Quality of information offered to women by drug sellers providing medical abortion in Nigeria: Evidence from providers and their clients

Abstract

BackgroundEvidence confirmed that the demand for medical abortion (MA) increased significantly during the COVID-19 outbreak in many developing countries including Nigeria. In an abortion-restrictive setting like Nigeria, local pharmacies, and proprietary patent medicine vendors (PPMVs) continue to play a major role in the provision of MA including misoprostol. There is the need to understand these providers' knowledge about the use of misoprostol for abortion and the quality of information they provide to their clients. This analysis is focused on assessing the quality of care provided by both drug seller types, from drug sellers' and women's perspectives.MethodologyThis study utilized primary data collected from drug sellers (pharmacists and PPMVs) and women across 6 Local Government Areas in Lagos State, Nigeria. The core sample included 126 drug sellers who had sold abortion-inducing drugs and 386 women who procured abortion-inducing drugs from the drug sellers during the time of the study. We calculate quality-of-care indices for the care women received from drug sellers, drawing on WHO guidelines for medication abortion provision. The index based on information from the sellers had two domains—technical competency and information provided to clients, while the index from the women's perspectives includes an additional domain, client experience.ResultsResults show that the majority of drug sellers in the sample, 56% (n = 70), were pharmacists. However, far more than half of women 60% (n = 233) had visited PPMVs. Overall, the total quality score amongst all drug sellers (mean 0.48, SD0.15) was higher than the total score calculated based on women's responses (mean 0.39, SD 0.21). Using our quality-of-care index, pharmacies and PPMVs seem to have similar technical competency (mean score of 0.23, SD 0.13 in both groups (range 0–1), whilst PPMV's performed better on the information provided to client domain (mean score of 0.79, SD 0.17 compared with pharmacies 0.69, SD 0.25). Based on women's reports, PPMVs scored better on both quality of care domains (technical competency and information provided to clients) compared with pharmacies.Program/Policy ImplicationIn resource-constrained settings such as Nigeria, particularly in the context of health emergencies like COVID-19, there is the need to continue to strengthen and engage PPMVs' capacity and skills in dispensing and administration of MA drugs as a harm reduction strategy. Also, there is the need to target frontline providers in pharmacies for training and skill upscale in MA provision.

Motivations for using misoprostol for abortion outside the formal healthcare system in Colombia: a qualitative study of women seeking postabortion care in Bogotá and the Coffee Axis

“…These data were collected as part of a larger study aimed at understanding informal access to and use of medication abortion in Colombia, Indonesia, and Nigeria. Other results from the study have been published elsewhere [21][22][23][24][25][26].…”

Using Respondent-Driven Sampling to measure abortion safety in restrictive contexts: Results from Kaya (Burkina Faso) and Nairobi (Kenya)

“…This result has programmatic implications in Burkina Faso: pharmacists can be a key source of information on and provision of MA, given appropriate training and referral linkages. Some interventions in Kenya and also Nigeria have successfully tapped into this strategy already (Reiss et al 2016;Baum et al 2020;Stillman et al 2020b;Akinyemi et al 2022).…”

“…Such a situation was observed in the Ouagadougou Health and Demographic System, where wealthier parents in formal central areas reported more episodes of morbidity for their children than poorer, uneducated parents in informal peripheral areas, although child mortality was twice as high in the latter than former areas (Rossier, Soura, and Duthé 2019). When it comes to abortion, recent work has underlined women's difficulties in self-reporting bleeding (amounts, duration), one of the key aspects of abortion-related complications (Akinyemi et al 2022). Finally, about 1 in 10 women reported encountering stigma during the abortion process in Kaya, and 1 in 8 in Nairobi, showing that stigma is an important aspect of safety that should be taken into consideration (Ganatra et al 2017).…”

Effectiveness of self-managed abortion during the COVID-19 pandemic: Results from a pooled analysis of two prospective, observational cohort studies in Nigeria

“…However, inequities exist in who is able to access safe versus unsafe methods of abortion [6,9]. As a result of limited access to clinical abortion care and a desire for privacy and autonomy, some Nigerians choose to obtain and use medication abortion pills (misoprostol alone, or in combination with mifepristone) to end their pregnancies on their own, without the support of a clinician [9][10][11][12][13][14]. This practice of ending a pregnancy on one's own is referred to as self-managed abortion [15].…”

“…Estimates suggest that more than half of the abortions in Nigeria each year are self-managed in a non-clinical setting [13]. A growing evidence base suggests that selfmanaged abortion is safe, effective, and high quality [15] including several recent studies in Nigeria [9][10][11][12][13][14][16][17][18]. Recognizing the need for safe, self-managed abortions, grassroots feminist organizations have formed over several decades to counsel people with information and support through a self-managed medication abortion at no cost.…”