Exploring the Availability and Accessibility of Medication Abortion Pills in India: A Multi-Methods Study in the Post-COVID-19 Period

Abstract

India holds a unique position in the abortion care provision landscape globally, as it is a key supplier of medication abortion (mifepristone/misoprostol) pills to global telemedicine-based providers such as Women on Web, expanding abortion access in several countries. However, domestically, structural barriers to abortion care, such as overregulation of the regimen by drug authorities, limited service availability in government facilities, and inadequate implementation of telemedicine, impede access for abortion seekers. Furthermore, the COVID-19 pandemic exacerbated these existing challenges by restricting the mobility of care seekers and causing supply chain disruptions.

This project utilizes a multi-method approach to comprehensively assess the pandemic's impact on abortion services. This dissertation project explores the existing knowledge on the pandemic's impact on abortion services through a scoping review and assesses pharmacy access to medication abortion without a prescription using mystery client surveys in major Indian cities. Additionally, it documents the perspectives of women who obtained an abortion through in-depth interviews and the experiences of clinicians who provided this care during these times through key informant interviews.

This project reveals a disconnect between the existing abortion regulatory framework and the needs and modalities through which women obtain this care. The findings reveal that existing pharmacy overregulation and overmedicalization of abortion services, along with pandemic mobility barriers, adversely impacted access. Excessive regulatory enforcement by drug authorities under the misinformed pretext of reducing presumptive female sex-selective abortion has potentially led to the virtual wiping out of medication abortion pills from pharmacies in Mumbai. The project highlights a regulatory shift from pharmacy workers to clinicians' dispensing the regimen, even though pharmacy dispensing is permitted, which indicates overmedicalization of abortion care. Despite the pandemic-induced mobility barriers, telemedicine remains largely unimplementable due to the in-person visit requirement.

This project calls for policy changes aimed at regulatory unburdening of abortion care in India. Policies aimed at mitigating overregulation by engaging with drug authorities to reaffirm the legal status of pharmacy dispensing, expanding the abortion provider base with the requisite training, and facilitating the adoption of telemedicine to further access are warranted.