Pharmacy employee knowledge and attitudes related to misoprostol and abortion in Tanzania

Misoprostol is a drug widely used in the provision of medication abortion. While misoprostol is sold in many developing countries, legal restrictions on abortion, particularly in sub-Saharan Africa, limit its registration for this indication. Studies in Latin America have explored pharmacy sales of misoprostol for abortion, but there is limited data from African countries. We surveyed 179 pharmacy employees from 150 pharmacies in seven regions of Tanzania in April 2012 to determine stock availability and knowledge and attitudes regarding misoprostol sales. One-third (32%) of pharmacies had misoprostol in stock at the time of the survey. The most common reason mentioned for ordering misoprostol was demand from individual customers, while those pharmacies who did not order reported that they feared the drug would be “misused”. One-third of respondents (32%) spontaneously mentioned abortion as an indication for which misoprostol could be used; however, less than 10% could give an appropriate dose. Half of respondents reported ever dispensing misoprostol, with 19% of those citing abortion was the most common reason for which women purchase the drug. In addition, reported prescription requirement was high. In legally restrictive settings, misoprostol sold by pharmacies is likely used for medication abortion. However, correct dose information is limited, increasing the probability of women experiencing incomplete abortions. Future research should include simulated sales encounters, including mystery shoppers, to validate the extent to which and for what indications pharmacies in countries with legal restrictions on abortion sell misoprostol to consumers.