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Abstract
Introduction In 2006, abortion was decriminalised in Colombia under certain circumstances. Yet, women avail themselves of ways to terminate pregnancy outside of the formal health system. This study explored how drug sellers engage with women who attempt to purchase misoprostol from them.
Methods A mapping exercise was undertaken to list small-chain and independent drug stores in two regions in Colombia. A sample (n=558) of drug stores was selected from this list and visited by mystery clients between November and December 2017. Mystery clients sought to obtain a medication to bring back a delayed period, and described the experience, the information obtained and the medications proffered in exit interviews.
Results Misoprostol was offered for purchase in 15% of the visits; in half of visits, only information about misoprostol was shared, while no information about misoprostol was provided on the remaining visits. Over half of sellers who refused to sell any medication provided referrals, most commonly to an abortion provider. Among visits which included discussion of misoprostol, two out of five sellers provided dosage instructions with most recommending the minimum adequate dosage. Mystery clients received little information on the physical effects to expect with the use of misoprostol and possible complications.
Conclusions As misoprostol is being obtained from some drug sellers without a prescription, capacitating this cadre with at least a minimum of standardised information on dosage, routes of administration and expected effects and outcomes have the potential to improve reproductive health outcomes for women who choose to terminate pregnancies this way in Colombia.
- abortion
- counselling
- health education
- service delivery
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Footnotes
Twitter @Marie77Ann
Presented at The work was previously presented at the 2018 Clacai: Consorcio Latinoamericano contra el aborto inseguro conference in Quito, Ecuador (October, 2018), at the 2019 Population Association of America meetings in Austin (April, 2019) and at the 2019 CLACAI conference in Santa Cruz, Bolivia (June, 2019).
Collaborators Additional contributions from individuals who are not authors: Elena Prada contributed to the design of the study, trained and supervised fieldworkers, contributed to the interpretation of the data, and reviewed an earlier version of the manuscript. Akinrinola Bankole contributed to the study design, contributed to the exit interview survey, contributed to the interpretation of the data; and reviewed an earlier version of the manuscript. Adesegun Fatusi, María Mercedes Vivas and Sophia Sadinsky also reviewed an earlier draft of this paper. The advisory committee reviewed and commented on the study design, provided feedback on preliminary results, and gave guidance on the framing and dissemination of the study findings. Rachel Murro managed the formatting and submission of the manuscript to the journal.
Contributors AMM: Conceived of the study; created the study design, conceptualised aspects of the analysis and drafted the majority of the manuscript; also managed the majority of the revisions to the manuscript based on reviewer feedback. NB: Designed the exit interview survey; trained fieldworkers on the mystery client component; drew the sample; led on the analysis of the mystery client data; contributed to the writing of the manuscript; and managed a substantial number of revisions to the manuscript based on reviewer feedback. JO: Contributed to the design of the exit interview survey; trained and supervised fieldworkers on the mystery client component; identified the universe; contributed to the interpretation of the data; reviewed the manuscript and provided comments; answered numerous questions asked by reviewers which contributed to the revision of the manuscript. HW: Contributed to the design of the exit interview survey; implemented changes to the exit interview survey; participated in data analysis; reviewed the manuscript and provided comments. CV: Contributed to the study design; participated in the fieldwork training and supervision; participated in the identification of the universe; contributed to the interpretation of the data; reviewed the manuscript and provided comments; answered numerous questions asked by reviewers which contributed to the revision of the manuscript.
Funding The study on which this article is based was made possible by UK Aid from the UK Government (project #203177-101), the Dutch Ministry of Foreign Affairs (activity #4000000282) and an anonymous foundation.
Disclaimer The views expressed are those of the authors and do not necessarily reflect the positions and policies of the donors. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. All authors had full access to the data, and the corresponding author had final responsibility for the decision to submit for publication.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. We are ready to collaborate with others who may be interested in using these data; a member of the study team must be part of the analysis team and the confidentiality of our respondents will be protected at all times.