Beyond the law: Misoprostol and medical abortion in Dar es Salaam, Tanzania

I H Solheim; K M Moland; C Kahabuka; A B Pembe; A Blystad

doi:10.1016/j.socscimed.2019.112676

Beyond the law: Misoprostol and medical abortion in Dar es Salaam, Tanzania

Soc Sci Med. 2020 Jan:245:112676. doi: 10.1016/j.socscimed.2019.112676. Epub 2019 Nov 14.

Authors

I H Solheim¹, K M Moland², C Kahabuka³, A B Pembe⁴, A Blystad²

Affiliations

¹ Global Health Anthropology Research Group at the Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen (UiB), Norway. Electronic address: ingrid.solheim@live.no.
² Global Health Anthropology Research Group at the Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen (UiB), Norway; Centre for Intervention Science in Maternal and Child Health (CISMAC), UiB, Norway.
³ CSK Research Solutions, Dar es Salaam, Tanzania.
⁴ Muhimbili University of Health and Associated Sciences, Dar es Salaam, Tanzania.

PMID: 31810016
DOI: 10.1016/j.socscimed.2019.112676

Abstract

Misoprostol has during the past few years become an important obstetric drug used for different purposes both within and outside hospitals in Tanzania. In this paper, we analyze how misoprostol is perceived, accessed and used off-label as an abortion drug in the city and region of Dar es Salaam. The study took place in Dar es Salaam's three districts from July to November 2015, and had a qualitative explorative approach. We carried out in-depth interviews (42) with the following main categories of informants: women having undergone medical abortion (15), health care workers with experiences from post abortion care (16) and drug vendors (11). Focus group discussions (10) were carried out with young women. A client simulation study was carried out in 64 drugstores across Dar es Salaam assessing the availability of misoprostol and the advice given concerning its use. In addition, shorter qualitative interviews were carried out with representatives of NGOs and public agencies working with sexual and reproductive health issues (17). Our findings reveal that in Dar es Salaam, misoprostol is well known, available and accessed for abortion purposes through drugstores and health providers. Women tend to prefer misoprostol over other abortion methods since it allows for a private, low-cost, safer and less uncomfortable abortion experience. But, while misoprostol facilitates women's agency in the process of seeking abortion, a series of obstacles shaped by a restrictive abortion law and an unregulated pharmaceutical market hinder its safe use. Central obstacles are profit-seeking providers, suboptimal user instructions and poor provider follow-up. In the discussion of the material we draw upon Van der Geest, Hardon and Whyte's concept of the 'social life of pharmaceuticals' and indicate the ways in which misoprostol acts as an agent of change in the social relations connected to abortion.

Keywords: Global health; Medical abortion; Misoprostol; Sexual and reproductive health; Tanzania; Unsafe abortion.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Abortifacient Agents, Nonsteroidal / therapeutic use
Abortion, Induced / legislation & jurisprudence
Abortion, Induced / methods
Abortion, Induced / trends
Adult
Female
Focus Groups / methods
Health Personnel / psychology*
Health Personnel / trends
Humans
Interviews as Topic / methods
Misoprostol / therapeutic use*
Off-Label Use / legislation & jurisprudence*
Pregnancy
Qualitative Research
Tanzania

Substances

Abortifacient Agents, Nonsteroidal
Misoprostol