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Treading the thin line: pharmacy workers’ perspectives on medication abortion provision in Lusaka, Zambia

Footman, Katharine, Chelwa, Nachela, Douthwaite, Megan, Mdala, James, Mulenga, Drosin, Brander, Caila and Church, Kathryn (2021) Treading the thin line: pharmacy workers’ perspectives on medication abortion provision in Lusaka, Zambia. Studies in Family Planning, 52 (2). 179 - 194. ISSN 0039-3665

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Identification Number: 10.1111/sifp.12151


Context: Despite liberal abortion laws, safe abortion access in Zambia is impeded by limited legal awareness, lack of services, and restrictive clinical policies. As in many countries with restricted abortion access, women frequently seek abortions informally from pharmacies. Methods: We conducted 16 in-depth interviews in 2019 to understand the experiences and motivations of pharmacy workers who sell medication abortion (MA) drugs in Lusaka. Results: We found that pharmacy staff reluctantly assume a gatekeeper role for MA due to competing pressures from clients and from regulatory constraints. Pharmacy staff often decide to provide MA, motivated by their duty of care and desire to help clients, as well as financial interests. However, pharmacy workers’ motivation to protect themselves from legal and business risk perpetuates inequalities in abortion access, as pharmacy workers improvise additional eligibility criteria based on personal risk and values such as age, partner approval, reason for abortion and level of desperation. Conclusion: These findings highlight how pharmacy staff informally determine women’s abortion access when laws and policies prevent comprehensive access to safe abortion. Reform of clinical guidelines, public education, strengthened public sector availability, task-sharing, and improved access to prescription services are needed to ensure women can legally access safe abortion.

Item Type: Article
Official URL:
Additional Information: © 2021 The Authors
Divisions: Social Policy
Subjects: R Medicine > RA Public aspects of medicine
R Medicine > RG Gynecology and obstetrics
Date Deposited: 26 Feb 2021 16:39
Last Modified: 20 Oct 2021 02:57

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