In Nigeria, where abortion is highly restricted and access to services is limited, more and more people are self-managing their abortions after going to patent medicine vendors (PMVs) for abortion information and pills.
PMVs play a vital role in the provision of primary health services in Nigeria. They are licensed to sell prepackaged patent medicines and their shops “supply a large portion of the drugs used by the public in African countries to treat their illnesses.” But little has been known about the knowledge and practices of PMVs with regard to dispensing abortion pills—or what the experiences and outcomes are for the people obtaining those medications.
A recent evaluation by Ipas sheds new light on the issue. It concludes that, with ongoing training and support, PMVs can dispense the drugs in appropriate doses and be an important source of safe abortion care. Significantly, the study also lends support to the growing abortion self-care movement, where people seeking abortion obtain pills on their own, without a prescription from a doctor, and then self-manage their abortions, often without the support of a health provider.
The evaluation followed an intervention in 2015-2018 to train, mentor and support PMVs to accurately dispense abortion medications (misoprostol-alone regimens for abortion and postabortion care) as part of a harm reduction approach to stem the number of unsafe abortions in Nigeria, which has one of the highest maternal death rates in the world. It explored the knowledge and practices of the PMVS post-intervention and the experiences of women who obtained either abortion or post-abortion care from a participating PMV.
The self-data record from the 141 PMVs participating in the intervention showed that they had provided misoprostol for nearly 5,000 clients seeking an abortion over the course of the three-year period. In addition, a majority had dispensed misoprostol in appropriate doses and provided clients with information on how to use the drug and on methods of contraception.
Follow-up interviews with clients found that 86% reported having had a successful abortion, with 99% saying they would return to a PMV for future services. The PMVs had stayed in contact with the clients in the event of complications. Well over 90% of the clients reported they had had no complications.
The outcomes of this intervention and the follow-up evaluation support the abortion self-care movement in that so many of the clients of the participating PMVs had successful abortions, says Kristen Shellenberg, Ipas senior researcher.
These women—on their own and without a prescription from a doctor—got misoprostol, and they went home and had a safe abortion,” Shellenberg says. “Misoprostol-alone is often talked about as less desirable option than the combination of mifepristone and misoprostol, but more and more data are showing that misoprostol-alone leads to safe and successful outcomes and should be considered an important part of the abortion care continuum.”
The evidence shared in this paper will also provide useful information for programs designed to improve medical abortion access and to explore the potential the PMV market offers in Nigeria.