Assessing the Medication Abortion Drug Dispensing Practices of Private Sector Chemists through Mystery Client surveys in Nepal

Abstract

Background: Unplanned pregnancies remain a common problem in Nepal, despite a decline in the total fertility rate from 5.1 births per woman in 1984-1986 to 2.6 births in 2008-2010. Specifically, 27.5% of currently married women of reproductive age (WRA) have an unmet need for family planning. Furthermore, maternal morbidity and mortality due to unsafe abortions remain high, with estimates that about half of maternal deaths are due to unsafe abortion Methods: In February 2013, PSI/Nepal conducted a Mystery Client (MC) survey with 260 chemists to gather information about MA dispensing practices and counseling behavior amongst chemists. Two scenarios were developed to represent different types of possible clients: in Scenario A, the wife is 6-7 weeks pregnant and in the Scenario B the wife is 13-14 weeks pregnant. Results: Only 14% chemists from Scenario A and 65.4% chemists from Scenario B followed this protocol. Only 5% chemists are selling MA drug for less than Rs 500 (the PSI recommended price is Rs 425).Chemists are still recommending separate pack drugs and Ayurvedic drugs for MA. Only 75.8% clients were given correct counseling on MA drug regimens, 80.7% on route of administration, 72% on possible side effects, 82.8% on symptoms of complications, and 66.1% on adverse events and complications. Many chemists do not use a referral mechanism to government approved Safe Abortion Services (SAS) sites when clients are above 9 weeks of gestation, have adverse events, or experienced complications Conclusions: A stronger market monitoring mechanism and advocacy are needed to ensure that chemists are selling MA drugs, particularly Medabon, within government protocol. A market supervision mechanism should be further improved to monitor adherence to recommended price amongst private sector chemists. Provider Behavior Change Communication (PBCC) activities and program messages should continue to focus on the use of safe MA drugs like Medabon over unsafe MA drugs. Efforts should focus on improving chemists’ knowledge and counseling skills so that they can provide complete and better quality services to their clients. Increase the availability of communication materials like posters to increase client awareness. PBCC efforts should re-emphasize this important aspect of the MA provision. Keywords: drug dispensing practices; medication abortion; mystery client surveys; Nepal; private sector chemists.