Women's experiences using drugs to induce abortion acquired in the informal sector in Colombia: qualitative interviews with users in Bogotá and the Coffee Axis.

In 2006, abortion in Colombia was decriminalised under certain circumstances. Yet some women continue to avail themselves of ways to terminate pregnancies outside of the formal health system. In-depth interviews (IDIs) with women who acquired drugs outside of health facilities to terminate their pregnancies (n = 47) were conducted in Bogotá and the Coffee Axis in 2018. Respondents were recruited when they sought postabortion care at a health facility. This analysis examines women's experiences with medication acquired outside of the health system for a termination: how they obtained the medication, what they received, how they were instructed to use the pills, the symptoms they were told to expect, and their abortion experiences. Respondents purchased the drugs in drug stores, online, from street vendors, or through contacts in their social networks. Women who used online vendors more commonly received the minimum dose of misoprostol according to WHO guidelines to complete the abortion (800 mcg) and received more detailed instructions and information about what to expect than women who bought the drug elsewhere. Common instructions were to take the pills orally and vaginally; most women received incomplete information about what to expect. Most women seeking care did not have a complete abortion before coming to the health facility (they never started bleeding or had an incomplete abortion). Women still face multiple barriers to safe abortion in Colombia; policymakers should promote better awareness about legal abortion availability, access to quality medication and complete information about misoprostol use for women to terminate unwanted pregnancies safely.

What does informal access to misoprostol in Colombia look like? A mystery client methodology in Bogotá and the Coffee Axis.

INTRODUCTION: In 2006, abortion was decriminalised in Colombia under certain circumstances. Yet, women avail themselves of ways to terminate pregnancy outside of the formal health system. This study explored how drug sellers engage with women who attempt to purchase misoprostol from them. METHODS: A mapping exercise was undertaken to list small-chain and independent drug stores in two regions in Colombia. A sample (n=558) of drug stores was selected from this list and visited by mystery clients between November and December 2017. Mystery clients sought to obtain a medication to bring back a delayed period, and described the experience, the information obtained and the medications proffered in exit interviews. RESULTS: Misoprostol was offered for purchase in 15% of the visits; in half of visits, only information about misoprostol was shared, while no information about misoprostol was provided on the remaining visits. Over half of sellers who refused to sell any medication provided referrals, most commonly to an abortion provider. Among visits which included discussion of misoprostol, two out of five sellers provided dosage instructions with most recommending the minimum adequate dosage. Mystery clients received little information on the physical effects to expect with the use of misoprostol and possible complications. CONCLUSIONS: As misoprostol is being obtained from some drug sellers without a prescription, capacitating this cadre with at least a minimum of standardised information on dosage, routes of administration and expected effects and outcomes have the potential to improve reproductive health outcomes for women who choose to terminate pregnancies this way in Colombia.

Managing unplanned pregnancies in five countries: perspectives on contraception and abortion decisions.

Why is induced abortion common in environments in which modern contraception is readily available? This study analyses qualitative data collected from focus group discussions and in-depth interviews with women and men from low-income areas in five countries--the United States, Nigeria, Pakistan, Peru and Mexico--to better understand how couples manage their pregnancy risk. Across all settings, women and men rarely weigh the advantages and disadvantages of contraception and abortion before beginning a sexual relationship or engaging in sexual intercourse. Contraception is viewed independently of abortion, and the two are linked only when the former is invoked as a preferred means to avoiding repeat abortion. For women, contraceptive methods are viewed as suspect because of perceived side effects, while abortion experience, often at significant personal risk to them, raises the spectre of social stigma and motivates better practice of contraception. In all settings, male partners figure importantly in pregnancy decisions and management. Although there are inherent study limitations of small sample sizes, the narratives reveal psychosocial barriers to effective contraceptive use and identify nodal points in pregnancy decision-making that can structure future investigations.

Social stigma and disclosure about induced abortion: results from an exploratory study.

It is well recognised that unsafe abortions have significant implications for women's physical health; however, women's perceptions and experiences with abortion-related stigma and disclosure about abortion are not well understood. This paper examines the presence and intensity of abortion stigma in five countries, and seeks to understand how stigma is perceived and experienced by women who terminate an unintended pregnancy and influences her subsequent disclosure behaviours. The paper is based upon focus groups and semi-structured in-depth interviews conducted with women and men in Mexico, Nigeria, Pakistan, Peru and the United States (USA) in 2006. The stigma of abortion was perceived similarly in both legally liberal and restrictive settings although it was more evident in countries where abortion is highly restricted. Personal accounts of experienced stigma were limited, although participants cited numerous social consequences of having an abortion. Abortion-related stigma played an important role in disclosure of individual abortion behaviour.

Gender role beliefs at sexual debut: qualitative evidence from two brazilian cities.

CONTEXT: Culturally based beliefs about gender roles influence women's sexual behavior and their ability to protect themselves from unwanted sexual experiences. Studying the beliefs that influence women's behavior at sexual debut helps contextualize unwanted sexual intercourse. METHODS: Twenty-four focus groups on women's beliefs about gender roles at sexual debut were conducted in 2002 with low- and middle-income women aged 18-21 and 30-39 who were recruited from public and private venues in Recife, capital of Pernambuco, and Belo Horizonte, capital of Minas Gerais, Brazil. The data were analyzed for common themes, and quotations were chosen to illustrate those themes. RESULTS: Focus group participants perceived that men have an urgent need for sex. This perception caused women to fear abandonment, anger or violence if they refused to have sex with their partner. The participants believed that women had to act passive the first time they had sex because taking the initiative (for example, by asking their partner to practice contraception) would lead him to accuse them of having previous sexual experience. Also, they believed they had to say no to sex under all circumstances to protect their reputation. CONCLUSION: To decrease the occurrence of unwanted intercourse, interventions must address the social expectations that influence men's and women's sexual behavior.

Cross-border procurement of contraception. estimates from a postpartum survey in El Paso, Texas.

Along the US-Mexico border, US residents have the option of crossing to Mexico in order to purchase hormonal contraception sold over-the-counter at very low prices in pharmacies. We investigated the prevalence of cross-border contraceptive procurement by way of a survey of 3134 women who delivered in a large public hospital in El Paso, Texas, between 1996 and 1997. Pills, injectables, condoms and IUDs were the most commonly used methods by women in the birth interval preceding delivery. Among multiparous women, 41% of pills and 54% of injectables were obtained in Mexico. However, almost all condoms were obtained in the United States. In this largely Hispanic population, the prevalence of cross-border procurement was highest among women who were born and educated in Mexico. Discontinuation of pills and injectables was lower when obtained across the border than in the United States. These findings support the proposition that reducing the medical requirements to acquire pills and injectables and making them available at low cost would augment their use in low-income populations.