Exploring the availability and accessibility of medication abortion pills in Delhi, India: A mystery client study in community pharmacies

Abstract

Objectives: Although medication abortion drugs technically require a prescription in India, research suggests that they are often available directly from pharmacies. We conducted a mystery client study in the capital city of Delhi to explore the availability, accessibility, and pharmacy dispensing practices of mifepristone/misoprostol in the absence of a prescription.

Study design: Using two predetermined client profiles-one of an unmarried woman and one of her male partner-we visited community pharmacies in different neighborhoods. Mystery clients began the interaction with a request for "a pill to bring back" a period after a positive pregnancy test. We documented product availability, price, and outcome and assessed the quality of the client-pharmacy worker interaction. We analyzed these encounters using descriptive statistics and for themes.

Results: In late 2022, we made 172 visits to 86 pharmacies. Medication abortion pills were available at more than half of the pharmacy visits (n = 91, 53%), and our mystery clients purchased the drugs without a prescription during 22% (n = 37) of all visits. The woman and man clients purchased mifepristone/misoprostol on a similar number of occasions, but we assessed the pharmacy worker interactions with the man as more positive. Pharmacy workers provided varied information about the regimen, and the encounters were brief.

Conclusions: Medication abortion drugs appear to be available without a prescription in a sizable minority of pharmacies in Delhi, India. Our findings suggest that identifying ways to work with pharmacy workers to support their ability to provide medically accurate information about the optimal mifepristone/misoprostol regimen is warranted.

Implications: Pharmacy access to mifepristone/misoprostol has the potential to greatly reduce barriers to accessing abortion care in India. Despite technically requiring a prescription, medication abortion drugs are available behind the counter at a sub-set of pharmacies in Delhi. Future research on formalizing and supporting pharmacy access and exploring abortion seekers' experiences with pharmacy access is warranted.

Keywords: Abortion; India; Mifepristone; Misoprostol; Mystery client; Pharmacy.