Inability to Obtain Medication Abortion in Pharmacies and Drug Stores in Addis Ababa, Ethiopia: Findings from a Mystery Client Study

Stephanie Kung, Guttmacher Institute
Alice Cartwright, Guttmacher Institute
Delayehu Bekele, St. Paul Institute for Reproductive Health and Rights (SPIRHR)
Niguse Tadele, Addis Ababa University
Mahari Yidego, Performance Monitoring for Action (PMA)
Kidist Lemma, St. Paul’s Hospital Millennium Medical College
Tesfaye Hurisa, St. Paul’s Hospital Millennium Medical College

Background: Little is known about dispensation of Medication Abortion (MA) without a prescription in pharmaceutical outlets in Ethiopia. We explored factors associated with inability to access MA without a prescription in these settings. Methods: Mystery clients (MCs) visited 600 outlets in Addis Ababa to request MA without a prescription. We ran tests for association to understand factors associated with inability to obtain MA. We descriptively analyzed the reasons MCs were unable to obtain MA, and compared MC and stock survey results to assess consistency between stock survey results and MC visit outcome. Results: MCs were unable to obtain MA in three-quarters of visits (76.5%). In multivariable regression, MCs assisted by female staff or outlet employees had nearly twice the odds of being unable to obtain MA compared to male staff (aOR = 1.61; 95% CI = 1.02-2.54) and to managers/owners (aOR = 1.78; 95% CI = 1.06-2.99). MCs who disclosed their marital status and the reason for wanting an abortion had significantly lower odds of being unable to obtain MA compared to MCs who were not asked these details (aOR = 0.43; 95% CI = 0.25-0.73; and aOR = 0.49; 95% CI = 0.29-0.82, respectively). Not selling MA was the main reason MCs were unable to obtain MA. Conclusions: The practice of selling MA without a prescription is already happening, though clients are unable to obtain MA for reasons other than needing a prescription. There is potential for involving pharmacists in the expansion of safe abortion services in Ethiopia.

Keywords: Sexual and Reproductive Health and Rights

See paper.

  Presented in Session 147. Medical Abortion: Safety and Methods