{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T13:43:50Z","timestamp":1783950230177,"version":"3.55.0"},"reference-count":21,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2024,5,9]],"date-time":"2024-05-09T00:00:00Z","timestamp":1715212800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000008","name":"David and Lucile Packard Foundation","doi-asserted-by":"publisher","award":["2019-68460"],"award-info":[{"award-number":["2019-68460"]}],"id":[{"id":"10.13039\/100000008","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Abortion was legalized in Nepal in 2002; however, despite evidence of safety and quality provision of medical abortion (MA) pills by pharmacies in Nepal and elsewhere, it is still not legal for pharmacists to provide medication abortion in Nepal. However, pharmacies often do provide MA, but little is known about who seeks abortions from pharmacies and their experiences and outcomes. The purpose of this study is to understand the experiences of women seeking MA from a pharmacy, abortion complications experienced, and predictors for denial of MA. Data was collected from women seeking MA from four pharmacies in two districts of Nepal in 2021\u20132022. Data was collected at baseline (N = 153) and 6 weeks later (N = 138). Using descriptive results and multi-variable regression models, we explore differences between women who received and did not receive MA and predictors of denial of services. Most women requesting such pills received MA (78%), with those who were denied most commonly reporting denial due to the provider saying they were too far along. There were few socio-demographic differences between groups, with the exception of education and gestational age. Women reported receiving information on how to take pills and what to do about side effects. Just under half (45%) of women who took pills reported no adverse symptoms after taking them and only 13% sought care. Most women seeking MA from pharmacists in Nepal are receiving services, information, and having few post-abortion symptoms. This study expands the previous limited research on pharmacy provision of MA in Nepal using a unique dataset that recruits women at the time of abortion seeking and follows them over time, overcoming potential biases present in other study designs. This suggests that expansion of the law to allow pharmacy distribution would increase accessibility and reflect current practice.<\/jats:p>","DOI":"10.1371\/journal.pgph.0003144","type":"journal-article","created":{"date-parts":[[2024,5,9]],"date-time":"2024-05-09T17:44:20Z","timestamp":1715276660000},"page":"e0003144","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Predictors and experiences of seeking abortion services from pharmacies in Nepal"],"prefix":"10.1371","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4758-6403","authenticated-orcid":true,"given":"Leila","family":"Harrison","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahesh","family":"Puri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Greene Foster","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0004-6386","authenticated-orcid":true,"given":"Sunita","family":"Karkia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8711-3029","authenticated-orcid":true,"given":"Nadia G.","family":"Diamond-Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,5,9]]},"reference":[{"key":"pgph.0003144.ref001","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.bpobgyn.2019.06.003","article-title":"Providing medical abortion services through pharmacies: Evidence from Nepal","volume":"63","author":"MC Puri","year":"2020","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"pgph.0003144.ref002","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1186\/s12905-015-0241-y","article-title":"\u201cI need to terminate this pregnancy even if it will take my life\u201d: a qualitative study of the effect of being denied legal abortion on women\u2019s lives in Nepal","volume":"15","author":"M Puri","year":"2015","journal-title":"BMC Women\u2019s Health"},{"issue":"1","key":"pgph.0003144.ref003","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1002\/ijgo.14141","article-title":"Predictors of prior unsuccessful pharmacy abortion attempts among women presenting for abortion in government certified clinics in Nepal","volume":"159","author":"C Ahlbach","year":"2022","journal-title":"Int J Gynecol Obstet"},{"issue":"2","key":"pgph.0003144.ref004","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1057\/jphp.2012.11","article-title":"Roles of pharmacists in expanding access to safe and effective medical abortion in developing countries: a review of the literature","volume":"33","author":"RK Sneeringer","year":"2012","journal-title":"J Public Health Policy"},{"issue":"4","key":"pgph.0003144.ref005","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1363\/42e2116","article-title":"Abortion Incidence and Unintended Pregnancy in Nepal","volume":"42","author":"M Puri","year":"2016","journal-title":"Int Perspect Sex Reprod Health"},{"issue":"3","key":"pgph.0003144.ref006","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1363\/44e6518","article-title":"Pharmacy Provision of Medication Abortion in Nepal: Pharmacy Owner and Worker Perspectives","volume":"44","author":"G Samari","year":"2018","journal-title":"Int Perspect Sex Reprod Health"},{"key":"pgph.0003144.ref007","unstructured":"Ministry of Health, Nepal; New ERA; and ICF. 2017. Nepal Demographic and Health Survey 2016. Kathmandu, Nepal: Minitry of Health, Nepal."},{"issue":"1","key":"pgph.0003144.ref008","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1111\/sifp.12049","article-title":"Medical Abortion Provision by Pharmacies and Drug Sellers in Low- and Middle-Income Countries: A Systematic Review","volume":"49","author":"K Footman","year":"2018","journal-title":"Stud Fam Plann"},{"key":"pgph.0003144.ref009","unstructured":"Advancing New Standards in Reproductive Health (ANSIRH). The Turnaway Study [Internet]. https:\/\/www.ansirh.org\/research\/ongoing\/turnaway-study."},{"issue":"3","key":"pgph.0003144.ref010","doi-asserted-by":"crossref","first-page":"e0282886","DOI":"10.1371\/journal.pone.0282886","article-title":"Denial of legal abortion in Nepal","volume":"18","author":"MC Puri","year":"2023","journal-title":"PLOS ONE"},{"issue":"11","key":"pgph.0003144.ref011","doi-asserted-by":"crossref","first-page":"e0278132","DOI":"10.1371\/journal.pone.0278132","article-title":"Medical abortion drug dispensing practices among private pharmacy workers in Nepal: A mystery client study","volume":"17","author":"A Sigdel","year":"2022","journal-title":"PLOS ONE"},{"issue":"4","key":"pgph.0003144.ref012","doi-asserted-by":"crossref","first-page":"100025","DOI":"10.1016\/j.xagr.2021.100025","article-title":"Differential treatment in the provision of medication abortion at pharmacies in Uttar Pradesh, India","volume":"1","author":"J 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