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BACKGROUND: In recent years a growing number of manufacturers and medical abortion products have entered country markets and health systems, with varying degrees of quality and accessibility. An interplay of factors including pharmaceutical regulations, abortion laws, government policies and service delivery guidelines and providers knowledge and practices influence the availability of medical abortion medicines. We assessed the availability of medical abortion in eight countries to increase understanding among policymakers of the need to improve availability and affordability of quality-assured medical abortion products at regional and national levels. METHODS: Using a national assessment protocol and an availability framework, we assessed the availability of medical abortion medicines in Bangladesh, Liberia, Malawi, Nepal, Nigeria, Rwanda, Sierra Leone and South Africa between September 2019 and January 2020. RESULTS: Registration of abortion medicines-misoprostol or a combination of mifepristone and misoprostol-was established in all countries assessed, except Rwanda. Mifepristone and misoprostol regimen for medical abortion was identified on the national essential medicines list/standard treatment guidelines for South Africa as well as in specific abortion care service and delivery guidelines for Bangladesh, Nepal, Nigeria, and Rwanda. In Liberia, Malawi, and Sierra Leone-countries with highly restrictive abortion laws and no abortion service delivery guidelines or training curricula-no government-supported training on medical abortion for public sector providers had occurred. Instead, training on medical abortion was either limited in scope to select private sector providers and pharmacists or prohibited. Community awareness activities on medical abortion have been limited in scope across the countries assessed and where abortion is broadly legal, most women do not know that it is an option. CONCLUSION: Understanding the factors that influence the availability of medical abortion medicines is important to support policymakers improve availability of these medicines. The landscape assessments documented that medical abortion commodities can be uniquely impacted by the laws, policies, values, and degree of restrictions placed on service delivery programs. Results of the assessments can guide actions to improve access.

Background: The use of medical abortion using either a combination of mifepristone and misoprostol, or misoprostol alone has contributed to increased safety and decreased mortality and morbidity. The availability of quality medical abortion medicines is an essential component in the provision of quality abortion care. Understanding the factors that influence the availability of medical abortion medicines is important to help in-country policymakers, program planners, and providers improve availability and use of medical abortion. Methods: Using a national assessment protocol and an availability framework, we assessed the availability of medical abortion medicines across five elements (Registration & Quality Assurance, Policy & Financing, Procurement & Distribution, Provider Knowledge, and End-user Knowledge) in eight countries: Botswana, Burkina Faso, Central African Republic, Democratic Republic of the Congo, Eswatini, Lesotho, Namibia and Uganda between November 2020 and November 2021. The assessment included an online desk review and virtual or telephone-based key informant interviews. Results: Registration of medical abortion medicines—misoprostol or co-packaged mifepristone and misoprostol products (combi-pack)—was established in all countries, except the Central African Republic. In Lesotho and Eswatini, the national regulatory agency is still in development and importation of Cytotec™ misoprostol is permitted for off-label use in obstetrics/gynecology. Misoprostol was included in all countries' essential medicines lists, except Botswana. Burkina Faso and Democratic Republic of the Congo also include mifepristone on their essential medicines list and medical abortion regimens in national abortion care service and delivery guidelines. Additionally, guidelines clarified health worker roles in the provision of abortion care specific to the legal context of each country and permitted task-shifting of abortion service provision. Where guidelines did not exist, medical abortion medicines and their use were not well integrated into the public health care system. Community awareness activities on abortion rights and services have been limited in scope across the countries assessed, however, end-users' awareness of misoprostol as a medical abortion medicine was reported. Conclusion: The national landscape assessments identified several cross-cutting opportunities to improve availability of medical abortion medicines, including importing quality-assured medical abortion medicines; developing nationally approved abortion service and delivery guidelines that optimize healthcare worker roles; and expanding communication strategies to reach end-users and pharmacists. [ABSTRACT FROM AUTHOR]