Mapping access to medication abortion in Maputo, Mozambique

Objective: To characterize access to co-packaged mifepristone and misoprostol (“combi-pack”) for medication abortion in Maputo, Mozambique. Study design: A cross-sectional, secret shopper study was conducted among pharmacies in Maputo between June and September 2022. Students were trained to act as patients seeking abortion. Shoppers visited all commercial pharmacies in Maputo to obtain information about combi-pack availability, administration, and side effects. Pharmacies were visited by two shoppers; one with a prescription and one without. Cost and availability were evaluated according to neighborhood socioeconomic status. Results: We conducted 250 visits among 155 pharmacies. Combi-pack was available at 80.6% of pharmacies; only 8.4% required a prescription. Median cost was 1000 meticais ($15.65 USD) (range 350–1700 MT, $5.48–26.60 USD). Pharmacy worker instructions on combi-pack administration were fully accurate at only 3.7% of visits, while 45.2% gave partially correct instructions and 47.9% gave no instructions at all. Side effects and hospital precautions were discussed at 48.9% and 22.9% of pharmacy visits, respectively. Low-income neighborhoods were more likely to dispense combi-pack compared to high-income neighborhoods (94.9% vs. 68.9%, p = 0.001). Yet, combi-pack cost significantly more in low-income compared to high-income neighborhoods (median cost 1300 MT [$20.35 USD] vs. 950 MT [$14.87 USD], p < 0.001). Dispensing combi-pack with or without a prescription was not significantly correlated with neighborhood income level. Conclusions: Overall, combi-pack is widely available in Maputo with significant variations in dispensing practices and cost by neighborhood income level. Interventions to improve pharmacy-based counseling, specifically targeted towards low-income neighborhoods, are needed to increase access to safe abortion services. Implications: Co-packaged mifepristone-misoprostol was widely available at commercial pharmacies in Maputo, Mozambique. Most pharmacies dispensed medication abortion without a prescription and provided limited information on medication administration and potential side effects, particularly in lower income neighborhoods. Improving pharmacist counseling and focusing interventions in low-income neighborhoods can promote safety of medication abortion.