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. 2024 Dec 27;20(Suppl 1):195.
doi: 10.1186/s12978-024-01898-8.

A descriptive summary of the WHO availability assessments of medical abortion medicines in eight African countries

Amy Grossman  1 , Ndola Prata  1   2 , Sarah Jones  1 , Laurence Läser  3 , Bela Ganatra  4 , Antonella Lavelanet  4 , Natalie Williams  1 , Chilanga Asmani  5 , Hayfa Elamin  5 , Leopold Ouedraogo  5 , Lucy Sejo Maribe  6 , Dina Vladimirovna Gbenou  7 , Yelmali Clotaire Hien  7 , Moussa Dadjoari  8 , Fousséni Dao  9 , Mariette Claudia Adame Gbanzi  10 , Robert Mulunda Kanke  11 , Franck Biayi Kanumpepa  12 , Dudu Dlamini  13 , Grace Motsoanku Mefane  14 , Sirak Hailu Bantiewalu  15 , Mary Nana Ama Brantuo  15 , Olive Sentumbwe-Mugisa  16 , Richard Mugahi  17 , Olumuyiwa Adesanya Ojo  5 , Adeniyi Kolade Aderoba  5 , Ulrika Rehnström Loi  4
Affiliations

A descriptive summary of the WHO availability assessments of medical abortion medicines in eight African countries

Amy Grossman et al. Reprod Health. .

Abstract

Background: The use of medical abortion using either a combination of mifepristone and misoprostol, or misoprostol alone has contributed to increased safety and decreased mortality and morbidity. The availability of quality medical abortion medicines is an essential component in the provision of quality abortion care. Understanding the factors that influence the availability of medical abortion medicines is important to help in-country policymakers, program planners, and providers improve availability and use of medical abortion.

Methods: Using a national assessment protocol and an availability framework, we assessed the availability of medical abortion medicines across five elements (Registration & Quality Assurance, Policy & Financing, Procurement & Distribution, Provider Knowledge, and End-user Knowledge) in eight countries: Botswana, Burkina Faso, Central African Republic, Democratic Republic of the Congo, Eswatini, Lesotho, Namibia and Uganda between November 2020 and November 2021. The assessment included an online desk review and virtual or telephone-based key informant interviews.

Results: Registration of medical abortion medicines-misoprostol or co-packaged mifepristone and misoprostol products (combi-pack)-was established in all countries, except the Central African Republic. In Lesotho and Eswatini, the national regulatory agency is still in development and importation of Cytotec™ misoprostol is permitted for off-label use in obstetrics/gynecology. Misoprostol was included in all countries' essential medicines lists, except Botswana. Burkina Faso and Democratic Republic of the Congo also include mifepristone on their essential medicines list and medical abortion regimens in national abortion care service and delivery guidelines. Additionally, guidelines clarified health worker roles in the provision of abortion care specific to the legal context of each country and permitted task-shifting of abortion service provision. Where guidelines did not exist, medical abortion medicines and their use were not well integrated into the public health care system. Community awareness activities on abortion rights and services have been limited in scope across the countries assessed, however, end-users' awareness of misoprostol as a medical abortion medicine was reported.

Conclusion: The national landscape assessments identified several cross-cutting opportunities to improve availability of medical abortion medicines, including importing quality-assured medical abortion medicines; developing nationally approved abortion service and delivery guidelines that optimize healthcare worker roles; and expanding communication strategies to reach end-users and pharmacists.

Keywords: Abortion; Botswana; Burkina Faso; Central African Republic; Combi-pack; Democratic Republic of the Congo; Eswatini; Lesotho; Medical abortion; Mifepristone; Misoprostol; Namibia; Uganda.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethics approval was conferred by the Research and Ethics Committee in Lesotho (Ref: ID 2021-29) on 13 June 2021 and a waiver conferred by the Ministry of the Health and Social Services, Research Management Committee off ice of the Executive Director in Namibia (Ref: 17/3/3/SJ) on 12 May 2021. Ethics approval was not applicable in the other country assessments as the ministries of health led and deemed them programme assessments. The information collected during the desk review is public available data and the key informants all participated within their official capacity and were selected by the ministries of health. Verbal informed consent to participate in the assessment was obtained from all participants. Consent for publication: Consent was sought from the Research Management Committee (RMC) of the Ministry of Health and Social Services (MoHSS) in Namibia, as requested in the approval for publication of the report: Landscape assessment on availability of Co-package mifepristone-misoprostol (Combipack) letter from the MoHSS, to publish the manuscript in a peer review journal. No other consent was needed. Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the views of, and should not be attributed to, the World Health Organization. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted the names of proprietary products are distinguished by initial capital letters. Competing interests: The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Number of registered MA medicines with and without quality assurance by country. *Health products are imported, not formally registered given the NRA is not fully operational
See this image and copyright information in PMC

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