title: Delivering medical abortion at scale: a study of the retail market for medical abortion in Madhya Pradesh, India.
abstract: BACKGROUND
  Medical abortion (mifepristone and misoprostol) has the potential to contribute to reduced maternal mortality but little is known about the provision or quality of advice for medical abortion through the private retail sector. We examined the availability of medical abortion and the practices of pharmacists in India, where abortion has been legal since 1972.
  
  
  METHODS
  We interviewed 591 pharmacists in 60 local markets in city, town and rural areas of Madhya Pradesh. One month later, we returned to 359 pharmacists with undercover patients who presented themselves unannounced as genuine customers seeking a medical abortion.
  
  
  RESULTS
  Medical abortion was offered to undercover patients by 256 (71.3%) pharmacists and 24 different brands were identified. Two thirds (68.5%) of pharmacists stated that abortion was illegal in India. Only 106 (38.5%) pharmacists asked clients the timing of the last menstrual period and 38 (13.8%) requested to see a doctor's prescription - a legal requirement in India. Only 59 (21.5%) pharmacists correctly advised patients on the gestational limit for medical abortion, 97 (35.3%) provided correct information on how many and when to take the tablets in a combination pack, and 78 (28.4%) gave accurate advice on where to seek care in case of complications. Advice on post-abortion family planning was almost nonexistent.
  
  
  CONCLUSIONS
  The retail market for medical abortion is extensive, but the quality of advice given to patients is poor. Although the contribution of medical abortion to women's health in India is poorly understood, there is an urgent need to improve the practices of pharmacists selling medical abortion.
authors.affiliation: Department of Global Health and Development, Faculty of Public Health and Policy, London School Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Timothy
authors.initials: T
authors.lastname: Powell-Jackson
authors.affiliation: Population Council, New Delhi, India.
authors.forename: Rajib
authors.initials: R
authors.lastname: Acharya
authors.affiliation: Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Veronique
authors.initials: V
authors.lastname: Filippi
authors.affiliation: Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Carine
authors.initials: C
authors.lastname: Ronsmans
mesh_terms: D000028:Abortion, Induced / Q000379:methods*; D000022:Abortion, Spontaneous / Q000139:chemically induced*; D000328:Adult; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D015735:Mifepristone / Q000008:administration & dosage*; D016595:Misoprostol / Q000008:administration & dosage*; D010595:Pharmacists; D011247:Pregnancy; D017149:Private Sector
chemical_list: D016595:Misoprostol; D015735:Mifepristone
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