Women’s self-reported experiences using misoprostol obtained from drug sellers: a prospective cohort study in Lagos State, Nigeria

Abstract

ObjectivesThis study aimed to assess the safety and effectiveness of self-managed misoprostol abortions obtained outside of the formal health system in Lagos State, Nigeria.DesignThis was a prospective cohort study among women using misoprostol-containing medications purchased from drug sellers. Three telephone-administered surveys were conducted over 1 month.SettingData were collected in 2018 in six local government areas in Lagos State.ParticipantsDrug sellers attempted to recruit all women who purchased misoprostol-containing medication. To remain in the study, participants had to be female and aged 18–49, and had to have purchased the medication for the purpose of abortion. Of 501 women initially recruited, 446 were eligible for the full study, and 394 completed all three surveys.Primary and secondary outcome measuresUsing self-reported measures, we assessed the quality of information provided by drug sellers; the prevalence of potential complications; and the proportion with completed abortions.ResultsAlthough drug sellers provided inadequate information about the pills, 94% of the sample reported a complete abortion without surgical intervention about 1 month after taking the medication. Assuming a conservative scenario where all individuals lost to follow-up had failed terminations, the completion rate dropped to 87%. While 86 women reported physical symptoms suggestive of complications, only six of them reported wanting or needing health facility care and four subsequently obtained care.ConclusionsDrug sellers are an important source of medical abortion in this setting. Despite the limitations of self-report, many women appear to have effectively self-administered misoprostol. Additional research is needed to expand the evidence on the safety and effectiveness of self-use of misoprostol for abortion in restrictive settings, and to inform approaches that support the health and well-being of people who use this method of abortion.

Self-managed medication abortion outcomes: results from a prospective pilot study

“…The findings presented here build on a robust body of evidence that points to a similar conclusion: self-managed medication abortion with accurate information on how to use the pills can be effective and safe [ 2 , 7 , 8 , 11 , 14 , 15 , 22 , 30 – 33 ]. This pilot study has demonstrated that research conducted in close partnership with groups that provide abortion accompaniment is a promising avenue to improve understanding of self-managed abortion.…”

Self-managed medication abortion outcomes: results from a prospective pilot study

“…The ndings presented here build on a robust body of evidence that points to a similar conclusion: selfmanaged medication abortion with accurate information on how to use the pills can be effective and safe. (2,7,8,11,14,15,22,(28)(29)(30)(31) This pilot study has demonstrated that research conducted in close partnership with groups that provide abortion accompaniment is a promising avenue to improve understanding of self-managed abortion. These groups facilitate the e cient identi cation of people selfmanaging their abortions (a group that has been historically di cult to identify and recruit for studies (25)) and enables deeper insight into these experiences given the naturally consistent interaction that often occurs between counselors and callers throughout the accompaniment process.…”

Drug sellers’ knowledge and practices, and client perspectives after an intervention to improve the quality of safe abortion care outside of formal clinics in Nigeria

“…1 Evidence on people's experience obtaining misoprostol or mifepristone-misoprostol directly from pharmacies or drug sellers is limited. [2][3][4] Abortion in Nigeria is legally allowed only to save a woman's life. 5 However, a study conducted in 2012 reported an annual incidence of 1.25 million abortions.…”

“…In Nigeria, patent and proprietary medicine vendors or PMVs play an important role in the provision of basic healthcare services 11 12 including reproductive health, [13][14][15][16] though knowledge of their role in abortion care is limited. 3 PMVs are persons without formal training in pharmacy who sell orthodox pharmaceutical products in retail for profit. Many PMVs are known to have medical training, though this is not a requirement, and they often operate from shops.…”