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Beyond the law: Misoprostol and medical abortion in Dar es Salaam, Tanzania

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  • Solheim, I.H.
  • Moland, K.M.
  • Kahabuka, C.
  • Pembe, A.B.
  • Blystad, A.

Abstract

Misoprostol has during the past few years become an important obstetric drug used for different purposes both within and outside hospitals in Tanzania. In this paper, we analyze how misoprostol is perceived, accessed and used off-label as an abortion drug in the city and region of Dar es Salaam. The study took place in Dar es Salaam's three districts from July to November 2015, and had a qualitative explorative approach. We carried out in-depth interviews (42) with the following main categories of informants: women having undergone medical abortion (15), health care workers with experiences from post abortion care (16) and drug vendors (11). Focus group discussions (10) were carried out with young women. A client simulation study was carried out in 64 drugstores across Dar es Salaam assessing the availability of misoprostol and the advice given concerning its use. In addition, shorter qualitative interviews were carried out with representatives of NGOs and public agencies working with sexual and reproductive health issues (17). Our findings reveal that in Dar es Salaam, misoprostol is well known, available and accessed for abortion purposes through drugstores and health providers. Women tend to prefer misoprostol over other abortion methods since it allows for a private, low-cost, safer and less uncomfortable abortion experience. But, while misoprostol facilitates women's agency in the process of seeking abortion, a series of obstacles shaped by a restrictive abortion law and an unregulated pharmaceutical market hinder its safe use. Central obstacles are profit-seeking providers, suboptimal user instructions and poor provider follow-up. In the discussion of the material we draw upon Van der Geest, Hardon and Whyte's concept of the ‘social life of pharmaceuticals’ and indicate the ways in which misoprostol acts as an agent of change in the social relations connected to abortion.

Suggested Citation

  • Solheim, I.H. & Moland, K.M. & Kahabuka, C. & Pembe, A.B. & Blystad, A., 2020. "Beyond the law: Misoprostol and medical abortion in Dar es Salaam, Tanzania," Social Science & Medicine, Elsevier, vol. 245(C).
    • Handle: RePEc:eee:socmed:v:245:y:2020:i:c:s0277953619306719
    DOI: 10.1016/j.socscimed.2019.112676
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    References listed on IDEAS

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    1. Coast, Ernestina & Murray, Susan F., 2016. "“These things are dangerous”: Understanding induced abortion trajectories in urban Zambia," Social Science & Medicine, Elsevier, vol. 153(C), pages 201-209.
    2. van der Geest, Sjaak, 1982. "The efficiency of inefficiency : Medicine distribution in South Cameroon," Social Science & Medicine, Elsevier, vol. 16(24), pages 2145-2153, January.
    3. Johnson-Hanks, Jennifer, 2002. "The lesser shame: abortion among educated women in southern Cameroon," Social Science & Medicine, Elsevier, vol. 55(8), pages 1337-1349, October.
    4. Silberschmidt, Margrethe & Rasch, Vibeke, 2001. "Adolescent girls, illegal abortions and "sugar-daddies" in Dar es Salaam: vulnerable victims and active social agents," Social Science & Medicine, Elsevier, vol. 52(12), pages 1815-1826, June.
    5. Chiarello, Elizabeth, 2013. "How organizational context affects bioethical decision-making: Pharmacists' management of gatekeeping processes in retail and hospital settings," Social Science & Medicine, Elsevier, vol. 98(C), pages 319-329.
    6. Suh, Siri, 2014. "Rewriting abortion: Deploying medical records in jurisdictional negotiation over a forbidden practice in Senegal," Social Science & Medicine, Elsevier, vol. 108(C), pages 20-33.
    7. Izugbara, Chimaraoke O. & Egesa, Carolyne & Okelo, Rispah, 2015. "‘High profile health facilities can add to your trouble’: Women, stigma and un/safe abortion in Kenya," Social Science & Medicine, Elsevier, vol. 141(C), pages 9-18.
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    1. Ouedraogo, Ramatou & Juma, Kenneth, 2020. "From the shadows to light. Perceptions of women and healthcare providers of post-abortion care in Burkina Faso," Social Science & Medicine, Elsevier, vol. 260(C).

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