# Exploring pharmacy provision of medication abortion pills in Nepal: a mixed-methods study of pharmacy workers’ knowledge and practices

## TL;DR

This study explores how pharmacy workers in Nepal handle medication abortion pills, finding that many are knowledgeable but face legal and supply chain challenges.

## Contribution

The study provides new insights into pharmacy workers' knowledge and practices regarding medication abortion in Nepal, highlighting barriers and opportunities for expanding access.

## Key findings

- Most pharmacy workers are knowledgeable about the legal status and timing of medication abortion.
- About 16% of pharmacy workers stock and sell medication abortion pills, typically requiring a prescription.
- Non-provision is linked to lack of training, legal uncertainty, and inconsistent supply.

## Abstract

In Nepal, pharmacists are legally permitted to dispense medication abortion drugs with a prescription but provision of mifepristone/misoprostol without a prescription is prohibited. However, one in five Nepalese women seeking medication abortion pills do so directly from pharmacies. This mixed-methods study aimed to understand pharmacy workers’ knowledge of and practices related to medication abortion care and the reasons behind their provision or non-provision of these pills with and without a prescription. We surveyed 489 pharmacy workers and conducted semi-structured interviews with 25 pharmacy workers in major cities in Nepal’s Koshi province. Our survey findings revealed that pharmacy workers are knowledgeable about the legal status of medication abortion (n = 414, 85%), medication abortion in general (n = 404, 83%), and its timing for use (n = 347, 86%). About 16% of pharmacy workers (n = 77) reported stocking and selling medication abortion pills, all in the form of combination packages of mifepristone/misoprostol; the average price was Nepali Rupees 660 (USD5). Pharmacy workers who stocked and sold medication abortion pills reported doing so because of the legal permissibility of the practice and community demand; most required a prescription prior to dispensing the medications. Those who did not stock mifepristone/misoprostol cited lack of training, confusion regarding the legal status of medication abortion, business risks associated with provision, and the inconsistent supply of the combination packages. The role of small, community-based pharmacies as service delivery points for medication abortion as a means to expanding access to safe, effective, and accessible care merits further consideration by researchers and policy makers in Nepal.

In Nepal, medication abortion drugs are legally permitted to be dispensed by pharmacists if the patient has a prescription. We conducted this study to understand what pharmacy workers in Nepal know about medication abortion and how they dispense pills. We conducted short surveys with nearly 500, and semi-structured interviews with 25, pharmacy workers in Nepal’s Koshi province. Our survey findings revealed that pharmacy workers are knowledgeable about the legal status of medication abortion and when abortion pills can be used. About one in six reported that they carried medication abortion drugs and would dispense them if the patient had a prescription. Those that did not stock medication abortion drugs reported that lack of training, legal and business risks, and supply chain problems influenced their decision. Efforts to work with small, community-based pharmacies to expand access to safe, effective, and accessible medication abortion care in Nepal appear warranted.