NIGERIA – Drug sellers need training on safe abortion with misoprostol

Although abortion is legally permitted in Nigeria only to save a woman’s life, studies have shown that medical abortion pills, particularly misoprostol, have become widely available in recent years through the country’s large market of formal and informal drug vendors.

A new study looked at women’s experience with self-managed misoprostol abortions in Lagos State. It was jointly conducted by the Nigeria-based Academy for Health Development (AHEAD) and Centre for Research, Evaluation Resources and Development (CREED) and the US-based Guttmacher Institute.

It found that drug sellers were the only source of information about misoprostol for three-quarters of the 400 women aged 18–49 who self-managed an abortion using misoprostol. The research also established that most women who participated in the study did not receive adequate or accurate information about how to administer misoprostol, how much to use, or what to expect during the abortion process. For example, only 67% of participants were told to anticipate bleeding and 35% were told to expect cramping – both of which are a normal part of the medical abortion process.

Even so, it found that Nigerian women effectively self-manage medical abortions, and that 94% of women reported complete abortion without medical intervention within one month of taking misoprostol.

Moreover, 70% of the women stated that they would use misoprostol in the future if they were to experience another unintended pregnancy; while 9% reported that they would have attempted to induce an abortion using unsafe methods had they not had access to misoprostol.

The authors recommend additional training for drug sellers in order to improve the quality of information and services women receive from them in pharmacies. It urges the federal, state, and local governments to work with drug sellers’ associations to improve the quality of abortion pill services in the country, as they were found to have a critical role as the first or often only point of care for women in communities in providing abortion pills.

It calls for improving drug sellers’ knowledge of evidence-based information on possible complications and how women can access post-abortion care who purchase misoprostol for abortion if required.

Many Nigerian women and girls are dying from pregnancy-related conditions, with 40% of deaths occurring among teenagers every year, when they use unsafe drugs for abortion. Drug sellers needed to know what women/girls should expect during the abortion process, potential signs of complications, where to access medical care and referral mechanisms to save women from dying.

“The desire to see the lives of young girls saved from pregnancy-related deaths and the overall desire to improve the lives of young people so that they can flower to be part of our community and our nation in positive ways and achieve their own potentials. That is our greatest interest in doing this study.”

“One of the things we need to realise in the issue of abortion is that if a woman wants to achieve pregnancy, she will do everything to achieve it. For a woman who wants to abort a pregnancy, she will also do almost everything to achieve it.”

Nigeria has licensed misoprostol for post-partum haemorrhage, but has not approved it for abortion. The authors called on the Ministry of Health to consider the use of misoprostol as a harm reduction approach to preventing morbidity and mortality caused by unsafe abortion procedures.

SOURCES: Guardian Nigeria, by Stanley Akpunonu, 17 December 2020 ; The Nation Online Nigeria, by Adekunle Yusuf, 18 December 2020 + PHOTO: Members of the research team