Creating privacy in pharmacies in West Africa

There is a substantial unmet need for contraception in West Africa. Providing contraception in private pharmacies, which often are highly accessible, may alleviate some access barriers. However, privacy is a key concern for provision of contraceptives in pharmacies, and whether users view pharmacies as private is ambiguous. While some pharmacy users note their privacy benefits, others suggest a lack of privacy. The ACEPT Project aims to introduce the administration of injectable and implant contraceptives into pharmacies across Côte d'Ivoire, Senegal, and Togo. Baseline data collected prior to implementation of the ACEPT project across the 3 countries included in-depth interviews with both pharmacies and users and ethnographic observations of pharmacies. Qualitative data were first analysed by country teams, and emergent cross-cutting themes were identified collaboratively. Physical, private space is scarce in pharmacy settings in West Africa. In this context, users employ tactics to uphold both audio (not being heard) and visual (not being seen) privacy. These tactics include using coded language or hiding a contraceptive purchase among other products. Pharmacists are experts at reading user privacy cues and "play along" with user tactics. Pharmacists also engineer "virtual" private space in the pharmacy through arrangement of shelving and products and identifying private corners of the pharmacy when needed. Privacy is currently constructed momentarily in ways that render the public pharmacy space private. As contraceptive services in pharmacies expand, especially to include injectable and implant administration, this type of privacy creation may need to be addressed, and physical private space will become essential.