of ways to terminate pregnancies outside of the formal health system. In-depth interviews (IDIs) with women who acquired drugs outside of health facilities to terminate their pregnancies (n = 47) were conducted in Bogotá and the Coffee Axis in 2018. Respondents were recruited when they sought postabortion care at a health facility. This analysis examines women's experiences with medication acquired outside of the health system for a termination: how they obtained the medication, what they received, how they were instructed to use the pills, the symptoms they were told to expect, and their abortion experiences. Respondents purchased the drugs in drug stores, online, from street vendors, or through contacts in their social networks. Women who used online vendors more commonly received the minimum dose of misoprostol according to WHO guidelines to complete the abortion (800 mcg) and received more detailed instructions and information about what to expect than women who bought the drug elsewhere. Common instructions were to take the pills orally and vaginally; most women received incomplete information about what to expect. Most women seeking care did not have a complete abortion before coming to the health facility (they never started bleeding or had an incomplete abortion). Women still face multiple barriers to safe abortion in Colombia; policymakers should promote better awareness about legal abortion availability, access to quality medication and complete information about misoprostol use for women to terminate unwanted pregnancies safely.

IntroductionIn 2006, abortion was decriminalised in Colombia under certain circumstances. Yet, women avail themselves of ways to terminate pregnancy outside of the formal health system. This study explored how drug sellers engage with women who attempt to purchase misoprostol from them.MethodsA mapping exercise was undertaken to list small-chain and independent drug stores in two regions in Colombia. A sample (n=558) of drug stores was selected from this list and visited by mystery clients between November and December 2017. Mystery clients sought to obtain a medication to bring back a delayed period, and described the experience, the information obtained and the medications proffered in exit interviews.ResultsMisoprostol was offered for purchase in 15% of the visits; in half of visits, only information about misoprostol was shared, while no information about misoprostol was provided on the remaining visits. Over half of sellers who refused to sell any medication provided referrals, most commonly to an abortion provider. Among visits which included discussion of misoprostol, two out of five sellers provided dosage instructions with most recommending the minimum adequate dosage. Mystery clients received little information on the physical effects to expect with the use of misoprostol and possible complications.ConclusionsAs misoprostol is being obtained from some drug sellers without a prescription, capacitating this cadre with at least a minimum of standardised information on dosage, routes of administration and expected effects and outcomes have the potential to improve reproductive health outcomes for women who choose to terminate pregnancies this way in Colombia.

Introducción: este artículo presenta algunos de los conocimientos socialmente compartidos entre mujeres adolescentes de 14 a 18 años, que habitan en Soacha y el suroccidente de Bogotá, sobre el aborto, la adopción y la continuación del embarazo. Desarrollo: se desarrollaron nueve grupos focales en los que participaron 58 adolescentes. Ellas comentaron sus percepciones sobre el aborto, la continuación del embarazo y la adopción. Percibieron la maternidad en la adolescencia como una situación que emerge de una conducta sexual descuidada, al tiempo que valoraron la maternidad como un hecho intrínseco a la vida de las mujeres. El estigma ocupó un lugar preponderante en las representaciones que las adolescentes elaboraron sobre el aborto. Fue percibido como una opción facilista y condenable, pues permitía evadir la maternidad e interrumpía una vida en desarrollo. La adopción fue más aceptada que el aborto, pero cuestionada por dejar la crianza de un hijo a terceros. Las intervenciones de las adolescentes sugieren que, frente a la reproducción, ocupan un lugar de subordinación frente a sus madres y compañeros erótico-afectivos, quienes inciden en su toma de decisiones reproductivas con preponderancia. Conclusiones: la valoración de la maternidad y el feto devienen de prácticas y creencias católicas y patriarcales que generan en las adolescentes una fuerte estigmatización hacia la adopción y el aborto. Este artículo propone algunas recomendaciones para organizaciones no gubernamentales y prestadores de salud, con el fin de reducir el estigma frente estas opciones reproductivas.

Most abortions are attributable to unplanned pregnancy. The Guttmacher Institute calculated that in 2015 to 2019 there were 64 unintended pregnancies worldwide per 1000 women and 61% of these ended in induced abortion. 1 The rate of unintended pregnancies and the proportion ending in abortion have increased in countries with restricted abortion compared with 1990 to 1994. 1