Post-abortion contraceptive use among women purchasing medication abortion from pharmacies vs. clinics: Evidence from Cambodia and Ghana
To understand differences in post-abortion contraceptive use between women accessing medication abortion (MA) in pharmacies compared to clinics. We conducted secondary analysis of data from two non-randomized non-inferiority trials that compared MA outcomes for pharmacy and clinic clients in Cambodi...
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| Veröffentlicht in: | Contraception (Stoneham) Jg. 153; S. 111243 |
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01.01.2026
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| Abstract | To understand differences in post-abortion contraceptive use between women accessing medication abortion (MA) in pharmacies compared to clinics.
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.
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.
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.
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. |
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| AbstractList | To understand differences in post-abortion contraceptive use between women accessing medication abortion (MA) in pharmacies compared to clinics.OBJECTIVETo understand differences in post-abortion contraceptive use between women accessing medication abortion (MA) in pharmacies compared to clinics.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 3,791 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.STUDY DESIGNWe 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 3,791 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.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.RESULTSContraceptive 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.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.CONCLUSIONSUse 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.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.IMPLICATIONSGreater 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. To understand differences in post-abortion contraceptive use between women accessing medication abortion (MA) in pharmacies compared to clinics. 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. 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. 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. 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. To understand differences in post-abortion contraceptive use between women accessing medication abortion (MA) in pharmacies compared to clinics. 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. 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. 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. 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. |
| ArticleNumber | 111243 |
| Author | Mao, Bunsoth Agula, Caesar Menzel, Jamie Eckersberger, Elisabeth Antobam, Samuel Pearson, Erin Bawah, Ayaga Kapp, Nathalie Saphonn, Vonthanak |
| Author_xml | – sequence: 1 givenname: Erin orcidid: 0000-0002-6056-1454 surname: Pearson fullname: Pearson, Erin email: eepearson@health.ucsd.edu organization: Center on Gender Equity and Health, Department of Medicine, University of California, San Diego, La Jolla, CA, United States – sequence: 2 givenname: Jamie surname: Menzel fullname: Menzel, Jamie organization: Center on Gender Equity and Health, Department of Medicine, University of California, San Diego, La Jolla, CA, United States – sequence: 3 givenname: Bunsoth surname: Mao fullname: Mao, Bunsoth organization: Medical College, University of Health Sciences, Phnom Penh, Cambodia – sequence: 4 givenname: Caesar surname: Agula fullname: Agula, Caesar organization: Regional Institute for Population Studies, University of Ghana, Accra, Ghana – sequence: 5 givenname: Samuel surname: Antobam fullname: Antobam, Samuel organization: Regional Institute for Population Studies, University of Ghana, Accra, Ghana – sequence: 6 givenname: Elisabeth surname: Eckersberger fullname: Eckersberger, Elisabeth organization: Technical Excellence Team, Ipas, Chapel Hill, NC, United States – sequence: 7 givenname: Ayaga surname: Bawah fullname: Bawah, Ayaga organization: Regional Institute for Population Studies, University of Ghana, Accra, Ghana – sequence: 8 givenname: Vonthanak surname: Saphonn fullname: Saphonn, Vonthanak organization: Medical College, University of Health Sciences, Phnom Penh, Cambodia – sequence: 9 givenname: Nathalie surname: Kapp fullname: Kapp, Nathalie organization: International Planned Parenthood Federation, London, United Kingdom |
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| Cites_doi | 10.1177/1536867X1001000104 10.1136/bmjsrh-2019-200377 10.1016/j.contraception.2016.10.002 10.1136/bmjgh-2020-004763 10.1016/j.contraception.2024.110538 10.7326/M21-4380 10.1136/bmjsrh-2022-201722 10.2196/16276 10.1080/23293691.2024.2426159 10.1363/43e3817 10.1080/17441692.2016.1174280 10.1016/j.contraception.2017.12.009 10.1371/journal.pone.0325882 10.1016/j.contraception.2011.01.013 10.1186/s12889-016-3726-1 |
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| Keywords | Clinic Ghana Cambodia Medication abortion Pharmacy Post-abortion contraception |
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We conducted... To understand differences in post-abortion contraceptive use between women accessing medication abortion (MA) in pharmacies compared to clinics.OBJECTIVETo... |
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| SubjectTerms | Abortion, Induced Adolescent Adult Ambulatory Care Facilities - statistics & numerical data Cambodia Clinic Contraception Behavior - statistics & numerical data Female Ghana Humans Medication abortion Pharmacies - statistics & numerical data Pharmacy Post-abortion contraception Pregnancy Young Adult |
| Title | Post-abortion contraceptive use among women purchasing medication abortion from pharmacies vs. clinics: Evidence from Cambodia and Ghana |
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