We undertook a systematic review to assess 1) the level and quality of pharmacy and drug shop provision of medical abortion (MA) in low- and middle-income countries (LMICs) and 2) interventions to improve quality of provision. We used standardized terms to search six databases for peer-reviewed and grey literature. We double-extracted data using a standardized template, and double-graded studies for methodological quality. We identified 22 studies from 16 countries reporting on level and quality of MA provision through pharmacies and drug sellers, and three intervention studies. Despite widespread awareness and provision of MA drugs, even in legally restricted contexts, most studies found that pharmacy workers and drug sellers had poor knowledge of effective regimens. Evidence on interventions to improve pharmacy and drug shop provision of MA was limited and generally low quality, but indicated that training could be effective in improving knowledge. Programmatic attention should focus on the development and rigorous evaluation of innovative interventions to improve women's access to information about MA self-management in low-and middle-income countries.
Published in a peer-reviewed journal of the Population Council. Katharine Footman is Research Portfolio Manager, and Barbara Reichwein is Director, Research, Monitoring and Evaluation Team, Health Systems Department, Marie Stopes International, London. Katherine Keenan is Lecturer in Demography, Department of Geography and Sustainable Development, University of St Andrews, UK. Kate Reiss is a Research Degree Student, Department of Population Health, London School of Hygiene and Tropical Medicine, London. Pritha Biswas is Senior Advisor, Medical Development Team, Marie Stopes International, India. Kathryn Church is Senior Strategic Research Manager, Research, Monitoring and Evaluation Team, Health Systems Department, Marie Stopes International, London; and Honorary Assistant Professor, Department of Population Health, London School of Hygiene and Tropical Medicine, London.