Int J Gynaecol Obstet. 2015 Oct 23. pii: S0020-7292(15)00633-5. doi: 10.1016/j.ijgo.2015.07.008. [Epub ahead of print]

Client-pharmacy worker interactions regarding medical abortion in Zambia in 2009 and 2011

Hendrickson C, Fetters T, Mupeta S, Vwallika B, Djemo P and Raisanen K


Objective: To examine sales practices, knowledge, and behavior of pharmacy workers regarding medical abortion in 2009 and 2011 in Zambia, where hostile and stigmatizing attitudes still result in high rates of unsafe abortion.

Methods: Four mystery clients visited pharmacies during 2009 and 2011, and recorded their experiences following their interactions using a standardized form. Bivariate analysis examined pharmacy workers' attitudes, behavior, and medical abortion-dispensing practices.

Results: Mystery clients visited 76 pharmacies in 2009 and 80 pharmacies in 2011. In 2011, mystery clients reported hostile interactions with pharmacy workers at 8 (10%) pharmacy visits, a relative decrease from 7 (22%) in 2009 (P=0.0353). In 2009, less than half (35 [46%]) of clients received information or had the opportunity to purchase medical abortion drugs in comparison with 53 (66%) in 2011 (P=0.0110). In 2011, more pharmacy workers mentioned a valid medical abortion drug in comparison with 2009 (42 [53%] vs 31 [41%], respectively); however, guidance for women on misoprostol use was minimal.

Conclusions: Pharmacy workers exhibited increased awareness of misoprostol, less hostility, and a willingness to sell medical abortion drugs; however, they continued to provide inadequate information on misoprostol for medical abortion. Effective training of pharmacy employees is vital in increasing access to safe induced-abortion care.

Comment: This paper shows two important things: first, that pharmacy workers often do not have sufficient knowledge about medical abortion; and, second, that if they are properly trained, they are very valuable in the prevention of unsafe abortion, owing to the women's easy access to them and the openness of their approach. (HMV)