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Global health
Original research
Women’s self-reported experiences using misoprostol obtained from drug sellers: a prospective cohort study in Lagos State, Nigeria
  1. Melissa Stillman1,
  2. Onikepe Owolabi1,
  3. Adesegun O Fatusi1,2,
  4. Akanni I Akinyemi3,4,
  5. Amanda L Berry1,
  6. Temitope P Erinfolami4,5,
  7. Olalekan S Olagunju4,5,
  8. Heini Väisänen6,
  9. Akinrinola Bankole1
  1. 1Department of Research, Guttmacher Institute, New York, New York, USA
  2. 2Academy for Health Development (AHEAD), Ile-Ife, Nigeria
  3. 3Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, United States
  4. 4Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
  5. 5Centre for Research, Evaluation, Resources and Development (CRERD), Ile-Ife, Nigeria
  6. 6Department of Social Statistics and Demography, University of Southampton, Southampton, Hampshire, UK
  1. Correspondence to Ms Melissa Stillman; mstillman{at}guttmacher.org

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.

  • gynaecology
  • international health services
  • quality in health care
  • public health
  • reproductive medicine
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-034670

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    Footnotes

    • Contributors OO, AB, MS, AOF and AIA participated in the conceptualisation of the project and designed the study. AOF, AIA, MS, OO, AB, ALB, TPE, OSO and HV participated in project planning. MS, ALB, OO and TPE programmed the study tools into SurveyCTO for electronic data collection. AIA, TPE and OSO coordinated all aspects of fielding. AIA, AOF, TPE and OSO conducted the piloting of the study protocol and tools. AIA, TPE and OSO selected fieldworkers and organised the trainings. MS, AIA, TPE, OSO, AOF and HV co-led fieldwork trainings. AOF liaised with the Ministry of Health and relevant drug seller associations to get permission to conduct fieldwork at the local level. AOF and AIA convened the Technical Advisory Committee. MS, OO, TPE and ALB analysed the data. MS, OO, ALB, TPE and OSO wrote the first draft of the article; all other authors critically reviewed the draft, and MS led the revisions. The entire team contributed to the development of study tools, participated in the conceptualisation of the paper, and reviewed and approved the final version of the paper. All authors had full access to all the data in the study, and the corresponding author had final responsibility for the decision to submit for publication.

    • Funding The study on which this article is based was made possible by UK Aid from the UK Government (project number 203177-101), the Dutch Ministry of Foreign Affairs (activity number 4000000282) and an anonymous foundation.

    • Disclaimer The views expressed are those of the authors and do not necessarily reflect the positions and policies of the donors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Patient consent for publication Not required.

    • Ethics approval The National Health Research Ethics Committee in Nigeria and the Institutional Review Board of Guttmacher Institute approved the study.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. A member of the study team must be involved in the analysis of the data, and confidentiality of respondents will be protected at all times.