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Mapping access to medication abortion in Maputo, Mozambique.
Christine M Zachek1, Santos Guilherme M Santos2, Maimuna Marenah1
1Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, CA, United States.
Contraception
|April 18, 2025
Summary
Medication abortion combi-packs are widely available in Maputo, Mozambique, but counseling on administration and side effects is often inadequate, especially in low-income areas. Interventions are needed to improve access to safe abortion services.
Area of Science:
- Reproductive Health
- Pharmaceutical Access
- Global Health
Background:
- Medication abortion, using co-packaged mifepristone and misoprostol (combi-pack), is a key component of reproductive healthcare.
- Access to safe medication abortion services is crucial, particularly in resource-limited settings.
- Understanding pharmacy dispensing practices is vital for improving patient outcomes.
Purpose of the Study:
- To characterize the availability and dispensing practices of co-packaged mifepristone and misoprostol (combi-pack) for medication abortion in Maputo, Mozambique.
- To assess the cost, accuracy of information provided, and socioeconomic disparities in access to medication abortion.
- To identify areas for intervention to improve safe abortion services.
Main Methods:
- A cross-sectional, secret shopper study was conducted in Maputo, Mozambique, between June and September 2022.
- Trained students posed as patients seeking medication abortion at commercial pharmacies, with and without prescriptions.
- Data collected included combi-pack availability, cost, administration instructions, and discussion of side effects, analyzed by neighborhood socioeconomic status.
Main Results:
- Combi-pack was available in 80.6% of pharmacies, with 8.4% requiring a prescription. Median cost was 1000 meticais ($15.65 USD).
- Accurate administration instructions were provided in only 3.7% of visits; side effects were discussed in 48.9%.
- Combi-pack was more likely dispensed in low-income neighborhoods (94.9%) but cost more (1300 MT) compared to high-income areas (68.9% dispensed, 950 MT cost).
Conclusions:
- Co-packaged mifepristone-misoprostol is widely accessible in Maputo pharmacies, though dispensing practices and information provision vary significantly by socioeconomic neighborhood.
- Inadequate counseling on medication abortion administration and side effects, particularly in lower-income areas, highlights a critical gap in patient safety.
- Targeted interventions focusing on improving pharmacy-based counseling in low-income neighborhoods are essential to enhance access to safe medication abortion services.
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