Mystery Client Study 2019: Assessing the Medication Abortion Drug Dispensing Practices among Private Sector Pharmacist and Pharmacy Workers providing services using Mystery Client approach in 30 districts of Nepal

Funded by: Population Services International/Nepal (PSI/Nepal)


In Nepal, unintended pregnancies and unsafe abortions continue to be an issue. As a result, maternal morbidity and mortality from unsafe abortions continue to be significant. The goal of this study was to evaluate pharmacists’ and pharmacy workers’ Medical Abortion drug dispensing practices, which included assessing pharmacists’ actual practice of determining clients’ medical eligibility for MA drug and gestational age, accuracy of information provided to clients regarding MA drug regimen, and accuracy of information provided to clients regarding complications and referral in the event of complications.
Method: A cross-sectional study design with two stages of random sampling for public and private OK clinics, with equal allocation for public and probability proportionate to size for province-wise allocation for private OK clinics. Women between the ages of 18 to 49 who had obtained family planning services on the day of data collection made up the study population. 59 private OK clinics from six provinces (Province 1, 2, 3, Gandaki, 5, and Sudurpaschim) and 60 public health facilities from provinces 2 and 5 made up the sampling unit. The study comprised 504 clients from private OK clinics and 240 from public facilities.


Only 14 % of Scenario A chemists and 65.4 % of Scenario B chemists followed this protocol. Only 75.8% of clients received proper MA drug regimen counseling, 80.7 percent received proper route of administration counseling, 72 percent received proper side effects counseling, 82.8 percent received proper symptom of complications counseling, and 66.1 percent received proper adverse events and complications counseling. When clients are beyond 9 weeks pregnant, have adverse reactions, or have encountered problems, many chemists do not use a referral mechanism to government-approved Safe Abortion Services (SAS) locations.


To ensure that chemists are selling MA medications in accordance with government procedure, a stronger market monitoring mechanism and advocacy are required. The use of safe MA medications over unsafe MA drugs should continue to be the emphasis of IEC materials on safe abortion, awareness activities, and program themes.

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