Pharmacy workers in Nepal can provide the correct information about using mifepristone and misoprostol to women seeking medication to induce abortion

Abstract

In Nepal, despite policy restrictions, both registered and unregistered brands of mifepristone and misoprostol can easily be obtained at pharmacies. Since many women visit pharmacies for abortion information, ensuring that they receive effective care from pharmacy workers remains an important challenge. We conducted an operations research study to examine whether trained pharmacy workers can correctly provide information on safe use of mifepristone and misoprostol for early first trimester medical abortion. Pharmacy workers in one district were given orientation and training using a harm-reduction approach, and compared with a non-equivalent comparison group in the second district. Overall, trained pharmacy workers' knowledge increased substantially, but no increase was found in the comparison group. Compared to the baseline (65%), 97% of trained pharmacy workers knew up to what stage of pregnancy and how women should use mifepristone and misoprostol. A higher percentage of pharmacy workers in the intervention group (77%) compared to the comparison group (49%) were knowledgeable at follow-up about determining whether an abortion was successful, implying a need for improving this aspect of training. As many mid-level health providers run their own pharmacies and offer medical abortion pills, it is important for the government to consider training these providers and registering their pharmacies as safe medical abortion service outlets.

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

“…The study also included refresher training after 10 months and an end‐line evaluation at one year. At baseline, knowledge of MA in both the intervention and control groups was high, which the authors speculated was due to recent NGO training in the area, but knowledge fell among the control group during the study, highlighting the need for training to be periodic (Tamang, Puri, Lama, and Shrestha 2015). …”

“…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).…”

“…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.…”

“…Two were reported in peer‐reviewed journals (Fetters et al. 2015; Tamang, Puri, Lama, and Shrestha 2015) and one was a conference abstract for which we could access the full paper (Reiss et al. 2015a).…”

“…2015; Reiss et al. 2015a; Tamang, Puri, Lama, and Shrestha 2015), printed materials (Tamang, Puri, Lama, and Shrestha 2015), and one‐to‐one education visits (Reiss et al. 2015a).…”