Availability of medical abortion pills and the role of chemists: a study from Bihar and Jharkhand, India.

The clinical safety, efficacy and acceptability of mifepristone and misoprostol in the Indian context have been well studied, but little is known about how they are being used, who is using them, how women access them or how providers, chemists, women and their partners perceive medical abortion. This paper reports on part of a study on these issues, a survey of 209 chemists, in the Indian states of Bihar and Jharkhand in 2004. It found that only 34% of the interviewed chemists stocked mifepristone and misoprostol, sales volumes were low and there was more demand for cheaper, often ineffective preparations for abortion. Men were more likely to buy abortifacient drugs than women. Chemists knew mifepristone and misoprostol were prescription drugs but less about dosage and side effects. Most sales appeared to be prescription driven, but some over-the-counter sales did occur, especially when ability to pay seemed high or the chemist knew the customer. Chemists need accurate information on the drugs they sell as abortifacients, encouragement to promote pregnancy tests, training in encouraging women to see a provider prior to purchase, and visual and written material to hand out. Better adherence to existing regulations for all prescription drugs is important, but the best course is to increase the availability of low-cost, safe abortion services at primary care level.