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Treading the Thin Line: Pharmacy Workers’ Perspectives on Medication Abortion Provision in Lusaka, Zambia
Author(s) -
Footman Katharine,
Chelwa Nachela,
Douthwaite Megan,
Mdala James,
Mulenga Drosin,
Brander Caila,
Church Kathryn
Publication year - 2021
Publication title -
studies in family planning
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.529
H-Index - 68
eISSN - 1728-4465
pISSN - 0039-3665
DOI - 10.1111/sifp.12151
Subject(s) - abortion , pharmacy , medicine , misoprostol , medical prescription , family medicine , economic growth , nursing , public relations , business , political science , pregnancy , economics , genetics , biology
Context : Despite liberal abortion laws, safe abortion access in Zambia is impeded by limited legal awareness, lack of services, and restrictive clinical policies. As in many countries with restricted abortion access, women frequently seek abortions informally from pharmacies.Methods : We conducted 16 in‐depth interviews in 2019 to understand the experiences and motivations of pharmacy workers who sell medication abortion (MA) drugs in Lusaka.Results : We found that pharmacy staff reluctantly assume a gatekeeper role for MA due to competing pressures from clients and from regulatory constraints. Pharmacy staff often decide to provide MA, motivated by their duty of care and desire to help clients, as well as financial interests. However, pharmacy workers’ motivation to protect themselves from legal and business risk perpetuates inequalities in abortion access, as pharmacy workers improvise additional eligibility criteria based on personal risk and values such as age, partner approval, reason for abortion, and level of desperation.Conclusion : These findings highlight how pharmacy staff informally determine women's abortion access when laws and policies prevent comprehensive access to safe abortion. Reform of clinical guidelines, public education, strengthened public sector availability, task sharing, and improved access to prescription services are needed to ensure women can legally access safe abortion.