Medical abortion can be provided safely and effectively by pharmacy workers trained within a harm reduction framework: Nepal

Tamang, Anand; Puri, Mahesh; Masud, Sazina; Karki, Deepak Kumar; Khadka, Diksha; Singh, Minal; Sharma, Poonam; Gajurel, Subash

doi:10.1016/j.contraception.2017.09.004

Cited by 32 publications

(40 citation statements)

References 9 publications

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“…In Nepal too, as the study by Tamang et al in this Special Edition shows, the majority of women who went straight to a pharmacy for MA pills to use at home were less than 6 weeks pregnant (70%) and a further 27% were less than 10 weeks. None of the women in that study had complications with pill use [6]. Moreover, as shown in the systematic review undertaken by Kapp et al for this Special Edition existing research "supports the use of medical abortion at gestational ages b42 days".…”

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confidence: 64%

“…Medical abortion in optimal conditions means that the role of obstetrician-gynecologists can effectively disappear from abortion care, with the exception of complicated pregnancies. They can be replaced by trained midwives and nurses, family planning providers and pharmacy workers after a simple training course, as the papers in this Special Edition from Nepal by Tamang et al [6] and Kyrgyzstan by Johnson et al show is possible [10]. Such research confirms that WHO's 2015 guidelines on allowing trained mid-level providers to manage almost all abortions [11] actually work in practice and should be implemented universally.…”

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confidence: 81%

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Medical abortion pills have the potential to change everything about abortion

Berer¹,

Hoggart

2018

Contraception

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confidence: 64%

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confidence: 81%

Medical abortion pills have the potential to change everything about abortion

Berer¹,

Hoggart

2018

Contraception

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“…Comparable results have also been reported from eastern Democratic Republic of Congo where only 18% of women sought abortion care from a physician, nurse or midwife [ 17 ]. These results may speak to the growing body of literature that many women may choose to access oral abortifacients from pharmacies [ 18 ] and to terminate pregnancies with little health care intervention [ 19 ]. However, the DHS data did not specifically report on pharmacies and this is an area that should be considered for future study.…”

Section: Discussionmentioning

confidence: 95%

Abortion care in Haiti: A secondary analysis of demographic and health data

2018

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BackgroundAbortion-related mortality accounts for 8% of all global maternal deaths and 97% of the estimated 25 million unsafe abortions performed each year occur in low- and middle-income countries. Haiti has the highest rate of maternal mortality in the western hemisphere and to further understand the circumstances of induced abortion in Haiti, the current work uses data from the 2012 Demographic and Health Survey (DHS) to describe the methods of induced abortion in Haiti between 2007–2012 and to identify potential factors associated with use of different abortion methods.MethodsThis is a secondary analysis of nationally representative cross-sectional data from the 2012 Haitian DHS, a two-stage cluster randomized household survey. Analysis included descriptive statistics on participant demographics, methods of abortion, and location of / assistant for the abortion. Multivariate regression was conducted to determine if demographic characteristics were associated with: 1) increased or decreased odds of having an abortion; or 2) increased or decreased odds of reporting an evidence based or non-evidence based method of abortion.ResultsAmong the 14,287 women of childbearing age who completed the 2012 Haiti DHS survey, 289 women reported having an induced abortion in the previous five years. Recommended methods, manual vacuum aspiration (MVA) or misoprostol alone, were used in 26.6% of the abortions (n = 77). Additionally, 13.8% (n = 40) of abortions used these recommended methods in combination with a non-evidenced based method such as injections, plants or tablets. A total of 92 women had a dilation and curettage (D&C) abortion, either alone (n = 77) or in combination with another method (n = 15) and over a quarter (n = 80) of reported abortions were conducted by non-evidence based methods (n = 80). A majority of abortions using a recommended method were assisted by a relative/friend (n = 28) or were unassisted (n = 34). Most abortions occurred in private homes (n = 174) with hospitals/clinics being the second most common location (n = 84). Women in the middle (OR = 3.3, 95% CI = 2.0–5.6) and highest (OR = 7.4, 95% CI = 4.4–12.3) wealth brackets were more likely to have had an abortion in comparison to women in the lowest wealth bracket. Women who had ever been in a marital union were more likely to have had an abortion than those who had not. The only demographic factor predictive of aborting using a recommended method was living in an urban area, with urban-dwelling women being less likely to use a recommended abortion method (OR = 0.4, 95% CI = 0.2–0.9) in comparison with women living in rural settings.ConclusionIn a nationally representative survey in Haiti, 2% of women of childbearing age reported having an abortion in the five years prior to the survey. A large proportion of these abortions were carried out using non-evidence based methods and over half occurred outside of the formal health care system. Understanding women’s attitudes, knowledge and barriers around abortion is paramount to improving knowledge ...

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“…While these studies document that pharmacists are more willing to discuss and provide reproductive health services, such as emergency contraception and condoms, and refer their customers to appropriate care following the intervention, none are able to assess longer‐term impact of their interventions on pharmacist behaviours or on client‐related reproductive health outcomes . A recent intervention in Nepal found that pharmacists trained in MA provided safe and satisfactory care, which was sustained for about 5 years …”

Section: Introductionmentioning

confidence: 99%

“…4 A recent intervention in Nepal found that pharmacists trained in MA provided safe and satisfactory care, which was sustained for about 5 years. 17 Given the increasing evidence that pharmacies are the first and primary point of contact for 11.5 million MA users in India, coupled with the clear dearth in tested pharmacist-based interventions to improve the quality of MA care, our team developed a simple informational and graphic handout (infographic) with information on MA dosing, timing, expected symptoms, side effects, and when to seek care. In India, MA is most commonly purchased and taken through a combination pack ("combi-packs") of one mifepristone (200 mg) and four misoprostol tablets (200 mcg each), thus two types of medication to be taken with specified time spacing must be explained.…”

mentioning

confidence: 99%

An intervention to improve the quality of medication abortion knowledge among pharmacists in India

Diamond‐Smith

Phillips

Percher

et al. 2019

Intl J Gynecology & Obste

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Objective To test an infographic two‐pager on medication abortions (MA) aimed to improve pharmacists counseling in India. Methods A quantitative baseline survey was conducted among 283 pharmacists in three districts around Lucknow, Uttar Pradesh in January 2018. The intervention (infographic) was given to 117 of these pharmacists a few weeks later and a follow‐up survey was conducted 3 months later with 281 pharmacists. In addition, mystery clients were sent to 115 of the pharmacists. Results A statistically significant improvement in knowledge post‐intervention was found, compared to pre‐, for almost all quality items measured. Difference‐in‐difference estimators showed a difference in knowledge among indicators related to misoprostol in particular. However, mystery client reports showed few differences in pharmacist behaviors between intervention and control pharmacists. Conclusion This simple, paper‐based intervention, which required no training, showed a significant improvement in pharmacists’ knowledge and was welcomed by the providers. Translating knowledge into behavior change, however, seems more difficult to impact. Adapting this simple intervention to motivate providers to change behaviors could improve the quality of care provided by pharmacists in India.

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Medical abortion can be provided safely and effectively by pharmacy workers trained within a harm reduction framework: Nepal

Abstract: The role of pharmacy workers as providers of correct and complete information on safe and effective use of MA needs to be recognized and policies formulated to allow them to provide MA drugs for first trimester use.

Cited by 32 publications

References 9 publications

Medical abortion pills have the potential to change everything about abortion

Medical abortion pills have the potential to change everything about abortion

Abortion care in Haiti: A secondary analysis of demographic and health data

An intervention to improve the quality of medication abortion knowledge among pharmacists in India

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