Pharmacies have long been a critical source of abortion pills, but…

According to a study done in 2015, pharmacies in India have long been a critical source of abortion pills. Of 15.6 million abortions, 81% were with abortion pills, 14% surgical and 5% other methods. Of the surgical abortions, 75% were done in private facilities, and 25% in public facilities. Of abortions with pills, 91% took place outside facilities, 2% in public facilities and 7% in private facilities.

In many countries, people can walk into pharmacies and buy medications over or under the counter. When it comes to abortion pills, WHO’s 2015 guideline on health worker roles in safe abortion care said pharmacists can safely play the following roles in provision of medical abortion pills during the first trimester of pregnancy:

  • assessing eligibility for medical abortion,
  • administering the medications and managing the process and common side-effects independently,
  • assessing completion of the procedure and the need, if any, for clinic-based follow-up.

Studies from Canada to Nepal have shown that pharmacists can be trusted with this role when they have had some simple training. However, aspects that can be problematic are:

  • the woman may not go to the pharmacy herself but send someone else who is not sure what they are looking for, such as a husband,
  • the pharmacy worker may or may not be approachable and willing to help,
  • the pharmacy may not carry the pills at all, or is more likely to carry misoprostol but not mifepristone,
  • an untrained pharmacy worker may not know enough to give good advice on dosage and regimen, or how to use the pills effectively, and there may be no packaging that gives this,
  • the pharmacy worker may not know the names of the right pills, so it would be best if the purchaser could provide an available brand name(s).

SOURCES: Susheela Singh et al. The incidence of abortion and unintended pregnancy in India, 2015.Lancet Global Health, 2018;6(1). (Open access) ; World Health Organization.Health worker roles in providing safe abortion care and post-abortion contraception, 2015 (page 7) ; Presentation by Katy Footman, Marie Stopes International, MSI webinar, 8 April 2020 ;PHOTO, Times of India, 26 Dec 2018