Pharmacy dispensing of abortion pills in Ghana: experiences of pharmacy workers and users

Correspondence to Dr Mercy Nana Akua Otsin, University of Education Winneba Faculty of Science Education, Winneba, Central, Ghana; [email protected]

WHAT IS ALREADY KNOWN ON THIS TOPIC

• Medical abortion is recognised by WHO as a safe and highly effective method of abortion.

• Despite pharmacy provision of medical abortion being against the Ghanaian abortion laws, it is an important and common source of care for women seeking abortions.

• There is limited evidence on the influence of the Ghanaian abortion law on pharmacy workers dispensing abortion pills and women who access their services.

WHAT THIS STUDY ADDS

• Making pharmacy provision of medical abortion illegal negatively impacts service providers and women using the service in diverse ways.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

• Providing technical support and training for pharmacy workers and legalising their involvement in medical abortion care is important in improving service standards and safety.

Introduction

In Africa, of every four abortions, three are unsafe. Sub-Saharan Africa, where Ghana is located, is estimated to bear 77% of the global burden of unsafe abortions^{1 2} and sub-Saharan African women are estimated to have the highest risk of death from unsafe abortions globally.^3–5 An unsafe abortion is defined as a procedure for terminating unwanted pregnancies either by persons lacking the necessary skills, or in an environment lacking minimal medical standards, or both.^{5 6}

Medical abortion is the use of pharmaceutical products to induce abortion.⁶ Medical abortion using the WHO recommended regimen of mifepristone and misoprostol or misoprostol alone is a safe and highly effective method of abortion in early pregnancy.⁶ Evidence suggests current declines in deaths and severity associated with unsafe abortion-related complications to increased use of medical abortion.^{2 7}

In Ghana induced abortion is an offence under the criminal code and both the woman and provider are liable to imprisonment not exceeding 5 years.^{8 9} Exceptions are available if abortions are performed by registered and trained health professionals in approved facilities, in cases of rape, incest, serious fetal anomaly and risk to the woman’s health.⁸ Despite these exceptions there is often a misunderstanding about the interpretation of the law among clinicians and the populace.⁹

Evidence shows an increasing reliance on medical abortion.¹⁰ In 2007,...