Frank discussion on abortion is virtually non-existent in the ultraconservative nations. By dispensing abortion medication, pharmacists can become central players in providing reproductive healthcare without diametrically opposing cultural norms.
By Dr Jamshed
World’s population has crossed 7 billion mark with many poor countries like Pakistan, Bangladesh, Nigeria and India, being among the most populous ones. In addition to the economic and climatic repercussions, unchecked population is harmful to women autonomy. In traditionally conservative countries like Pakistan, birth-control is a taboo outside some urban areas, and voluntary abortion is unthinkable. The lack of reproductive healthcare largely explains the population bomb in some countries, but not the others.
The acceptability of abortion is mainly a cultural issue, but a competent pharmacist can pave the way for medication abortion irrespective of the reasons for abortion. In other words, pharmacists can partly evade the contentious debate on abortion while providing the medical care necessary for the unfortunate women in many parts of the world. One example is the dispensing of medication abortion, which means inducing abortion by using medicines, particularly those approved by the US Food and Administration (FDA) for this purpose: namely, mifepristone (a progesterone antagonist) and/or misoprostol (a prostaglandin analog). When abortion is deemed inevitable in certain circumstances, the pharmacists can offer medication abortion as a safe and effective alternate to the uterine aspiration.
Several risks lurk if pharmacists do not step up. For example, unregulated channels will be more than willing to cash in on providing abortion-related medicines with zero contribution to country’s economy or any concrete promise of safety. The drugs will start being sold not in the reputable hospitals or clinics, but in countless shady places.
To avoid that, abortion medication needs to be officially accepted and declared as a pharmacist’s domain. In other words, it is crucial that the abortion medication is allowed to be dispensed, albeit on prescription, by the registered pharmacists, in addition to being delivered by the physicians in clinics and hospitals. This model, currently practiced in Australia and other developed countries, ensures wider access to medicines in a secure manner. With pharmacists’ help, the clinicians can reduce the logistical problems associated with dispensing abortion medication in their facilities.
The concerns of misuse of medication abortion can be mitigated through proper regulations. Pharmacist must first be certified to dispense the approved medicines. Places where abortion providers are limited, online ordering and mail-order provision by pharmacists could be an additional remedy. Pharmacists’ own experiences in providing abortion care might help bypassing geographic and cultural obstacles to reproductive health.
Over a period of time, the experienced pharmacists can then train the newbies. Grossman et al have recently shown that just an hour long training session of pharmacists on abortion medication dropped the dispensing-related adverse effects to zero. The patient satisfaction with the pharmacy experience was also phenomenal. Although the study was set in the USA, the model presented in this study provides a template for the Third World.
The change of societal norms and cultural practices require time. Pharmacists can play a key role in helping the women in need without challenging the fabric of diverse societies. Being able to guide and dispense abortion medication makes pharmacists the stepping stone towards women health and safety.
- United States Census Bureau [Internet]. US and world population clock. [cited August 18, 2021]. Available from https://www.census.gov/popclock/.
- American College of Obstetricians and Gynecologists. Medication abortion up to 70 days of gestation. Obstet Gynecol. 2020; 136(4):e31–e47. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/10/medication-abortion-up-to-70-days-of-gestation.
- Grossman D, Goldstone P. Mifepristone by prescription: a dream in the United States but reality in Australia. Contraception. 2015; 92(3):186–189. DOI: 10.1016/j.contraception.2015.06.014.
- Grossman D, Baba CF, Kaller S, Biggs MA, Raifman S, Gurazada T, et al. Medication abortion with pharmacist dispensing of mifepristone. Obstet Gynecol. 2021; 137(4):613–622. DOI: 10.1097/AOG.0000000000004312.