Contraception. 2025 Oct 10:111254. doi: 10.1016/j.contraception.2025.111254. Online ahead of print.
ABSTRACT
OBJECTIVES: The Nepal government allows medication abortion pills to be dispensed from pharmacies if the patient has a prescription. We aimed to assess the availability of medication abortion pills, with and without a prescription, from pharmacies and the provision practices of pharmacy workers in Eastern Nepal.
STUDY DESIGN: We conducted a cross-sectional survey among 489 pharmacy workers to document knowledge, availability, and provision practices related to medication abortion pills. After a month, we revisited 180 pharmacies using a mystery client approach to understand actual provision practices. We analyzed these data with descriptive statistics.
RESULTS: Pharmacy workers in about 16% (n=28/180) of surveyed pharmacies reported selling medication abortion pills. In contrast, mystery clients obtained these pills without a prescription in more than one-third (n=69/180, 38%) of their visits. All mystery clients obtained mifepristone and misoprostol either through combination packages (n=59/69, 86%) or in separate packages (n=10/69, 14%). Mystery clients paid an average of 1062 Nepali Rupees (NRS) (approximately USD8), about 1.6 times more than the NRS654 (approximately USD5) price reported during the survey. Pharmacy workers asked mystery clients questions about gestational age to confirm pregnancy status and provided information on the timing of use and possible side effects.
CONCLUSIONS: Despite the current regulatory status, our findings suggest mifepristone and misoprostol are available without a prescription in about two out of five community pharmacies in Eastern Nepal. Supporting efforts to ensure women seeking medication abortion pills from pharmacies have up-to-date and medically accurate information appears warranted.
IMPLICATIONS: Despite the regulatory status of medication abortion pills, pharmacies are increasingly becoming key players in the community-based distribution of mifepristone/misoprostol in Nepal. Task-sharing through pharmacy workers in providing medication abortion pills without a prescription at scale could advance equitable access to abortion care. Ensuring appropriate training and support for pharmacy workers is essential to safeguard service quality and safety.
PMID:41077341 | DOI:10.1016/j.contraception.2025.111254
