Client–pharmacy worker interactions regarding medical abortion in Zambia in 2009 and 2011

Abstract

Pharmacy workers exhibited increased awareness of misoprostol, less hostility, and a willingness to sell medical abortion drugs; however, they continued to provide inadequate information on misoprostol for medical abortion. Effective training of pharmacy employees is vital in increasing access to safe induced-abortion care.

Medical Abortion Provision by Pharmacies and Drug Sellers in Low‐ and Middle‐Income Countries: A Systematic Review

“…The earliest study was published in 1991 (conducted in 1985), but most were published since 2010; 13 of those had not been included in an earlier literature review on this topic (Sneeringer, Billings, Ganatra, and Baird 2012). The studies were conducted in various locations in Latin America (Billings et al 2009;Bonnema and Dalebout 1992;de Oddone et al 1991;Lara, Garcia, Wilson, and Paz 2011;Miller et al 2005;Zamberlin 2007), sub-Saharan Africa (Adinma and Adinma 2013;Akiode et al 2010;Fetters et al 2015;Hendrickson et al 2015;Reiss et al 2017) South Asia (Huda et al 2014;Mishra et al 2016;Powell-Jackson, Acharya, Filippi, and Ronsmans 2015;Reiss et al 2015b;Tamang, Puri, Lama, and Shrestha 2015;Tamang and Tamang 2005), and South East Asia (Ngo, Park, and Nguyen 2012). In two of the locations, legal restrictions on abortion did not make exceptions to save the mother's life at the time of study (Senegal and Dominican Republic); in the majority abortion was allowed only to save the mother's life or to preserve her health (Nigeria, Mexico, Peru, Paraguay, Bangladesh, Kenya, and Argentina); and in the remaining locations abortion was available on socioeconomic grounds or on request (Zambia, India, Vietnam, and Nepal).…”

“…One mystery client study in Kenya in 2013, however, reported higher provision levels (26 percent) (Reiss et al 2016). In a repeated mystery client survey in Zambia , a significant increase in misoprostol provision was recorded, from 51 percent in 2009 to 72 percent in 2011 (Hendrickson et al 2015). Misoprostol provision to mystery clients was common in legally restrictive settings such as Latin America (which studies were of mixed quality), ranging from 78-90 percent in Mexico (Billings et al 2009;Lara, Garcia, Wilson, and Paz 2011) to 64 percent in the Dominican Republic (Miller et al 2005) and 55 percent in Argentina (Zamberlin 2007).…”

“…The combined regimen of misoprostol and mifepristone was approved for use for MA in six of the locations at the time of study (Bangladesh, India, Zambia, Vietnam, Kenya, and Nepal) Ganatra, Manning, and Pallipamulla 2005;Hendrickson et al 2015;Mishra et al 2016;Ngo, Park, and Nguyen 2012;Powell-Jackson, Acharya, Filippi, and Ronsmans 2015;Reiss et al 2015b;Reiss et al 2016;Tamang, Puri, Lama, and Shrestha 2015). In all other locations misoprostol was registered for use to treat other illnesses such as gastric ulcers, but not for MA.…”

“…In all other locations misoprostol was registered for use to treat other illnesses such as gastric ulcers, but not for MA. Most studies were conducted in urban settings and involved interviews with pharmacy workers (10 studies: Adinma and Adinma 2013; Akiode et al 2010;de Oddone et al 1991;Fetters et al 2015;Ganatra, Manning, and Pallipamulla 2005;Mishra et al 2016;Reiss et al 2015b,;Reiss et al 2016;Reiss et al 2017;Tamang and Tamang 2005), mystery client surveys (where trained researchers pretend to be clients and record their experiences) (6 studies: Billings et al 2009;Hendrickson et al 2015;Huda et al 2014;Lara, Garcia, Wilson, and Paz 2011;Miller et al 2005;Zamberlin 2007), or a combination of the two (6 studies: Bonnema and Dalebout 1992;Lara, Abuabara, Grossman, and Díaz-Olavarrieta 2006;Ngo, Park, and Nguyen 2012;Powell-Jackson, Acharya, Filippi, and Ronsmans 2015;Reiss, Aung, Aung, and Ngo 2014;Reiss et al 2016). Indicators used to report MA provision varied considerably between studies, including for example: "stocking" or "selling" MA drugs in pharmacy worker surveys, and "offering," "recommending," mentioning," and "discussing" MA drugs in mystery client surveys.…”

“…Pharmacy worker/drug seller knowledge of or counseling on an effective misoprostol-only or mifepristone-misoprostol regimen was poor, ranging from 3 to 17 percent in Latin America (Billings et al 2009; Lara, Abuabara, Grossman, and Díaz-Olavarrieta 2006; Lara, Garcia, Wilson, and Paz 2011), from 9 to 41 percent in Asia (Ganatra, Manning, and Pallipamulla 2005;Huda et al 2014;Mishra et al 2016; Powell-Jackson, Acharya, Filippi, and Ronsmans 2015; Reiss et al 2015b, Reiss, Aung, Aung, and, and from 0 to 21 percent in Africa (Hendrickson et al 2015;Reiss et al 2016;Reiss et al 2017). A recent high-quality study in India comparing data from a mystery client study and a drug seller survey found that knowledge did not translate into accurate advice to clients: while 51 percent of pharmacy workers had correct knowledge of the dosage and timing of the combined regimen for MA, only 35 percent provided correct information to clients (Powell-Jackson, Acharya, Filippi, and Ronsmans 2015).…”