Post-abortion contraceptive use among women purchasing medication abortion from pharmacies vs. clinics: Evidence from Cambodia and Ghana

IF 2.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception Pub Date : 2026-01-01 Epub Date: 2025-10-02 DOI:10.1016/j.contraception.2025.111243

Erin Pearson , Jamie Menzel , Bunsoth Mao , Caesar Agula , Samuel Antobam , Elisabeth Eckersberger , Ayaga Bawah , Vonthanak Saphonn , Nathalie Kapp

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引用次数: 0

Abstract

Objective

To understand differences in post-abortion contraceptive use between women accessing medication abortion (MA) in pharmacies compared to clinics.

Study design

We conducted secondary analysis of data from two non-randomized non-inferiority trials that compared MA outcomes for pharmacy and clinic clients in Cambodia (2018–2019) and Ghana (2019–2021). A total of 3791 MA clients (clinic: n = 1966, pharmacy: n = 1825) were recruited from 60 urban sites (24 clinics, 36 pharmacies). We used Poisson models to assess differences in post-abortion contraceptive use between pharmacy and clinic clients and mediation analyses to explore the mechanisms through which MA purchase location influences post-abortion contraceptive outcomes.

Results

Contraceptive use 30 days post-abortion was reported by approximately half of clinic clients (Cambodia: 51.9%; Ghana 41.3%) and somewhat fewer pharmacy clients (Cambodia: 43.0%; Ghana: 27.0%), but this difference was not statistically significant (Cambodia: adjusted risk difference [aRD] = −6.6%; 95% CI: −16.4% to 3.3%; Ghana: aRD = −10.1%; 95% CI: −23.4% to 3.2%). Though overall post-abortion contraceptive use was comparable, pharmacy clients used less effective contraceptive methods than clinic clients. Offer of contraceptive information and methods at the point of MA purchase were significantly higher in clinics, and mediation analyses demonstrated that this explained differences in post-abortion contraceptive outcomes between pharmacy and clinic clients.

Conclusions

Use of more effective post-abortion contraceptive methods may be facilitated by offering contraceptive information and methods in pharmacies at the point of MA purchase, but further research and monitoring is required to ensure that these interventions are client-centered and not coercive.

Implications

Greater access to contraceptive information and methods in pharmacies at the point of MA purchase may facilitate use of effective post-abortion contraceptive methods for those self-managing their abortions via pharmacy purchase of MA.

查看原文本刊更多论文

从药店与诊所购买流产药物的妇女在流产后使用避孕药：来自柬埔寨和加纳的证据。

目的：了解药物流产（MA）妇女在药物流产后使用避孕药的差异。研究设计：我们对两项非随机非劣效性试验的数据进行了二次分析，这些试验比较了柬埔寨（2018-2019）和加纳（2019-2021）药房和诊所客户的MA结果。从60个城市站点（24个诊所，36个药房）共招募3791名MA客户（诊所：n=1966，药房：n=1825）。我们使用泊松模型来评估药房和诊所客户在堕胎后避孕药具使用方面的差异，并通过中介分析来探讨药物购买地点影响堕胎后避孕药具效果的机制。结果：大约一半的诊所客户（柬埔寨：51.9%；加纳：41.3%）报告堕胎后30天使用避孕药具，药店客户（柬埔寨：43.0%；加纳：27.0%）略有减少，但这种差异没有统计学意义（柬埔寨：调整风险差异[aRD]= -6.6%; 95% CI: -16.4%至3.3%；加纳：aRD= -10.1%; 95% CI: -23.4%至3.2%）。虽然总体堕胎后避孕使用是相当的，药房客户使用的避孕方法不如诊所客户有效。诊所在购买避孕药时提供的避孕信息和方法明显更高，中介分析表明，这解释了药房和诊所客户在堕胎后避孕结果的差异。结论：通过在药品购买点提供避孕信息和方法，可以促进流产后更有效的避孕方法的使用，但需要进一步研究和监测，以确保这些干预措施以客户为中心，而不是强制性的。含义：在药房购买避孕药具时，更多地获得避孕信息和方法，可能有助于那些通过药房购买避孕药具自我管理堕胎的人使用有效的堕胎后避孕方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Contraception 医学-妇产科学

CiteScore

4.70

自引率

17.20%

发文量

211

审稿时长

69 days

期刊介绍： Contraception has an open access mirror journal Contraception: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal Contraception wishes to advance reproductive health through the rapid publication of the best and most interesting new scholarship regarding contraception and related fields such as abortion. The journal welcomes manuscripts from investigators working in the laboratory, clinical and social sciences, as well as public health and health professions education.