A descriptive analysis of medical abortion commodity availability and pricing at retail outlets in 44 countries across four regions globally

Figures & data

Table 1. Overview of medical abortion commodities and the total number of unique brands identified by region and overall

	Africa	LAC	E. Europe /C. Asia	South /SE Asia	Overall
Misoprostol 200 mcg
% (n) of countries where misoprostol identified	100% (17/17)	100% (10/10)	100% (10/10)	100% (7/7)	100.0% (44/44)
% (n) of countries with only 1 brand found	41.2% (7/17)	50.0% (5/10)	30.0% (3/10)	14.3% (1/7)	36.4% (16/44)
Total num. of unique brands^a	17	20	5	23	61
Total num. of quality-assured brands^b	4	3	2	2	7
Highest num. of unique brands in a country	7	9	3	7	9
Mifepristone 200 mg
% (n) of countries where mifepristone identified	23.5% (4/17)	30.0% (3/10)	100% (10/10)	28.6% (2/7)	43.2% (19/44)
% (n) of countries with only 1 brand found	75.0% (3/4)	100% (3/3)	50.0% (5/10)	50.0% (1/2)	63.2% (12/19)
Total num. of unique brands^a	3	2	7	7	18
Highest num. of unique brands in a country	2	1	4	6	6
Combipack
% (n) of countries where combipacks identified	35.3% (6/17)	30.0% (3/10)	40.0% (4/10)	42.9% (3/7)	36.4% (16/44)
% (n) of countries with only 1 brand found	66.7% (4/6)	100% (3/3)	100% (4/4)	66.7% (2/3)	81.2% (13/16)
Total num. of unique brands^a	7	3	3	6	16
Total num. of quality-assured brands^c	3	2	1	1	4
Highest num. of unique brands in a country	3	1	1	5	5

a. Unique brands refer to products with unique brand names. Products with similar names but different manufacturers were also considered unique.

b. Quality-assured products are those approved by a stringent regulatory authority or pre-qualified by the WHO.

c. Quality-assured combipack means that the misoprostol is quality-assured per above definition.

Table 2. Median price of each medical abortion commodity by region and by country^a

Countries analysed	Misoprostol (N = 304)		Mifepristone (N = 59)		Combipacks (N = 44)
	Price data points available in each region	Price per tablet (USD)	Price data points available in each region	Price per tablet (USD)	Price data points available in each region	Price per pack (USD)
	% (n)	Median (range)	% (n)	Median (range)	% (n)	Median (range)
Africa: Overall	(n = 123)	0.66 (0.11–3.46)	(n = 7)	16.43 (6.00–21.86)	(n = 23)	10.25 (4.02–35.86)
Burkina Faso	14.6 (18)	0.51 (0.49–0.54)
Cameroon	5.7 (7)	1.33 (0.48–2.04)
Cape Verde	n/a^b
Cote d’Ivoire	2.4 (3)	0.55 (0.55–0.55)	n/a^b
DRC	8.9 (11)	0.60 (0.11–1.23)
Ethiopia	0.8 (1)	1.28			39.1 (9)	12.41 (4.02–16.79)
Ghana	3.3 (4)	0.89 (0.75–2.77)			n/a^b
Mali	11.4 (14)	0.61 (0.57–1.54)
Mozambique	4.9 (6)	2.17 (0.42–3.46)			30.4 (7)	6.06 (4.50–9.52)
Niger	6.5 (8)	0.56 (0.40–0.61)
Rwanda	3.3 (4)	0.75 (0.72–0.78)
Senegal	4.9 (6)	0.66 (0.66–0.66)
South Africa	4.1 (5)	0.64 (0.61–0.98)	14.3 (1)	16.43
Tanzania	5.7 (7)	0.50 (0.40–1.50)			8.7 (2)
Tunisia	2.4 (3)	0.73 (0.35–0.73)	42.9 (3)	21.86 (21.86–21.86)		25.00 (24.00–26.00)
Uganda	17.9 (22)	1.50 (0.30–3.00)	42.9 (3)	7.50 (6.00–8.00)	8.7 (2)	9.00
Zambia	3.3 (4)	1.41 (1.03–2.05)			13.1 (3)	20.50 (10.25–35.86)
LAC: Overall	(n = 49)	1.47 (0.11–27.63)	(n = 3)	24.47 (19.83–37.83)	(n = 2)	27.70 (26.60–28.80)
Barbados	n/a^b		n/a^b
Bolivia	10.2 (5)	0.49 (0.11–0.73)
Brazil	n/a^b
Chile^c	6.1 (3)	25.50 (25.50–27.63)^c	33.3% (1)	19.83
Ecuador	18.4 (9)	0.50 (0.50–0.50)
Guyana	2.0 (1)	4.80			50.0% (1)	28.80
Mexico	28.6 (14)	1.93 (0.64–5.19)	66.7% (2)	31.50 (24.47–37.83)	50.0% (1)	26.60
Paraguay	12.2 (6)	7.93 (1.60–20.00)
Peru	22.4 (11)	1.49 (0.62–3.11)
Uruguay	n/a^b				n/a^b
E. Europe/C. Asia: Overall	(n = 58)	1.07 (0.25–2.41)	(n = 43)	12.18 (1.77–22.43)	(n = 12)	12.29 (3.50–15.90)
Armenia	6.9 (4)	0.59 (0.38–0.63)	14.0 (6)	16.65 (16.10–17.85)
Azerbaijan	19.0 (11)	0.59 (0.35–1.54)	7.0 (3)	12.75 (12.18–12.75)
Georgia	13.8 (8)	0.47 (0.28–1.47)	11.6 (5)	9.83 (8.93–12.74)
Kazakhstan	12.1 (7)	1.28 (1.07–1.73)	18.6 (8)	12.96 (8.50–17.91)	8.3 (1)	15.00
Krygyzstan	10.3 (6)	0.57 (0.37–1.50)	4.7 (2)	3.02
Moldova	10.3 (6)	1.65 (1.57–1.87)	14.0 (6)	10.15 (3.19–13.85)	33.3 (4)	15.89 (14.54–15.90)
Russia Federation	5.2 (3)	0.27 (0.25–1.33)	11.6 (5)	8.26 (1.77–18.88)
Tajikistan	3.4 (2)	2.41	4.7 (2)	22.43	41.7 (5)	11.56 (11.33–12.46)
Ukraine	5.2 (3)	1.14 (1.12–1.31)	7.0 (3)	8.89 (8.89–9.36)
Uzbekistan	13.8 (8)	0.95 (0.50–1.27)	7.0 (3)	14.61 (13.20–15.20)	16.7 (2)	3.75 (3.50–4.00)
South/SE Asia: Overall	(n = 74)	0.09 (0.09–3.10)	(n = 6)	5.20 (2.08–9.80)	(n = 7)	5.40 (4.90–9.80)
Indonesia	18.9 (14)	1.39 (1.15–3.10)
Myanmar	8.1 (6)	0.32 (0.27–0.56)
Nepal	1.4 (1)	0.13	33.3 (2)	9.80	85.7 (6)	5.39 (4.90–9.80)
Pakistan	58.1 (43)	0.09 (0.09–0.10)
Sri Lanka	n/a^b				14.3 (1)	7.80
Thailand	8.1 (6)	0.42 (0.42–0.42)			n/a^b
Vietnam	5.4 (4)	0.24 (0.20–.40)	66.7 (4)	4.20 (2.08–6.00)

a. The price of each product was converted from its local currency into US dollars using the relevant historical exchange rate for each country from the midpoint of data collection.

 b. n/a denotes when a product was identified but price information was not available.

 c. Of note, Chile is the only high-income country in the sample that contributed data to the price analysis. When excluding Chile’s three price points for misoprostol, the overall median price per misoprostol tablet in LAC was $1.17 ($0.11–20.00).

Table 3. Price of misoprostol 200 mcg tablets stratified by location and other factors (N = 304)^a

Contextual factors and other product characteristics analysed	% Distribution (n) of available price data points in each category	Mean price per tablet (USD)	Median price per tablet (USD)	Price range per tablet (USD)
Region
Africa	40.5 (123)	0.95	0.66	0.11–3.46
LAC	16.1 (49)	4.14	1.47	0.11–27.63
E. Europe/C. Asia	19.1 (58)	1.02	1.07	0.25–2.41
South/SE Asia	24.3 (74)	0.49	0.09	0.09–3.10
Country’s income status^b
Low income	32.2 (98)	0.90	0.61	0.11–3.46
Lower-middle	42.8 (130)	0.75	0.49	0.09–3.10
Upper-middle	24.0 (73)	2.05	0.98	0.25–20.00
High income^c	1.0 (3)	26.21	25.50	25.50–27.63
Legal status of abortion^d
More restricted (Cat. I–II)	69.1 (210)	1.39	0.56	0.09–27.63
Less restricted (Cat. III–IV)	30.9 (94)	1.29	1.07	0.13–5.19
Outlet type where misoprostol identified
Private, retail pharmacy	70.4 (214)	1.17	0.64	0.09–20.00
Pharmacy at private hospital/NGO	10.9 (33)	0.79	0.50	0.09–4.80
Pharmacy at public hospital/clinic	9.5 (29)	0.58	0.42	0.09–2.05
Drug shop/seller	6.9 (21)	1.92	1.73	0.09–3.46
Other^e	2.3 (7)	11.49	1.14	0.11–27.63
Prescription requested to buy misoprostol	(n = 300)
Yes	61.7 (185)	0.99	0.66	0.09–4.80
No	38.3 (115)	1.98	0.56	0.09–27.63
Misoprostol brand quality-assured^f
Yes	59.5 (181)	1.50	0.63	0.11–27.63
No	40.5 (123)	1.15	0.62	0.09–25.50
Misoprostol packed in double alu blisters	(n = 292)
Yes	87.0 (254)	0.86	0.57	0.09–5.19
No	13.0 (38)	3.30	1.44	0.25–27.63
Num. of brands identified in country
≤ 2 misoprostol brands	41.1 (125)	1.91	0.64	0.25–27.63
≥3 misoprostol brands	58.9 (179)	0.98	0.61	0.09–5.19
Mifepristone and/or Combipack available in country
Yes	46.7 (142)	1.76	1.03	0.13–27.63
No	53.3 (162)	1.01	0.52	0.09–20.00

a. Price information available for 80.0% misoprostol products (304/380).

 b. Based on 2017 World Bank’s classifications of each country’s income status.

 c. Three price points were collected from a high-income country where misoprostol was purchased informally.

 d. Categories I–IV are based on the Center for Reproductive Rights’ Map on Abortion laws, 2014.

 e. Other outlet types include representative/agent from pharmaceutical company (n = 2), informal market (n = 3), gynaecologist (who purchased product in France) (n = 1), unknown (n = 1).

 f. Quality-assured products are those approved by a stringent regulatory authority or pre-qualified by the WHO.

Figure 1. Median (min–max) price of misoprostol in settings where laws on abortion are more vs. less restrictive by region

Figure 2. Median (min–max) price of quality-assured and non-quality-assured misoprostol by region

Table 4. Price of mifepristone 200 mg tablets and combipacks stratified by location and other factors

	Mifepristone 200 mg (N = 59) ^a				Combipacks (N = 44) ^b
Contextual factors and other product characteristics analysed	% Distribution (n) of available price data points in each category	Mean price per tablet (USD)	Median price per tablet (USD)	Price range per tablet (USD)	% Distribution (n) of available price data points in each category	Mean price per pack (USD)	Median price per pack (USD)	Price range per pack (USD)
Region
Africa	11.9 (7)	14.79	16.43	6.00–21.86	52.3 (23)	12.69	10.25	4.02–35.86
LAC	5.1 (3)	27.38	24.47	19.83–37.83	4.5 (2)	27.70	27.70	26.60–28.80
E. Europe/C. Asia	72.9 (43)	11.93	12.18	1.77–22.43	27.3 (12)	11.96	12.29	3.50–15.90
South/SE Asia	10.1 (6)	6.01	5.20	2.08–9.80	15.9 (7)	6.65	5.40	4.90–9.80
Country’s income status ^c
Low income	8.5 (5)	8.22	8.00	6.00–9.80	59.1 (26)	10.15	9.00	4.02–26.00
Lower-middle	56.6 (34)	12.14	10.60	2.08–22.43	34.1 (15)	13.53	12.12	3.50–35.86
Upper-middle	32.2 (19)	13.75	12.75	1.77–37.83	6.8 (3)	23.47	26.60	15.00–28.80
High income	1.7 (1)	19.83	19.83	19.83	(0)
Outlet type where product identified
Private, retail pharmacy	66.1 (39)	12.26	10.77	3.02–37.83	61.4 (27)	12.09	10.95	4.00–35.86
Pharmacy at private hospital/NGO	16.9 (10)	11.02	9.21	1.77–24.47	25.0 (11)	13.13	11.68	3.50–28.80
Pharmacy at public hospital/clinic	10.2 (6)	16.08	18.98	2.08–21.86	2.3 (1)	12.12	12.12	6.92–26.00
Drug shop/seller	n/a				9.0 (4)	12.56	8.66
Other ^d	6.8 (4)	12.53	12.94	4.40–19.83	2.3 (1)	4.02	4.02
Prescription requested for buying product	(n = 54)				(n = 42)
Yes	64.8 (35)	11.51	10.44	2.08–37.83	54.8 (23)	13.22	14.54	4.50–35.86
No	35.2 (19)	13.78	13.20	1.77–24.47	45.2 (19)	11.09	9.80	3.50–26.60
Brand quality-assured ^e
Yes	n/a	n/a	n/a	n/a	38.6 (17)	12.63	9.52	4.02–35.86
No					61.4 (27)	11.94	11.33	3.50–28.80
Num. of misoprostol brands identified in country
≤2 brands	62.7 (37)	13.34	12.96	1.77–22.43	47.7 (21)	13.53	12.46	4.02–28.80
≥3+ brands	37.3 (22)	10.96	9.39	2.08–37.83	52.3 (23)	11.00	7.79	3.50–35.86

a. Price information available for 67.8% of mifepristone products (59/87).

b. Price information available for 72.1% of combipacks (44/61).

c. Based on 2017 World Bank’s classifications of each country’s income status.

d. Other outlet types include representative/agent from pharmaceutical company (n = 2), informal market (n = 1), and unknown (n = 2).

e. Quality-assured combipacks are those that include a misoprostol brand that has been approved by a stringent regulatory authority or pre-qualified by the WHO.

Data availability statement

The data that support the findings of this study are available upon reasonable request to the authors.