New study finds women in Lagos, Nigeria effectively self-manage medication abortions

Additional training for drug sellers could improve quality of information and services women receive

A new study finds that drug sellers play a critical role in providing information and access to medication abortion in Lagos, the most populous city in Nigeria. Although abortion is legally permitted in Nigeria only to save a woman’s life, medication abortion drugs, particularly misoprostol, have become widely available in recent years through the country’s large market of formal and informal drug vendors. The  study, conducted jointly by the Nigeria-based Academy for Health Development (AHEAD) and Centre for Research, Evaluation Resources and Development (CRERD), and U.S.-based Guttmacher Institute, documents for the first time women’s experiences accessing and using misoprostol outside the health system. Researchers found that drug sellers were the only source of information about misoprostol for three-quarters of the 400 women aged 18–49 who self-managed an abortion using misoprostol.

Most women who participated in the study, however, did not receive adequate or accurate information about how to administer misoprostol, how much to use, or what to expect during the abortion process. For example, only 67% of participants were told to anticipate bleeding and 35% were told to expect cramping, both of which are a normal part of the medication abortion process. The authors recommend providing training to improve drug sellers’ knowledge of and communication about the safe and effective use of misoprostol to protect women’s health and well-being.

"Overall, 85% of participants in our study said they would recommend misoprostol to a friend with an unintended pregnancy," said Onikepe Owolabi, senior research scientist at the Guttmacher Institute and co-investigator on the study. "For many women, drug sellers are the first, and often only, point of care, which means they are a vital resource for providing high-quality information about this medication."

The data suggest that misoprostol obtained from drug sellers is effective and provides an alternative for women who may otherwise use harmful methods to end an unintended pregnancy. Seventy percent of women stated that they would use misoprostol in the future if they were to experience another unintended pregnancy. Nine percent of women reported that they would have attempted to induce an abortion using unsafe methods had they not had access to misoprostol.

"We found that 94% of women reported a complete abortion without medical intervention within one month of taking misoprostol, which speaks to the safety and effectiveness of misoprostol as a method for self-managed abortion," explains Akanni Akinyemi,  Professor of Demography at Obafemi Awolowo University and Director at CRERD.

This research demonstrates that the quality of information and services provided by drug sellers is a key factor affecting women’s abortion experiences. The researchers recommend that the Nigerian government take steps to improve drug sellers’ knowledge of medication abortion and to ensure they have the resources necessary to provide high-quality services to their clients, including referral mechanisms if appropriate. Providing evidence-based information on possible complications and access to postabortion care to all women who purchase misoprostol for abortion is crucial.

While these findings may not be generalizable to the rest of the country and women’s experiences may differ, it is likely that self-use of misoprostol will continue to be a safe and effective alternative for women who may otherwise induce an abortion using unsafe methods, particularly in settings where abortion is legally restricted.