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. 2023 Apr 11;20(Suppl 1):58.
doi: 10.1186/s12978-023-01574-3.

Availability of medical abortion medicines in eight countries: a descriptive analysis of key findings and opportunities

Amy Grossman  1 , Ndola Prata  1   2 , Natalie Williams  1 , Bela Ganatra  3 , Antonella Lavelanet  3 , Laurence Läser  3 , Chilanga Asmani  4 , Hayfa Elamin  4 , Leopold Ouedraogo  4 , Md Mahmudur Rahman  5 , Musu Julie Conneh-Duworko  6 , Bentoe Zoogley Tehoungue  7 , Harriet Chanza  8 , Henry Phiri  9 , Bharat Bhattarai  10 , Narayan Prasad Dhakal  11 , Olumuyiwa Adesanya Ojo  12 , Kayode Afolabi  13 , Theopista John Kabuteni  14 , Binyam Getachew Hailu  15 , Francis Moses  16 , Sithembile Dlamini-Nqeketo  17 , Thembi Zulu  18 , Ulrika Rehnström Loi  19
Affiliations

Availability of medical abortion medicines in eight countries: a descriptive analysis of key findings and opportunities

Amy Grossman et al. Reprod Health. .

Erratum in

Abstract

Background: In recent years a growing number of manufacturers and medical abortion products have entered country markets and health systems, with varying degrees of quality and accessibility. An interplay of factors including pharmaceutical regulations, abortion laws, government policies and service delivery guidelines and provider's knowledge and practices influence the availability of medical abortion medicines. We assessed the availability of medical abortion in eight countries to increase understanding among policymakers of the need to improve availability and affordability of quality-assured medical abortion products at regional and national levels.

Methods: Using a national assessment protocol and an availability framework, we assessed the availability of medical abortion medicines in Bangladesh, Liberia, Malawi, Nepal, Nigeria, Rwanda, Sierra Leone and South Africa between September 2019 and January 2020.

Results: Registration of abortion medicines-misoprostol or a combination of mifepristone and misoprostol-was established in all countries assessed, except Rwanda. Mifepristone and misoprostol regimen for medical abortion was identified on the national essential medicines list/standard treatment guidelines for South Africa as well as in specific abortion care service and delivery guidelines for Bangladesh, Nepal, Nigeria, and Rwanda. In Liberia, Malawi, and Sierra Leone-countries with highly restrictive abortion laws and no abortion service delivery guidelines or training curricula-no government-supported training on medical abortion for public sector providers had occurred. Instead, training on medical abortion was either limited in scope to select private sector providers and pharmacists or prohibited. Community awareness activities on medical abortion have been limited in scope across the countries assessed and where abortion is broadly legal, most women do not know that it is an option.

Conclusion: Understanding the factors that influence the availability of medical abortion medicines is important to support policymakers improve availability of these medicines. The landscape assessments documented that medical abortion commodities can be uniquely impacted by the laws, policies, values, and degree of restrictions placed on service delivery programs. Results of the assessments can guide actions to improve access.

Keywords: Abortion; Combi-pack; Medical abortion; Mifepristone; Misoprostol.

Plain language summary

Unsafe abortion is a leading cause of death and disability among women of reproductive age. Medical management of abortion with mifepristone and misoprostol pills, or just misoprostol, is a safe and effective way to end a pregnancy. Owing to an increase in the number of medical abortion products that have entered country health systems, we examined access to these medicines from supply to demand in selected countries. The overarching goal of the national landscape assessments was to produce evidence to support advocacy efforts and policymaking for improved access to quality medical abortion products that is appropriate to the needs of the country. This paper aims to describe key findings across eight country settings on the availability of medical abortion medicines and identify key opportunities to improve access to them across countries.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The five pillars of availability of a medical product related service, applied to MA. Source: Rehnstrom Loi et al. [11]
See this image and copyright information in PMC

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