The over-the-counter drug enabling women to have safe abortions in Nigeria

Research from Nigeria, where abortion is only legal if a woman’s life is in danger, suggests women are using misoprostol to have safe abortions despite having low knowledge of how it works.  

Misoprostol is a drug that is used to prevent and treat stomach ulcers, start labour and treat bleeding after delivery. It can also be used to cause an abortion.

Misoprostol is widely available from pharmacies and other drug sellers in Nigeria. But the legal restrictions on abortion mean women are sometimes unable to get professional guidance on using the drug, and instructions in misoprostol packets do not outline how to use the drug for abortion. As a result women may have to rely on their own knowledge to use the drug to safely and effectively have an abortion.

This is the first study of its kind to examine the link between women’s sexual and reproductive health (SRH) knowledge, including knowledge of misoprostol, and using misoprostol to safely self-induce an abortion.

Researchers interviewed 394 women (ages 18-49) from urban and rural areas in Lagos state who had used misoprostol to have an abortion.

The women were recruited through pharmacists and other drug sellers who had sold them misoprostol. Due to the illegality of their actions, study participants received a ‘burner’ phone to participate in the study.

Most women (96%) had successfully ended their pregnancy and 6% had sought care from a health facility for post-abortion complications.

Women’s general SRH knowledge was low. Only half (52%) correctly knew there are times in the menstrual cycle when women are more fertile than others.

Here a link was found between knowledge levels and safe use of misoprostol, as women with a high-level of SRH knowledge were almost seven times more likely to have safely ended their pregnancy compared to those with low SRH knowledge. They were also 2.5 times more likely to seek care for complications.

Despite most women using misoprostol successfully, their knowledge about the drug was low. Only 65% correctly knew their period would return within 3-6 weeks of using the drug. And only 12-20% knew how long after conception misoprostol can be used to end a pregnancy (9-28 weeks), how many times a year it can be used (3 times) and how soon a woman can get pregnant again after use (at next ovulation). Women also had limited understanding of how misoprostol works in the body.

The research suggests that policies that increase SRH knowledge (e.g. sexuality education) could further improve women's ability to self-manage abortions.

Accurate knowledge of how misoprostol works might also increase the number of women using this safer method to end a pregnancy rather than replying on more dangerous methods.

However, it is important to note that the women in this study are not representative of all women in Nigeria. Only a minority of Nigerian women have abortions, only 30% of those abortions are carried out by using medication, and just 6.5% involve misoprostol. Women who use misoprostol are therefore a small minority. 

More research with larger groups of women is needed to better understand the association between SRH knowledge and effective use of misoprostol.