Knowledge, provision of information and barriers to high quality medication abortion provision by pharmacists in Uttar Pradesh, India

Nadia Diamond-Smith,Malvika Saxena,Aradhana Srivastava,Pravesh Dwivedi,Joanna Percher

doi:10.1186/s12913-019-4318-4

Abstract

BackgroundThe use of medication abortion is increasing rapidly in India, the majority of which is purchased through pharmacies. More information is needed about the quality of services provided by pharmacist about medication abortion, especially barriers to providing high quality information. The goal of this study was to explore the quality of pharmacist medication abortion provision using mixed methods to inform the developed of an intervention for this population.MethodsData was collected via convenience sampling using three methods: a quantitative survey of pharmacists (N = 283), mystery clients (N = 111), and in-depth qualitative interviews with pharmacist (N = 11). Quality indictors from the quantitative data from surveys and mystery clients were compared. Qualitative interviews were used to elucidate reasons behind findings from the quantitative survey.ResultsQuality of information provided to client purchasing medication abortion was low, especially related to timing and dosing of misoprostol (18% of pharmacists knew correct timing) and side effects (31% not telling any information on side effects). Mystery clients reported lower quality (less correct information) than pharmacists reported about their own behaviors. Qualitative interviews suggested that many barriers exist for pharmacists, including perceptions about what information clients can understand and desire, and also lack of comfort giving certain information to certain types of clients (young women).ConclusionsIt is essential to improve the quality of information given to client purchasing medication abortion from pharmacists. Our findings highlight specific gaps in knowledge and reasons for poor quality information. Differences in guidelines available at that time from the Indian Government, World Health Organization, and the medication abortion boxes may lead to confusion amongst pharmacists and potentially clients. Interventions need to improve both knowledge about medication abortion and also biases in the provision of care.

Highlights

The use of medication abortion is increasing rapidly in India, the majority of which is purchased through pharmacies
This paper aims to explore the knowledge and information given by pharmacists who sell medication abortion (MA), and the barriers to providing high quality information and care through mixed methods, including a survey, mystery clients, and World Health Organization (WHO) guidelines for MA use up to 63 days
We interviewed whoever was at the pharmacy seeing clients on the day of the visit as this most accurately represented who clients would be interacting with

Summary

Introduction

The use of medication abortion is increasing rapidly in India, the majority of which is purchased through pharmacies. In Uttar Pradesh, where an estimated 3.15 million abortions take place annually, over 1 million individuals are treated for induced abortion complications at clinics [20] Many of these are likely unnecessary interventions because individuals did not know how to differentiate between normal progress of MA versus a complication necessitating additional care. Treatment for these perceived complications often use dilation and curettage, an invasive and outdated procedure, used at a higher rate in Uttar Pradesh than in other Indian states studied by Guttmacher in 2015 [21]

Objectives

Methods

Results

Discussion

Conclusion