Reproductive Health Matters 2014; Supplement (43):1–12

Pharmacy workers in Nepal can provide the correct information about using mifepristone and misoprostol to women seeking medication to induce abortion

Tamang A, Puri M, Lama K and Shrestha P

Abstract

In Nepal, despite policy restrictions, both registered and unregistered brands of mifepristone and misoprostol can easily be obtained at pharmacies. Since many women visit pharmacies for abortion information, ensuring that they receive effective care from pharmacy workers remains an important challenge. We conducted an operations research study to examine whether trained pharmacy workers can correctly provide information on safe use of mifepristone and misoprostol for early first trimester medical abortion. Pharmacy workers in one district were given orientation and training using a harm-reduction approach, and compared with a non-equivalent comparison group in the second district. Overall, trained pharmacy workers’ knowledge increased substantially, but no increase was found in the comparison group. Compared to the baseline (65%), 97% of trained pharmacy workers knew up to what stage of pregnancy and how women should use mifepristone and misoprostol. A higher percentage of pharmacy workers in the intervention group (77%) compared to the comparison group (49%) were knowledgeable at follow-up about determining whether an abortion was successful, implying a need for improving this aspect of training. As many mid-level health providers run their own pharmacies and offer medical abortion pills, it is important for the government to consider training these providers and registering their pharmacies as safe medical abortion service outlets.

Comment: This is another paper which shows that information, and even delivery of medication, for safe abortion can be given by trained pharmacy workers, without affecting safety and efficacy. The World Health Organization (WHO) recommends a regimen of 200 mg of mifepristone administered orally, followed 24–48 hours later by 800 µg of misoprostol used vaginally, buccally or sublingually for termination of pregnancies up to 9 weeks (63 days) LMP. With a regimen of repeated doses of misoprostol, it is also safe and effective between 9 and 12 weeks of gestation. (HMV)