Nonclinical Distribution of the Pill in the Developing World

Abstract

The death toll from pregnancy and childbirth in the developing world ranges from 200 to 600 per 1000 live births. Medical budgets are limited clinics and hospitals scarce and physicians in short supply. In Thailand for example there is an average of only 1 doctor for 20 thousand people in the rural areas where about 80% of the population lives. To require a doctors examination prior to pill prescription is unrealistic and counterproductive under these circumstances. Many powerful medications that require prescriptions in the industrialized countries are sold over the counter in the 3rd World and ways of distributing the pill outside the medical system have been developed. At least 95 programs for nonclinical distribution of contraceptives have been established most operating in 14 Asian and 20 Latin American countries with 6 in Africa. Some rely on nonphysician medical personnel such as nurse-midwives and specially trained auxiliary midwives to distribute pills often from health stations in the countryside. Other programs involve educating interested villagers about the advantages of birth control and training them to distribute pills to women who are free of conditions that would contraindicate pill use. The village distributors many using their homes as a base are provided with a list of such contraindications during their training. A 3rd type of nonclinical distribution -- social marketing -- utilizes the network of small privately owned shops that are found in most villages. Shopkeepers who agree to participate are provided with a free supply of oral contraceptives and are permitted to sell them at low cost and keep the profit. All nonclinical programs are government approved and many are government sponsored. The authors believe that such distribution efforts are ethically sound and health and life enhancing in the developing world environment. They urge that research on pill use by women in the developing world be expanded. (Authors modified) (Summary in FRE)