Pharmacies do not stock enough medication for medical abortion; low availability puts women’s lives at risk

Medical abortion pills are disappearing from the pharmacy shelves of several retail pharmacies across the country despite the government’s approval of the Medical Termination of Pregnancy (Amendment) Bill in March. The government allowed several changes in the MTP (Amendment Bill), 2020 and also extended the upper limit for allowing abortion from 20 weeks to 24 weeks.

However, a report by the Foundation for Reproductive Health Services India (FRHSI) said that more than half (53.4%) of chemists across India cited legal issues as a reason for not stockpiling drugs. medical abortion.

And up to 79% of pharmacies in the states of Assam, Haryana, Delhi, Madhya Pradesh, Punjab and Tamil Nadu emptied their stock of medical abortion pills during the January-March period.

According to VS Chandrashekar, Managing Director of FRHSI and a member of the Pratigya Campaign Advisory Group, medical abortion has increasingly become the preferred method of terminating a pregnancy in India. He added that the non-availability of drugs threatens women’s access to safe abortion.

Chandrashekar also said: “Evidence shows that MA drugs are a safe and effective means of terminating a pregnancy, their unavailability has the potential to reverse the gains made by the country in reducing unsafe abortions, mortality and maternal morbidity”.

The study surveyed 1,500 chemists in six states, including Delhi. In each state, five cities were covered, and in Delhi, five sub-districts.

The study pointed out that only 1% of pharmacists in Punjab stock abortion drugs; Madhya Pradesh 6.5%; Delhi 34%; and Tamil Nadu and Haryana 2% each. Assam was the only state where nearly 70% of pharmacies held stock related to termination of pregnancy.

Availability of AD drugs in six states.

According to the report, Delhi chemists (38.2%) and MPs (43.9%) said “too much paperwork/documentation requirements” was one of the main reasons for not not keeping enough abortion drugs in the store. In addition, the low demand for these drugs was also a deterrent.

About 54.8% of chemists reported that MA drugs were over-regulated compared to other Schedule H drugs. However, more than 40% of chemists said over-regulation was necessary to avoid abuse or the health complications of these drugs. The majority of pharmacists were reluctant to restock medical abortion pills as they have to keep separate records for this, which involves details of doctors and clients, as well as a photocopy of any government IDs. The chemists also said stockpiling these drugs could lead to trouble from drug inspectors, such as punishment or license cancellation.

About 65% of pharmacists said that the availability of medical abortion drugs has led to an increase in the abortion rate in the country. About 80% of pharmacists in Punjab and 66% of pharmacists in Madhya Pradesh felt that they had stopped stocking abortion drugs in order to reduce medical abortion. While in Assam, 36.8% felt that these drugs were harmful to women’s health.

“Medical abortion has reduced the cost of early abortion. In the time of COVID-19, many providers have begun to request a COVID-19 test before performing a surgical abortion, which may further increase the cost of service for women MA in comparison is cheaper as it does not require a clinical setup Unavailability of MA will drive women to seek surgical abortion, which can be costly and may further widen the gaps access,” said Debanjana Choudhuri, Senior Manager-Partnerships, FRHS India.

Nearly 85% of pharmacists said that taking medical abortion pills is an easy way to end a pregnancy because it is inexpensive, ensures confidentiality and saves time. However, 55% of them still believe that abortion drugs are ineffective.

About 9.8% of pharmacists in these six states said that abortion drugs could be used to terminate a pregnancy based on gender.

Dr. Rashmi Ardey, Director of Clinical Services, FRHS India, said the drug control authority needs to address the misconception regarding AD drugs and gender-specific sexual selection. According to Ardey, “The Ministry of Health and Family Welfare should clarify that AM drugs approved for use up to nine weeks in India cannot be used for the selective termination of pregnancy based on the sex”.

On the other hand, Chandrashekar urged the government to allow all MBBS doctors to prescribe MA drugs. So far, only physicians licensed as abortion providers under the MTP Act can prescribe AD drugs.

“At present, only 60,000 to 70,000 doctors can prescribe MMA drugs in all of India,” Chandrashekar said. “Expanding the pool of providers to all physicians can increase the number of physicians in India able to prescribe this drug to 800,000-1 million.”

About 82.3% of pharmacists in these six states said they had never sold abortion drugs without a prescription. About 10% said they would not sell abortion drugs to an unmarried woman, and would also refuse to fulfill demand if the unmarried woman was under 18. Only 3.5% of pharmacists in Delhi said they would provide abortion drugs to these women.

According to the report by IPas, an international organization on safe abortions, of the approximately 15.6 million abortions that occur each year in India, 73% are performed using MA drugs accessible outside the facilities, 16% in private health facilities, 6% in public health facilities and 5% through unsafe traditional methods.

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