Abortion in two francophone African countries: a study of whether women have begun to use misoprostol in Benin and Burkina Faso

Abstract

Objectives: This study aimed to document the means women use to obtain abortions in the capital cities of Benin and Burkina Faso, and to learn whether or not use of misoprostol has become an alternative to other methods of abortion, and the implications for future practice. Study design: We conducted in-depth, qualitative interviews between 2014 and 2015 with 34 women-21 women in Cotonou (Benin) and 13 women in Ouagadougou (Burkina Faso)about their pathways to abortion. To obtain a diverse sample in terms of socio-demographic characteristics, we recruited the women through our own knowledge networks, in health facilities where women are treated for unsafe abortion complications, and in schools in Benin. Results: The 34 women had had 69 abortions between them. Twenty-five of the women had had 37 abortions in the previous 5 years; the other abortions were 5-20 years before. Pathways to abortion were very different in the two cities. Lengthy and difficult pathways with unsafe methods often led to complications in Ougadougou, whereas most Cotonou women went to small, private health centers. Six of the 37 abortions in the previous 5 years involved misoprostol use, and were all among educated women with significant social and economic capital and personal contact with clinicians. Conclusions: Use of misoprostol for abortion has appeared in both Cotonou and Ougadougou in the past 5 years. Evidence that the use of misoprostol for abortion occurred among women with the most access to information and resources in this study suggests that increased awareness of and use of misoprostol in both countries is likely in the coming years. Implications: Although no pharmaceutical company that produces misoprostol has as yet tried to obtain marketing authorization in either Burkina Faso or Benin for gynecological-obstetric indications, making its use more potential than actual for the time being, international advocacy for access to medical abortion is growing rapidly and is likely to lead to many changes in this picture in the coming years.

The microeconomics of abortion: A scoping review and analysis of the economic consequences for abortion care-seekers

“…A review of studies in Latin American found that requirements of prescriptions for medical abortion are a barrier that encourage use of informal, often more costly, sources of medical abortion [ 85 ]. In Benin, misoprostol was sought in pharmaceutical markets to avoid navigating the logistics of having to obtain a prescription [ 86 ].…”

Overview and factors associated with pregnancies and abortions occurring in sex workers in Benin

“…In Benin, the abortion law allows women to access that procedure only if the life of the mother is in danger, in cases of rape, incest or malformations of the foetus [ 48 ]. Abortion in Cotonou seems to be fairly accessible in small private health centers but its cost (between 25.50 and 89.00 US dollars) [ 49 ] appears highly prohibitive for FSWs. Regardless of origin, 65% of all pregnancies occurring during sex work practice end in abortion.…”

A Pill in the Lifeworld of Women in Burkina Faso: Can Misoprostol Reframe the Meaning of Abortion

“…However, the context in Burkina Faso allows for some nuances, because women do not have equal access to abortion drugs, such as misoprostol. For example, a recent study in Ouagadougou has shown that the use of misoprostol is predominantly among women who have secondary and post-secondary education and who have high socioeconomic status [14]. Indeed, the introduction and use of misoprostol in Burkina Faso in the context of the restrictive abortion law gives opportunities to individuals with strong social networks and negotiating power to access misoprostol relatively easily, while those less powerful still struggle (Drabo 2019 forthcoming).…”

“…Misoprostol represents an addition to the existing abortion methods, such as vacuum aspiration, which health workers have often used to induce abortions clandestinely. Many women also use misoprostol to self-induce abortions [13,14,15,16], replacing abortifacients such as herbal tea [17], potions, high doses of anti-malarial drugs, or bleach [4]. Misoprostol does indeed diversify abortion access sources, because its marketing in pharmacies and drug stores makes it possible to access the drug in secrecy [18].…”