Assessing Information and Counselling Provision for Medical Abortion Care in Pharmacies Versus Clinics: Secondary Analysis of Two Non-Inferiority Cohort Studies

Objective: To evaluate aspects of information provision and counselling for medical abortion as provided through clinics compared with pharmacies. Design: Secondary analysis of data from two non-randomised, non-inferiority cohort studies. Population: Women seeking medical abortion at less than nine weeks gestational duration from either clinics or pharmacies in Cambodia and Ghana. Methods: Descriptive statistics are reported separately by country, comparing clinic and pharmacy clients on medical abortion counselling and information provision outcomes. Main Outcome Measures: Self-reported detailed information on the counselling and information received at the point of medical abortion access, from the health provider (clinic) or the pharmacy provider (pharmacy). Results: Participants received more medical abortion information from clinician providers than from pharmacy workers in both countries. The largest differences between clinic and pharmacy participants were seen in providing information about expected bleeding (Cambodia: 98.1% in clinics vs. 57.9% in pharmacies, p < 0.001; Ghana: 67.0% in clinics vs. 34.7% in pharmacies, p < 0.001) and information about expected cramping (Cambodia: 98.9% in clinics vs. 82.7% in pharmacies, p < 0.001; Ghana: 83.8% in clinics vs. 56.2% in pharmacies, p < 0.001). Fewer pharmacy participants across both countries reported receiving information on circumstances during the abortion process when one should seek medical attention (Cambodia: 90.6% in clinics vs. 48.9% in pharmacies, p < 0.001; Ghana: 90.8% in clinics vs. 79.1% in pharmacies, p < 0.001). Conclusions: Clinician providers in our study asked more questions related to medical eligibility and provided more information about the abortion process than pharmacists; however, almost all pharmacists provided information about how to take the regimen and some information about what to expect during the process. Pharmacists were less likely than clinicians to provide the clients with warning signs for which to seek medical care. Pharmacy interventions, including training, client-facing information, and supportive policies, should be the focus of future research.