Pharmacists in Ethiopia can develop the skills and knowledge to provide medication abortion and pharmacies have the potential to be essential hubs for safe and confidential abortion care, but most pharmacies and other drug sellers lack the stock of medications needed. These are among the key findings of new studies released Tuesday by the Guttmacher Institute, the St. Paul’s Institute for Reproductive Health and Rights (SPIRHR) and Ipas.
Abortion is legal for a broad range of indications in Ethiopia. Medication abortion is included in the national abortion practice guidelines and the two medications used —mifepristone and misoprostol—are both included on the national list of essential medicines. However, under current guidelines, women seeking medication abortion care must first seek clinical services to receive a prescription for the medications. Using a mystery client methodology, the Guttmacher/SPIRHR research showed that many pharmacists and drug sellers in Addis Ababa have the knowledge and skills needed to provide quality medication abortion care, indicating that they could provide frontline abortion care if the practice guidelines were amended and training was provided.
Pharmaceutical outlets are an important source of essential maternal and reproductive health medicines in Ethiopia, including for medication abortion, and maintaining consistent stock ensures access to these medicines when they are needed. The Guttmacher/SPIRHR analysis provides one of the first studies to evaluate the availability of mifepristone and misoprostol for medication abortion in pharmaceutical outlets in Ethiopia. Guttmacher and SPIRHR surveyed all 1,548 functional outlets in Addis Ababa and found that less than one-third (28%) of pharmacies and drug sellers regularly carried the necessary medications and only 17% had stock on the day of the survey.
“The implementation of safe abortion in Ethiopia led to a significant reduction in maternal mortality in our country,” said Professor Delayehu Bekele, Director of SPIRHR. And yet we know that significant gaps remain where services aren’t available and stigma and misinformation prevent women from seeking care. Together, these studies point to an important and cost-effective intervention that could contribute to a further decline in unsafe abortion.”
Ipas Ethiopia conducted a pilot study in the regional state of Oromia intended to increase direct access to self-managed abortion (SMA) with medications obtained through pharmacies in the towns of Adama and Shashemene, focusing on areas with high rates of unintended pregnancies and abortions occurring outside health facilities. Ipas’s study underscored the crucial role pharmacies play as sources of safe and confidential abortion care, revealing both the feasibility and demand for pharmacy-based SMA services. Follow-up surveys with clients who received drugs for medication abortion directly from pharmacies found that almost all clients followed the pharmacist’s directions (99%) and had complete abortions (98%).
Dr. Demeke Desta, Country Director of Ipas Ethiopia, noted the importance of having complementary studies on SMA to build the body of evidence needed to advocate for updating Ethiopia’s abortion policy:
“Along with the effort compounded by SPIRHR and Guttmacher, we were finally able to present these findings to the Ministry of Health and receive positive feedback. Now that the space and platform have been created, we will work together to use these results to influence policymakers, as Ethiopian women and girls still suffer from policy gaps in the area of self-managed [medication] abortion.”
The studies were released at a workshop with support from the Ethiopian Ministry of Health and attended by key leaders in sexual and reproductive health as well as women’s rights. Professor Sileshi Garoma, Senior Advisor to the State Minister of Health, welcomed the new findings:
“Today’s discussion is not only about presenting research findings; more importantly, it provides an opportunity for policymakers, health care providers, researchers, regulators and development partners to reflect on the implications of this evidence and explore how it can inform future policy directions, strengthen service quality, improve the supply chain system, and enhance access to accurate information and essential reproductive health services.”