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

IntroductionIn 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.MethodsA 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.ResultsMisoprostol 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.ConclusionsAs 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.

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Conclusion

10.1093/oso/9780190876128.003.0007 ◽

2018 ◽

Author(s):

Yana van der Meulen Rodgers

Keyword(s):

Family Planning ◽

Reproductive Health ◽

Health Services ◽

Health Outcomes ◽

Cost Effective ◽

Reproductive Health Services ◽

Cost Effective Approach ◽

Restrictive Legislation

Chapter 7 concludes by highlighting the three biggest messages from the analysis presented in this book: (1) the global gag rule has failed to achieve its goal of reducing abortions; (2) restrictive legislation is associated with more unsafe abortions; and (3) the expanded global gag rule is likely to have negative repercussions across a range of health outcomes for women, children, and men. They are simple but powerful messages that should be heard by policymakers over the voices calling for an ideologically based policy that fails to achieve its desired outcome. The chapter closes with a more constructive and cost-effective approach for US family-planning assistance that targets integrated reproductive health services.

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Exploring the association between the constitutional right to health and reproductive health outcomes in 157 countries

Sexual and Reproductive Health Matters ◽

10.1080/26410397.2019.1599653 ◽

2019 ◽

Vol 27 (1) ◽

pp. 168-180

Author(s):

Hiroaki Matsuura

Keyword(s):

Reproductive Health ◽

Health Outcomes ◽

Right To Health ◽

Constitutional Right

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An application of Systematic Anomalous Case Analysis to improve models predicting contraceptive use in the Philippines

Journal of Biosocial Science ◽

10.1017/s0021932021000122 ◽

2021 ◽

pp. 1-14

Author(s):

Subasri Narasimhan ◽

Jessica D. Gipson

Keyword(s):

Reproductive Health ◽

Health Outcomes ◽

Sexual And Reproductive Health ◽

Contraceptive Use ◽

Sexual Debut ◽

Case Analysis ◽

Reproductive Behaviour ◽

The Philippines ◽

Health And Nutrition ◽

Depth Interviews

Abstract Amidst persistently high unintended pregnancy rates and lags in contraceptive use, novel methodological approaches may prove useful in investigating sexual and reproductive health outcomes in the Philippines. Systematic Anomalous Case Analysis (SACA) – a mixed-methods technique – was employed to examine predictors of women’s lifetime contraceptive use. First, multivariable, longitudinal Poisson regression models predicted fertility and sexual debut using the 1998–2009 Cebu Longitudinal Health and Nutrition Surveys (CLHNS), then regression outliers and normative cases were used to identify 48 participants for in-depth interviews (2013–2014) for further examination. Qualitative findings from 24 women highlighted ‘control over life circumstances’ was critical, prompting the addition of two items to the original quantitative models predicting any contraceptive use (n=532). Each of the items, ‘what happens to [them] is their own doing’ and ‘[I] do not [have] enough control over direction life is taking [me]’, significantly and independently predicted any contraceptive use (aOR: 2.37 (CI: 1.24–4.55) and aOR: 0.46 (CI: 0.28–0.77), respectively). The findings demonstrate the utility of SACA to improve the understanding and measurement of sexual and reproductive health outcomes and underscore the importance of integrating psychosocial constructs into existing models of fertility and reproductive behaviour in the Philippines to improve sexual and reproductive health outcomes.

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Access to the Emergency Contraceptive Pill and Women's Reproductive Health: Evidence From Public Reform in Chile

Demography ◽

10.1215/00703370-9544015 ◽

2021 ◽

Author(s):

Damian Clarke ◽

Viviana Salinas

Keyword(s):

Reproductive Health ◽

Health Outcomes ◽

Well Being ◽

Public Health Care ◽

Data Sets ◽

Contraceptive Pill ◽

Emergency Contraceptive Pill ◽

Emergency Contraceptive ◽

Women’S Reproductive Health ◽

Women's Reproductive Health

Abstract We examine the sharp expansion in availability of the emergency contraceptive pill in Chile following legalized access through municipal public health care centers. We study the period 2002–2016 and a broad rollout of the emergency contraceptive pill occurring between 2008 and 2011. By combining a number of administrative data sets on health outcomes and pharmaceutical use, and using event-study and difference-in-differences methods, we document that this expansion improved certain classes of women's reproductive health outcomes, notably reducing rates of abortion-related morbidity. These improvements were greater in areas of the country where the rollout of the emergency contraceptive pill was more extensive. We also document some evidence that refusal to provide the emergency contraceptive pill upon a women's request was linked with a worsening in reproductive health outcomes. These results point to the importance of contraceptive access as a determinant of women's reproductive health and well-being and relates to a growing body of work documenting the importance of women's autonomy as a determinant of health.

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Adverse Adolescent Reproductive Health Outcomes After Pelvic Inflammatory Disease

Archives of Pediatrics and Adolescent Medicine ◽

10.1001/archpediatrics.2010.256 ◽

2011 ◽

Vol 165 (1) ◽

Cited By ~ 18

Author(s):

Maria Trent ◽

Catherine L. Haggerty ◽

Jacky M. Jennings ◽

Sunghee Lee ◽

Debra C. Bass ◽

...

Keyword(s):

Reproductive Health ◽

Health Outcomes ◽

Pelvic Inflammatory Disease ◽

Inflammatory Disease ◽

Adolescent Reproductive Health

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Abortion policies and reproductive health outcomes

Statistical Papers - United Nations (Ser. A), Population and Vital Statistics Report - Abortion policies and reproductive health around the world ◽

10.18356/7afcd1fa-en ◽

2014 ◽

pp. 14-16 ◽

Cited By ~ 7

Author(s):

Keyword(s):

Reproductive Health ◽

Health Outcomes

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“I’m More Open to Talking About It”: Women’s Experiences With Sexual Abuse and Reproductive Health

Journal of Interpersonal Violence ◽

10.1177/0886260520905077 ◽

2020 ◽

pp. 088626052090507

Author(s):

Stephanie Meier ◽

Kristin Brig ◽

Cara Delay ◽

Beth Sundstrom ◽

Laura Schwab-Reese ◽

...

Keyword(s):

Health Care ◽

Sexual Abuse ◽

South Carolina ◽

Reproductive Health ◽

Health Outcomes ◽

Sexual Coercion ◽

Comparative Method ◽

Care Seeking ◽

Health Care Experiences ◽

Negative Health Outcomes

Approximately one in three women experience sexual abuse, which can result in negative reproductive health consequences. A history of sexual abuse may negatively impact health care seeking and experience. The purposes of this article were to understand how women perceived their sexual abuse experiences and how these experiences integrated into their overall reproductive health, reproductive planning, and health care access. As part of a larger study about women’s reproductive health, researchers analyzed 16 in-depth interviews with women aged 18 years and older (range = 18–78) living in South Carolina (May–November 2016). A constant comparative method of data analysis was completed to explore women’s sexual abuse experiences as they related to reproductive health and health care experiences. HyperRESEARCH 3.7.3 assisted in data organization and management. Limited bodily agency impacted women’s ability to engage in family planning, particularly when partners utilized sexual coercion to maintain desired relationships and attain desired family size, regardless of women’s preferences. In addition, limited sexual violence and abuse discussion in health care contexts impacted women’s autonomy in reproductive health decision-making despite participants’ desire to engage in these discussions with providers. Participants expressed a desire for communication about their sexual abuse experiences; however, results indicated women had to navigate stigma within families and communities, which deterred disclosure and open discussion. Negative health outcomes and desire to discuss these experiences within the health care context highlighted a need for patient–provider communication about sexual abuse history as one aspect of gynecologic care. Findings from this study offer practical recommendations to guide communication about sexual abuse within reproductive health care experiences to empower women in their reproductive health choices. As these experiences may impact overall health and reproductive choices, provider-initiated conversations with adolescents and women may improve care and assist in prevention efforts, including the prevention of negative health outcomes.

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