In Bangladesh, prior to the availability of the approved combination regimen of mifepristone and misoprostol for menstrual regulation (MR), drug seller provision of misoprostol-only regimens for MR without a prescription was widespread but service quality was poor. Examining provider practices relating to misoprostol-only provision in Bangladesh may increase understanding of misoprostol use and provision in other low-resource, legally restrictive settings.
In 2013–2014, a countrywide cross-sectional knowledge, attitudes and practice survey was conducted among 777 randomly selected drug sellers; data were analyzed descriptively. Logistic regression was used to test the associations between exposure to three interventions designed to improve drug seller practice (nongovernmental organization [NGO]–led training, a call center and in-shop training from pharmaceutical company representatives) and correct knowledge of the misoprostol-only MR regimen.
Almost all (97%) of the drug sellers reported providing medications intended for MR; misoprostol-only was more commonly sold than the combination regimen (96% vs. 26%). Nine percent had received NGO–led training, 62% had received in-shop training from a pharmaceutical company representative and 27% had used the call center. Overall, 19% of drug sellers knew the correct misoprostol-only MR regimen, and 74% wanted more information about this regimen. Correct regimen knowledge was positively associated with receipt of NGO training and call center utilization (odds ratios, 2.0 and 1.9, respectively).
NGO–led training and call centers should be considered in other settings in which misoprostol alone is provided off-label for pregnancy termination.
Kate Reiss is research degree student, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London. Katherine Keenan is lecturer in demography, Department of Geography and Sustainable Development, University of St. Andrews, Scotland. Kathryn Church is director of global evidence, Technical Services Department, Marie Stopes International, London. Sally Dijkerman is senior research and evaluation officer, Ipas, Chapel Hill, NC, USA. Shahida Akter Mitu is monitoring and evaluation officer, Directorate General of Health Services, Dhaka, Bangladesh. Sadid Nuremowla is an independent consultant, Dhaka, Bangladesh. Thoai D. Ngo is director, Poverty, Gender and Youth Program, Population Council, New York.