Women’s self-reported experiences using misoprostol obtained from drug sellers: a prospective cohort study in Lagos State, Nigeria
Women’s self-reported experiences using misoprostol obtained from drug sellers: a prospective cohort study in Lagos State, Nigeria
Objectives This study aimed to assess the safety and effectiveness of self-managed misoprostol abortions obtained outside of the formal health system in Lagos State, Nigeria.
Design This was a prospective cohort study among women using misoprostol-containing medications purchased from drug sellers. Three telephone-administered surveys were conducted over 1 month.
Setting Data were collected in 2018 in six local government areas in Lagos State.
Participants Drug sellers attempted to recruit all women who purchased misoprostol-containing medication. To remain in the study, participants had to be female and aged 18–49, and had to have purchased the medication for the purpose of abortion. Of 501 women initially recruited, 446 were eligible for the full study, and 394 completed all three surveys.
Primary and secondary outcome measures Using self-reported measures, we assessed the quality of information provided by drug sellers; the prevalence of potential complications; and the proportion with completed abortions.
Results Although drug sellers provided inadequate information about the pills, 94% of the sample reported a complete abortion without surgical intervention about 1 month after taking the medication. Assuming a conservative scenario where all individuals lost to follow-up had failed terminations, the completion rate dropped to 87%. While 86 women reported physical symptoms suggestive of complications, only six of them reported wanting or needing health facility care and four subsequently obtained care.
Conclusions Drug sellers are an important source of medical abortion in this setting. Despite the limitations of self-report, many women appear to have effectively self-administered misoprostol. Additional research is needed to expand the evidence on the safety and effectiveness of self-use of misoprostol for abortion in restrictive settings, and to inform approaches that support the health and well-being of people who use this method of abortion.
gynaecology, international health services, public health, quality in health care, reproductive medicine
1-10
Stillman, Melissa
4476a8ec-d496-4aae-8ed2-0a75f818edeb
Owolabi, Onikepe
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Fatusi, Adesegun O.
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Akinyemi, Akanni
99b6089a-d258-4cad-9580-22132d4589ce
Berry, Amanda L.
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Erinfolami, Temitope P.
ec83f645-f3cf-4e95-b9ed-9ece5457d31f
Olagunju, Olalekan S.
c2a0ef13-4e0e-44a9-917c-73db515267a0
Vaisanen, Heini
ee5b9497-7825-4fd8-8b7e-3d5d2b164766
Bankole, Akinrinola
ca4d4a37-7770-4a2d-9fff-fb54f7c14195
5 May 2020
Stillman, Melissa
4476a8ec-d496-4aae-8ed2-0a75f818edeb
Owolabi, Onikepe
ac945e29-142d-44c9-8984-7f347cd24076
Fatusi, Adesegun O.
4d73250d-f972-4383-90fe-3c0245af99ee
Akinyemi, Akanni
99b6089a-d258-4cad-9580-22132d4589ce
Berry, Amanda L.
a61f364e-fb35-4db9-9e43-41075a4c6d16
Erinfolami, Temitope P.
ec83f645-f3cf-4e95-b9ed-9ece5457d31f
Olagunju, Olalekan S.
c2a0ef13-4e0e-44a9-917c-73db515267a0
Vaisanen, Heini
ee5b9497-7825-4fd8-8b7e-3d5d2b164766
Bankole, Akinrinola
ca4d4a37-7770-4a2d-9fff-fb54f7c14195
Stillman, Melissa, Owolabi, Onikepe, Fatusi, Adesegun O., Akinyemi, Akanni, Berry, Amanda L., Erinfolami, Temitope P., Olagunju, Olalekan S., Vaisanen, Heini and Bankole, Akinrinola
(2020)
Women’s self-reported experiences using misoprostol obtained from drug sellers: a prospective cohort study in Lagos State, Nigeria.
BMJ Open, 10 (5), , [e034670].
(doi:10.1136/bmjopen-2019-034670).
Abstract
Objectives This study aimed to assess the safety and effectiveness of self-managed misoprostol abortions obtained outside of the formal health system in Lagos State, Nigeria.
Design This was a prospective cohort study among women using misoprostol-containing medications purchased from drug sellers. Three telephone-administered surveys were conducted over 1 month.
Setting Data were collected in 2018 in six local government areas in Lagos State.
Participants Drug sellers attempted to recruit all women who purchased misoprostol-containing medication. To remain in the study, participants had to be female and aged 18–49, and had to have purchased the medication for the purpose of abortion. Of 501 women initially recruited, 446 were eligible for the full study, and 394 completed all three surveys.
Primary and secondary outcome measures Using self-reported measures, we assessed the quality of information provided by drug sellers; the prevalence of potential complications; and the proportion with completed abortions.
Results Although drug sellers provided inadequate information about the pills, 94% of the sample reported a complete abortion without surgical intervention about 1 month after taking the medication. Assuming a conservative scenario where all individuals lost to follow-up had failed terminations, the completion rate dropped to 87%. While 86 women reported physical symptoms suggestive of complications, only six of them reported wanting or needing health facility care and four subsequently obtained care.
Conclusions Drug sellers are an important source of medical abortion in this setting. Despite the limitations of self-report, many women appear to have effectively self-administered misoprostol. Additional research is needed to expand the evidence on the safety and effectiveness of self-use of misoprostol for abortion in restrictive settings, and to inform approaches that support the health and well-being of people who use this method of abortion.
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Accepted/In Press date: 12 March 2020
e-pub ahead of print date: 5 May 2020
Published date: 5 May 2020
Additional Information:
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords:
gynaecology, international health services, public health, quality in health care, reproductive medicine
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Local EPrints ID: 439592
URI: http://eprints.soton.ac.uk/id/eprint/439592
ISSN: 2044-6055
PURE UUID: 228fb6e5-7ffc-4855-aee4-87c7b5512ea7
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Date deposited: 27 Apr 2020 16:47
Last modified: 17 Mar 2024 03:40
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Contributors
Author:
Melissa Stillman
Author:
Onikepe Owolabi
Author:
Adesegun O. Fatusi
Author:
Akanni Akinyemi
Author:
Amanda L. Berry
Author:
Temitope P. Erinfolami
Author:
Olalekan S. Olagunju
Author:
Akinrinola Bankole
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