JMIR Publications

ABSTRACT

Background:

Annually there are approximately 25 million unsafe abortions, and this remains a leading cause of morbidity and maternal mortality. In settings where abortion is restricted, women are increasingly able to self-manage abortions by purchasing abortion medications such as misoprostol and mifepristone from pharmacies or other drug sellers. Better availability of these drugs has been shown to be associated with reductions in complications from unsafe abortion. In Bangladesh abortion is restricted; however menstrual regulation (MR) was introduced in the 1970s as an interim method of preventing pregnancy. Pharmacy provision of medications for MR is widespread, but customers purchasing these drugs often do not have access to quality information on dosage and complications, which means a higher risk of side effects and complications developing. In 2010, Marie Stopes Bangladesh (MSB) established a call centre to reduce potential harm from self-administration of MR medications. The call centre number was advertised widely in pharmacies and on MR product packaging.

Objective:

This study aimed to assess call centre use over time and how this changed when a new MR product (combined mifepristone-misoprostol) was introduced to the market and started to advertise the call centre number in November 2014.

Methods:

We conducted a secondary analysis of routine data collected by call centre workers between July 2012-August 2016. We investigated reported types of caller, call reason and reported usage of MR products, before and after November 2014. We used interrupted time series analysis (ITS) to formally assess levels of change in caller characteristics and reason for calling.

Results:

Over the 4-year period 287,095 calls about MR were received and the numbers of users steadily increased over time. The most common callers were MR-users (23.5%), their husbands (23.0%), pharmacy workers (22.9%) and village doctors (19.5%). Most MR calls were about misoprostol (75.0%), but after November 2014 a growing proportion were about the mifepristone-misoprostol regimen. The most common reasons for calling were to obtain information about regimen (72.7%), side effects (72.5%), and to report side effects (17.4%). The ITS analyses showed that after November 2014, an increasing number of calls were from MR-users who had taken the complete regimen (P=0.023), who were calling to discuss reported side effects (P=0.006) and pain medication (P=0.013), and there were fewer calls asking about dosages (P<0.001).

Conclusions:

The high call volume suggests that this call centre intervention addressed an unmet demand for information about MR medications from both MR users and healthcare providers. Call centre interventions may improve the quality of information available to MR-users, by providing information directly, as well as to drug sellers, and thus helping to reduce harm from self-medication of MR drugs.