Pharmacy recruitment of misoprostol users in Mexico: A feasibility study
Awarded 2012
Small Research Grants
Dalia Brahmi, MD, MPH

Background: In both legally restricted and less restricted settings in Mexico, women purchase misoprostol in community pharmacies without a prescription and use it at home. Because these abortions occur outside the health-care system, little is known about how women learn about misoprostol, assess their eligibility, know appropriate dosing regimens, and recognize complications. Identifying and assessing the health information needs of this hidden population is central to increasing safe abortion access to misoprostol-induced abortion at the community level. Because pharmacy workers often do not retain information on misoprostol dosage and eligibility, training pharmacists may not be as effective as providing women directly with information on misoprostol. Ipas evaluated the feasibility of a novel approach to reaching women who access misoprostol at community pharmacies with timely and appropriate information on misoprostol dosage and eligibility. Objectives: To determine whether 1) pharmacy vendors will distribute an information sheet about a study to women who are purchasing misoprostol at community pharmacies for medical abortion; 2) women undergoing abortion at the community level will contact a study team and agree to participate in a confidential interview; and 3) women who participate in the initial interview can be followed through phone contact or text message at 1–2 weeks and 1–2 months after medical abortion. Methods: We conducted a prospective pilot study to determine the feasibility of identifying women purchasing misoprostol for abortion at community pharmacies in Mexico by asking pharmacy workers to distribute fliers with the project contact information. The fliers asked women to call the local project number for additional information on misoprostol eligibility and use. We planned to ask clients who called if they would consent to an interview about their understanding of misoprostol use and their motivations for seeking misoprostol-induced abortion at the community level. We piloted the project in both a less restrictive (Federal District) and a restricted (Guanajuato) setting on the assumption that women who obtain misoprostol at community pharmacies in settings where they could obtain it for abortion within the formal health-care setting are likely different from women obtaining it from pharmacies in states where abortion is legally restricted. Findings and Conclusion: We had intended to limit the role of pharmacy workers to offering the project flier to pharmacy clients who bought misoprostol, but we found that pharmacies were nonetheless a major barrier to reaching women with appropriate information. At the largest chain pharmacies, where most women go to obtain misoprostol, company policies prohibited the distribution of fliers. Smaller chain pharmacies regularly rotate staff among pharmacies, hampering our ability to follow-up with the workers who had agreed to distribute fliers. We received a total of four calls from misoprostol clients, three in the Federal District and one in Celaya, but were able to interview only one caller. That client reported that she had previously had a misoprostol-induced abortion at a clinic in the Federal District and was too ashamed to return for a repeat abortion. She reported that all of the information that she had received on purchasing and using misoprostol had come from a friend. Developing strategies to reach women with timely, appropriate information on misoprostol is central to ensuring safe abortion access in restrictive settings or where women experience stigma when accessing abortion within the health-care system. However, our study demonstrated that it is not feasible to reach women who purchase misoprostol for abortion at community pharmacies by asking pharmacy workers to distribute project fliers to them. Investing in existing abortion hotlines and helping to foster connections between researchers and hotline groups may be a more efficient way to reach them.