COLOMBIA – What does informal access to misoprostol look like? A mystery client methodology in Bogotá and the Coffee Axis

by Ann M Moore,Nakeisha Blades,Juliette Ortiz,Hannah Whitehead,Cristina Villarreal

BMJ Sexual & Reproductive Health, 5 July 2020 Doi:10.1136/bmjsrh-2019-200572 (Open access)


Introduction – In 2006, abortion was decriminalised in Colombia under certain circumstances. Yet, women avail themselves of ways to terminate pregnancy outside of the formal health system. This study explored how drug sellers engage with women who attempt to purchase misoprostol from them.

Methods – A mapping exercise was undertaken to list small-chain and independent drug stores in two regions in Colombia. A sample (n=558) of drug stores was selected from this list and visited by mystery clients between November and December 2017. Mystery clients sought to obtain a medication to bring back a delayed period, and described the experience, the information obtained and the medications proffered in exit interviews.

Results – Misoprostol was offered for purchase in 15% of the visits; in half of visits, only information about misoprostol was shared, while no information about misoprostol was provided on the remaining visits. Over half of sellers who refused to sell any medication provided referrals, most commonly to an abortion provider. Among visits which included discussion of misoprostol, two out of five sellers provided dosage instructions with most recommending the minimum adequate dosage. Mystery clients received little information on the physical effects to expect with the use of misoprostol and possible complications.

Conclusions – As misoprostol is being obtained from some drug sellers without a prescription, capacitating this cadre with at least a minimum of standardised information on dosage, routes of administration and expected effects and outcomes have the potential to improve reproductive health outcomes for women who choose to terminate pregnancies this way in Colombia.

Conclusion of the paper – Access to misoprostol is a harm-reduction strategy that has the potential to protect women’s reproductive health when they desire to terminate unwanted pregnancies in locations where abortion is restricted. More and more healthcare is becoming user-controlled; misoprostol is one of the best examples of new technologies that make it possible to move reproductive healthcare into the hands of the user. This option is of particular importance in restrictive policy environments including Colombia. WHO identifies that there are uncertainties about pharmacists’ ability to access eligibility for medical abortion, administrate the medications and manage the process and side effects independently, and assess completion of the procedure and the need for further clinic-based follow-up, and that further research is needed to address these uncertainties. These results demonstrate the distance yet to go in Colombia to have a cadre of well-capacitated drug sellers safely providing medical abortion.