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COMMUNITY CASE STUDY article

Front. Reprod. Health
Sec. Access and Barriers to Reproductive Health Services
Volume 7 - 2025 | doi: 10.3389/frph.2025.1472696

Increasing access to self-managed abortion through pharmacies: Programmatic results and lessons from a pilot program in Oromia, Ethiopia

Provisionally accepted
Bekalu Chekol Bekalu Chekol 1*Abiyot Belai Mehari Abiyot Belai Mehari 1Blain Rezene Blain Rezene 1Samuel Muleye Wolelaw Samuel Muleye Wolelaw 1Yadeta Ayana Yadeta Ayana 2Elsabet Sisay Elsabet Sisay 1Sally Dijkerman Sally Dijkerman 3Genene Assefa Genene Assefa 1
  • 1 Ipas Ethiopia, Addis Ababa, Ethiopia
  • 2 Oromia Regional Health Bureau, Addis Ababa, Addis Ababa, Ethiopia
  • 3 Ipas (United States), Chapel Hill, North Carolina, United States

The final, formatted version of the article will be published soon.

    Despite increased availability of safe abortion following legal reform in Ethiopia, one-half of public sector abortion services are treatment of postabortion complications, indicating challenges meeting women's needs. Self-managed abortion (SMA)the ability of pregnant people to manage their unwanted pregnancies with or without the support of a health care provideris a safe, feasible, and acceptable option for women at gestational ages up to 12 weeks. Seeing the potential of SMA to vastly expand access to safe abortion and reduce postabortion complications, a pilot initiative targeting private pharmacies was implemented by the Ethiopian Ministry of Health, the Oromia Regional Health Bureau, and a non-profit organization. From December 2021 to March 2023, implementers trained and supported 41 pharmacies to provide SMA counseling and medical abortion drugs, with and without prescriptions, which was considered to contradict the legal framework at the time. Pharmacy clients' SMA experiences were documented in logbooks and via 21-day follow-up phone surveys. Thirty-two pharmacies (78%) supported 1,457 self-managed abortions during the pilot. Among clients with complete follow-up surveys (n=1233), 98.3% had a complete abortion without needing additional treatment. Only four clients (0.3%) reported a complication. The pilot demonstrated high demand for and feasibility of increasing access to quality SMA through private pharmacies in Ethiopia, but challenges remain due to the lack of a legal framework. We recommend providing multi-sector support on SMA to private pharmacies so they can in turn improve safe abortion accessibility by bringing safe, acceptable services closer to the people that need them.

    Keywords: abortion1, comprehensive abortion care2, Ethiopia3, self-managed abortion4, self-care5, private pharmacy6, medical abortion7, self-care8 Article Type: Community case study

    Received: 29 Jul 2024; Accepted: 24 Jan 2025.

    Copyright: © 2025 Chekol, Mehari, Rezene, Wolelaw, Ayana, Sisay, Dijkerman and Assefa. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Bekalu Chekol, Ipas Ethiopia, Addis Ababa, Ethiopia

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.