Exploring pharmacy provision of medication abortion pills in Nepal: a mixed-methods study of pharmacy workers’ knowledge and practices
Bibliographic record
Abstract
In Nepal, pharmacists are legally permitted to dispense medication abortion drugs with a prescription but provision of mifepristone/misoprostol without a prescription is prohibited. However, one in five Nepalese women seeking medication abortion pills do so directly from pharmacies. This mixed-methods study aimed to understand pharmacy workers’ knowledge of and practices related to medication abortion care and the reasons behind their provision or non-provision of these pills with and without a prescription. We surveyed 489 pharmacy workers and conducted semi-structured interviews with 25 pharmacy workers in major cities in Nepal’s Koshi province. Our survey findings revealed that pharmacy workers are knowledgeable about the legal status of medication abortion (n = 414, 85%), medication abortion in general (n = 404, 83%), and its timing for use (n = 347, 86%). About 16% of pharmacy workers (n = 77) reported stocking and selling medication abortion pills, all in the form of combination packages of mifepristone/misoprostol; the average price was Nepali Rupees 660 (USD5). Pharmacy workers who stocked and sold medication abortion pills reported doing so because of the legal permissibility of the practice and community demand; most required a prescription prior to dispensing the medications. Those who did not stock mifepristone/misoprostol cited lack of training, confusion regarding the legal status of medication abortion, business risks associated with provision, and the inconsistent supply of the combination packages. The role of small, community-based pharmacies as service delivery points for medication abortion as a means to expanding access to safe, effective, and accessible care merits further consideration by researchers and policy makers in Nepal.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".