Misoprostol Use and Its Impact on Measuring Abortion Incidence and Morbidity

Misoprostol is an effective and increasingly popular medication abortion option, especially in developing countries where abortion remains legally restricted. Taking a pill is noninvasive and the method does not require sophisticated storage. In settings where abortion is legally restricted, women can purchase the drug at pharmacies, often without a prescription, and self-administer it. Yet measuring misoprostol use remains a methodological challenge, especially where women and providers are hesitant to report use and/or accurate hospital records of women presenting with complications are unavailable. The research community is interested in developing sound methodologies to quantify self-use of misoprostol to induce abortion, since its use can impact the measurement of abortion incidence and morbidity in complex ways. Substantial self-use of misoprostol to induce abortion can potentially both temporarily increase and/or ultimately decrease overall induced abortion estimates. To address this research challenge, we present three types of data methodologies— national pharmacy sales data sets; face-to-face interviews; and pharmacy-based “mystery client” studies. We explain each method with its corresponding advantages and limitations, and how to incorporate the resulting data into abortion estimates. Finally, we highlight challenges in disseminating findings about misoprostol in settings where abortion is legally restricted.