A Safe Abortion in Her Hands

by Maria Dieter, Associate Content Manager, PSI @MariaDeets

Ritika Yadav* sat facing her husband, Pradip. They were mid- conversation, speaking quietly as they sat in their home in the ancient, bustling city of Patna, India.

“I’m …” Ritika was interrupted by her children playing a game in the next room, screaming with glee. She waited until they were finished. “… pregnant,” she finished.

They just couldn’t afford another child.

“Your sister told me that she took some medicine once so that she didn’t have a baby,” Ritika explained. “Can you go to the pharmacy and buy it for me?” Pradip set off for the pharmacy.

The pills Ritika asked for are known as medical abortion (MA), a combination of the drugs mifepristone and misoprostol. This is the most common method of abortion in India. The Guttmacher Institute and others estimated that in 2015, 81 percent of the 15.6 million abortions in India were MAs. Although a doctor’s prescription is required for MA, pharmacists often sell it over the counter.

Pradip returned an hour later with a small box of pills.

“The pharmacist explained how you should take the pills. I wrote it all down,” Pradip showed her a small yellow piece of paper with a few scribbles on it.

Ritika scrutinized his notes, her brow furrowed in concern. “I don’t understand,” she frowned. “These directions are different from what your sister said.” Ritika wasn’t sure what to do.

She turned over the package of pills. On the front was a bright pink and purple label that read “Safe Abort.” She carefully opened its contents, and reached inside to find the medication enclosed with a small piece of paper. Next to a set of written instructions on using the medication was an option directing her to download an app on her phone for more information.

PSI India Private Limited (IPL), a for-profit social enterprise founded by PSI, has been selling MA kits like Ritika’s since 2016 using the brand Safe Abort. As of April 2019, PSI IPL had sold almost 1.8 million Safe Abort kits, which it estimates has saved the lives of 2,300 Indian women.

This image from the Safe Abort video demonstrates how to take a mifeprostone tablet. Image courtesy of PSI/IPL.

In 2018, with funding from the David & Lucile Packard Foundation, PSI IPL interviewed 57 clients about their experiences with self- administering MA. They recognized more efficient and accessible systems were needed for informing clients about effective self- administration, so PSI IPL created an interactive system using Safe Abort’s packaging that instructs the client to scan the pack and play a video on her smartphone.

Ritika was curious about the app, so she used the phone she and Pradip shared to download it and was connected to the Safe Abort interactive information system. Bright images flashed on her smartphone as she watched a short video demonstrating how to take the pills correctly.

Pradip watched over Ritika’s shoulder. “Yeah, that’s exactly what the pharmacist told me,” he said.

Ritika smiled.

That night, Ritika easily followed the video’s instructions, which put her mind to rest as she safely self-managed her MA. It had been a difficult decision, and this tiny, scannable code had made all the difference. Relief washed over her.

*To respect privacy, the characters in this piece are composites of several men and women interviewed during the 2018 qualitative survey funded by the David and Lucile Packard Foundation.

—With contribution from Rachel Braden, Associate Program Manager, PSI IPL

This article appears in PSI’s Impact magazine, released in tandem with Women Deliver 2019, as part of an ongoing conversation about putting #PowerInHerHands.

Banner Image: Photo courtesy of PSI/IPL

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