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

by Yinka Abiola Adojutelegan, Amy J Coughlin, Kristen Shellenberg, Ayodeji Babatunde Oginni, Bridget Okeke, Okechi Ogueji

BMJ Sexual and Reproductive Health, 9 May 2021


Background – In Nigeria, where abortion is legally restricted, individuals seek medical abortion drugs, including misoprostol, directly from pharmacies or drug sellers. However, knowledge of drug sellers or patent medicine vendors (PMVs) dispensation practices and women’s experience with self-management is limited and research suggests poor quality of services. This study assesses the knowledge and practices of PMVs and women’s experiences after a harm reduction intervention to improve the provision of medication abortion using misoprostol.

Methods – We conducted a retrospective descriptive analysis of anonymised logbook data collected from 141 Nigerian PMVs who provided misoprostol for abortion to 4,924 clients between February 2015 and July 2018. We conducted a descriptive analysis of self-reported misoprostol dispensation practices with data from a cross-sectional survey of PMVs (n=120) from June 2016 to December 2018. We collected data on women’s experience obtaining misoprostol from 37 PMVs through a cross-sectional survey of women (n=260) from 4–19 June 2018.

Results – For clients where the misoprostol dose dispensed was recorded (n=3,784), 86% of clients were given 800 μg or more misoprostol, pain medication (97%) and a contraceptive method (92%). Most clients with an outcome recorded in the logbook (n=4,431) had a complete abortion (86%). Almost all women reported that they would return to the PMV for future services (99%).

Conclusions – Thousands of women seek abortion care from PMVs, demonstrating that they are an important source of abortion care in Nigeria, where abortion is legally restricted. The data reported were collected as part of planned monitoring and evaluation activities and not in a prospective study. PMVs were purposively selected, had prior clinical training and were licensed and thus may not be representative of PMVs without formal medical training.

The majority of PMVs monitored dispensed misoprostol in appropriate dosages and provided clients with information on drug administration and methods of contraception. Interventions designed to improve PMVs’ best practices around the provision of abortion care may help ensure the quality of services received by clients.

PHOTO by NigeriaHealthWatch, 2019