How often and under which circumstances do Mexican pharmacy vendors recommend misoprostol to induce an abortion?

August 2011

August 1, 2011 – Misoprostol has been sold in Mexican pharmacies since 1985. However, little is known about pharmacy vendors’ recommendations for misoprostol use as an abortifacient, especially after the legalization of first-trimester abortion in Mexico City in April 2007.

Ibis Project Manger Diana Lara, in collaboration with researchers from the Population Council Mexico office, sent three types of simulated clients, a young woman aged 18-25, an adult woman aged 26-35, and an adult man aged 20-30, to 192 pharmacies in eight cities, including Mexico City. Each simulated client was trained to ask for a drug to take to interrupt a pregnancy (the male simulated clients asked for the drug on behalf of a girlfriend), and then to ask follow up questions based on the pharmacist’s response. The simulated clients were also trained to ask about misoprostol directly (using the commercial name Cytotec) if the pharmacist did not mention it spontaneously.

The study team obtained information from 558 client-vendor interactions. In 24% of them, the vendors spontaneously recommended a drug when the simulated client asked for a drug to induce an abortion. Almost half of all vendors who made these spontaneous recommendations recommended Cytotec alone while 11% recommended taking other brands of drugs that contain misoprostol, 22% recommended a combination of abortifacient and nonabortifacient drugs, and 18% recommended nonabortifacient drugs.

In 78% of the client-vendor interactions, the vendor provided some information about Cytotec. Cytotec was recommended without a prompt from the simulated client in 18% of the encounters, while in 60% the vendor provided information after the client asked for it. However, in the majority of interactions, vendors provided incomplete information about dosage, administration, side effects, and complications. Only 15% of vendors recommended a correct dose.

While Cytotec was the most common drug mentioned spontaneously by vendors, the second most recommended drug was emergency contraception (EC), even when clients stated that they had a positive pregnancy test. Emergency contraceptive pills contain high doses of the hormones found in oral contraceptive pills and are used post-coitally to prevent pregnancy. EC is not an abortifacient.

This study illustrates that information about misoprostol is commonly given by Mexican pharmacists, but that they do not always provide correct information. Therefore, the study recommends that more should be done to educate women about safe and effective misoprostol use.

Lara D, Garcia S, Wilson K, Paz F. How often and under which circumstances do Mexican pharmacy vendors recommend misoprostol to induce an abortion? International Perspectives of Sexual and Reproductive Health. June 2011; 37(2):75-83.