Powell-Jackson Timothy, Acharya Rajib, Filippi Veronique, Ronsmans Carine
Department of Global Health and Development, Faculty of Public Health and Policy, London School Hygiene and Tropical Medicine, London, United Kingdom.
Population Council, New Delhi, India.
PLoS One. 2015 Mar 30;10(3):e0120637. doi: 10.1371/journal.pone.0120637. eCollection 2015.
Medical abortion (mifepristone and misoprostol) has the potential to contribute to reduced maternal mortality but little is known about the provision or quality of advice for medical abortion through the private retail sector. We examined the availability of medical abortion and the practices of pharmacists in India, where abortion has been legal since 1972.
We interviewed 591 pharmacists in 60 local markets in city, town and rural areas of Madhya Pradesh. One month later, we returned to 359 pharmacists with undercover patients who presented themselves unannounced as genuine customers seeking a medical abortion.
Medical abortion was offered to undercover patients by 256 (71.3%) pharmacists and 24 different brands were identified. Two thirds (68.5%) of pharmacists stated that abortion was illegal in India. Only 106 (38.5%) pharmacists asked clients the timing of the last menstrual period and 38 (13.8%) requested to see a doctor's prescription - a legal requirement in India. Only 59 (21.5%) pharmacists correctly advised patients on the gestational limit for medical abortion, 97 (35.3%) provided correct information on how many and when to take the tablets in a combination pack, and 78 (28.4%) gave accurate advice on where to seek care in case of complications. Advice on post-abortion family planning was almost nonexistent.
The retail market for medical abortion is extensive, but the quality of advice given to patients is poor. Although the contribution of medical abortion to women's health in India is poorly understood, there is an urgent need to improve the practices of pharmacists selling medical abortion.
药物流产（米非司酮和米索前列醇）有可能降低孕产妇死亡率，但对于通过私营零售部门提供的药物流产咨询服务的情况或质量，人们了解甚少。我们调查了印度药物流产的可及性以及药剂师的行为，印度自1972年起堕胎即为合法。
我们在中央邦城市、城镇和农村地区的60个当地市场采访了591名药剂师。一个月后，我们带着暗访患者回到其中359名药剂师处，这些患者未事先通知，以寻求药物流产的真实顾客身份出现。
256名（71.3%）药剂师向暗访患者提供了药物流产服务，共识别出24个不同品牌。三分之二（68.5%）的药剂师表示堕胎在印度是非法的。只有106名（38.5%）药剂师询问了患者最后一次月经的时间，38名（13.8%）要求查看医生处方——这在印度是一项法律要求。只有59名（21.5%）药剂师正确告知患者药物流产的孕周限制，97名（35.3%）提供了关于组合包装中片剂服用数量和时间的正确信息，78名（28.4%）就出现并发症时应前往何处就医给出了准确建议。关于流产后计划生育的建议几乎不存在。
药物流产的零售市场广泛，但向患者提供的咨询质量很差。尽管药物流产对印度女性健康的贡献尚不清楚，但迫切需要改善销售药物流产药品的药剂师的行为。
