Medical Abortion, Misoprostol, and Latin American Pharmacies

Well, isn't this a grand combination: Abortifacient provision is common at pharmacies [in Latin America] but knowledge about medications is low among pharmacy staff.

A number of studies have documented that women seek and that pharmacy staff distribute drugs intended to induce abortion at pharmacies in Latin America. Abortion is legally restricted in almost all of Latin America. Nonetheless, the region has one of the highest abortion rates in the world. In the 1990s, reports that women were using the prostaglandin analog misoprostol to self-induce abortion in Brazil emerged. Interviews with Brazilian women revealed that they tended to use misoprostol because of its lower price as compared with other medical alternatives, its immediate availability, the fact that the process seems more like a natural miscarriage and its apparent safety. In Brazil, prior to the drug's removal from the market, pharmacies were the main source of misoprostol.

Some evidence suggest that the availability and use of medical methods to terminate a pregnancy may contribute to declining complication rates from clandestine procedures, yet little is known about the role of pharmacist provision of medical abortifacients. We performed this study to learn more about pharmacists' knowledge and provision of medical abortifacients, particularly misoprostol, in a large Latin American city. Although the legislation of the country where the study was performed requires a prescription to purchase misoprostol, in practice, this law is not enforced and misoprostol is commonly sold without a prescription in pharmacies. Moreover, misoprostol is not approved for use as an abortifacient and legal abortions are very rare in the study country. We elected not to identify the study location because of the sensitive nature of the topic.

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Similar to a study on pharmacies in Mexico City in 1993, our study found that the most frequently recommended abortifacients were hormonal injectables in both the survey (67%) and the mystery client encounters (71%). Although there is no scientific evidence to support their efficacy, it is widely believed both by pharmacy staff and the general population in Latin America that hormonal injectables are effective abortifacients. In our study, the second most common abortifacient was misoprostol: 33% of pharmacy staff mentioned it in the survey and 39% recommended it in the mystery client encounters. However, knowledge about adequate dosage, route of administration, side effects, complications and effectiveness was poor. In fact, no information was offered (even when requested) on any of these topics in at least half of the mystery client encounters in which misoprostol was recommended. Few pharmacy staff had received formal training regarding misoprostol use; most had consulted a drug reference guide or learned about the medication from colleagues, which could explain why so little information was known about dosage, side effects and complications.

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