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USE OF MEDICINES BY WOMEN
Women and Health Learning Package
Developed by The Network: TUFH Women and Health Taskforce
Second edition, September 2006

Support for the production of the Women and Health Learning Package (WHLP) has been provided
by The Network: Towards Unity for Health (The Network: TUFH), Global Health through Education,
Training and Service (GHETS), and the Global Knowledge Partnership. Copies of this and other
WHLP modules and related materials are available on The Network: TUFH website at
http://www.the-networktufh.org/publications_resources/trainingmodules.asp or by contacting GHETS
by email at [email protected], or by fax at +1 (508) 448-8346.


About the author
Godwin Nwadibia Aja, MCH, CHES
Associate Professor, Department of Health Sciences
Babcock University
Ilishan-Remo, Ogun State, Nigeria

Godwin Nwadibia Aja is an associate professor of health promotion and education, and
coordinator of the Bachelor of Science degree program in Health Promotion and Education at
Babcock University, Nigeria. He is a member of Health Action International (HAI) Africa, a
sub-regional network of consumers’ groups, healthcare professionals and health policymakers
working for increased rationality in drug use, provision of quality health information, and
access to essential medicines. He is also the focal point for the Ecumenical Pharmaceutical
Network, a faith-based organization that works to increase the capacity of church-related
health institutions to provide high-quality pharmaceutical services. He is particularly
concerned about how health issues impact on women.
Mr Aja is the author of ABC of Rational Use of Medicine: A Handbook for Community
Education, funded by the UK Department for International Development (DFID) through its
support of the Networking for Rational Drug Use in Africa Project of the HAI Europe
Foundation in Amsterdam. He is also a member of The Network: TUFH Women and Health
Taskforce. He can be reached by e-mail at [email protected].
Women and Health Learning Package: Use of Medicines by Women USE OF MEDICINES BY WOMEN
Global Overview

There are documented differences between men and women in patterns of medicine use, with
women reporting higher use in both developing and developed countries.1 Self-medication is
a common option for women seeking health care,1,2 including the use of medicinal plants in
indigenous healing practices.3 According to the World Health Organization (WHO), such
practices are obvious factors determining health and the burden of ill health for women.4
Irrational use of drugs is a widespread hazard, with problems related to the prescription and
dispensing of medicines. Studies at some clinics have found that over 70% of the injections
that patients receive from primary healthcare providers are unnecessary or could be given in
an oral formulation.5 Unsafe injections cause an estimated 1.3 million early deaths and an
annual burden of US$ 535 million in direct medical costs.6 According to the WHO, half of
the 15 billion injections given per year are not sterile, and 25-75% of antibiotic prescriptions
are inappropriate. Furthermore, 50-90% of drug purchases are private7, usually from
untrained or poorly-trained medicine vendors. Physicians inappropriately prescribe expensive
antibiotics, which can be counterproductive to patients: for example, fungal infections are
linked to overuse of cephalosporins8.
Women need accurate and complete information about medicines, including contraceptives,
to counter unethical drug promotion. Some advertisements, for example, promote “iron and
vitamin supplements during pregnancy or while breastfeeding, as a way of being a ‘good’
mother.”9
The burden of reproductive and sexual ill-health is greatest in the poorest countries where
health services tend to be inaccessible and beyond the reach of many poor people. In
receiving quality information on medicine, women are empowered to use medicines
rationally (wisely and effectively). By increasing women's knowledge about safe use of
medicines, families will be less susceptible to exploitation. Irrational use has serious public
health implications, such as antimicrobial resistance and the waste of scarce family resources.
1 Obermeyer CM, Schulein M, Hardon A, Sievert LL, Price K, Santiago AC, Lazcano O, Kirumira EK, Neuman M (2004). Gender and medication use: an exploratory, multi-site study. Women Health 39(4):57-73. 2 Hjortsberg C (2003). Why do the sick not utilise health care? The case of Zambia. Health Econ. 12(9):755-770. 3 Gedif T, Hahn HJ (2002). Epidemiology of herbal drugs use in Addis Ababa, Ethiopia. Pharmacoepidemiol Drug Saf. 11(7):587-591. 4 Abrahams N, Jewkes R, Mvo Z (2002). Indigenous healing practices and self-medication amongst pregnant women in Cape Town, South Africa. Afri J Reprod Health 6(2):79-86. 5 http://www.who.int/gender/en/ 6 http://www.who.int/mediacentre/factsheets/fs231/en/ 7 The cost of unsafe injections by M.A. Miller & E. Pisani: Bulletin of the World Health Organization 77(10):808-811. 8 HAI Africa. 9 WHO Technical Report Series 838. Increasing the relevance of education for health professional-Report of a WHO study group on problem solving education for the health professions.WHO,Geneva 1993,P15. 10 Aja, GN (2001). ABC of Rational Use of Medicines: A Handbook for Community Education. Ibadan: Agbo Areo. Women and Health Learning Package: Use of Medicines by Women Regional Overview: Nigeria

Unrestricted sale and use of medicines by women and men necessitated the formulation of the
Nigerian National Drug Policy11 in 1990, which had the following objectives:
1. Stimulate awareness of the unsatisfactory drug situation in the country 2. Improve the drug supply system through improvements in the selection process, procurement practices, and storage and distribution 3. Ensure fair distribution of available drugs to all levels of health care from the most remote village health worker to the urban teaching and specialist hospitals on the basis of needs and prevailing health problems 4. Improve local capability in drug manufacture 5. Ensure the safety and efficacy of all drugs, whether imported or locally manufactured, through effective quality assurance and good manufacturing practices 6. Provide an administrative and legislative framework for the control and regulation of the importation, manufacture, storage, distribution, sale and use of drugs 7. Promote research on traditional medicines with the hope that some of them might be found suitable for development as medicines for regular use in the health system 8. Stimulate research on, and development of, basic chemicals and other pharmaceutical raw materials for the production, compounding and formulation of drugs 9. Stimulate greater understanding at decision-making levels in the government of the The National Agency for Food and Drug Administration and Control (NAFDAC)12 is primarily responsible for promoting and protecting public health in Nigeria through the active control and regulation of importation, exportation, distribution, advertisement, sale and consumption of processed foods, drugs, bottled water, chemicals (including medicinal drugs) and cosmetics. In recent times, the country’s drug distribution channels have witnessed a tremendous shake-up under the leadership of Dr. Dora Akinyuli. However, the present drug reporting system in Nigeria does not give women the opportunity to conveniently share their concerns and discuss their unpleasant experiences involving medicines. Thus, there is a need to sensitize women in particular on the benefits and harms of medicine use. 11 Federal Ministry of Health (1990). National Drug Policy. Lagos, Nigeria, p.10-12. 12 NAFDAC News (1996). Volume 1, No.1, April-December, p.1. Women and Health Learning Package: Use of Medicines by Women FACT SHEET
What women need to know about medicines

Medicines are drug compounds used to prevent diseases (such as vaccines), cure diseases
(chloroquine for malaria), help us feel better (Paracetamol for the relief of aches and pains),
and control diseases (insulin for diabetes).

What are the problems of medicine use?

Governments often find it extremely difficult to control the sale and use of medicines by
unauthorized persons. Even authorized persons, such as patented medicine dealers, though
licensed to sell medicines, are not always adequately trained. This is complicated by the
activities of pharmaceutical companies who recruit agents to sell medicines to unsuspecting
women and others in buses, car parks, markets, and other public places.
Many women are illiterate and are unable to read information on the leaflets found in some of
the medicine packets. The literate ones are often unable to clearly understand the medical
jargon used on the packet inserts. As a result, all kinds of medicines are consumed without
adequate information about the harms associated with them.
It is important to be aware that there are large numbers of fake and adulterated medicines in
our communities today. They look beautiful, but they do not act the way the makers say they
act. Profit is the driving force behind medicine sales, rather than the health needs of the
people they are supposed to be helping.
Self-medication can be life-threatening. Taking medication for the wrong disease can prove
deadly. The symptoms of two diseases may be similar while the underlying health problems
are entirely different. For example, fevers and headaches are symptoms for many conditions
such as malaria and typhoid.
What is rational use of medicines?
Rational use of medicine means using medicines wisely and with caution. It is about using
the right medicine by the right person, for the right illness, at the right time, in the right
quantity or dose, for the right length of time, and at the right price.10
Women, therefore, need to be careful when using medicines of any kind, prescribed or
unprescribed.
What are the common examples of irrational use of medicines?

• Prescribing too many medicines per patient (polypharmacy) • Prescribing injections where oral formulations would have been more appropriate • Prescribing or using medicines in inadequate doses or duration (for example, antibiotics for non-bacterial infections) thereby contributing to the growing problem of antimicrobial resistance • Physicians prescribing medicines without following clinical guidelines • Not using medicines as prescribed by a qualified health worker • Using or sharing medicines prescribed for someone else • Buying and using medicines previously prescribed by a physician without another due Women and Health Learning Package: Use of Medicines by Women • Unrestricted donation of unsolicited medicines from ‘overseas philanthropists’ to
Unfortunately, those who are ill often look for a quick cure, and will use any available
medicine that they think could bring relief to them.
What information about medicines do women need?

• Name of the medicine and manufacturer • Date of manufacture, batch and expiry date. • Average dose and dose interval for adults, children and elderly • Special conditions that require either increased or decreased use. • Extent of its side effects (if any). It is not easy to know which medicines are good or bad by just looking at them. Women who cannot read or write should ask someone to help them get the above information. It is, however, best to consult a physician. Women and Health Learning Package: Use of Medicines by Women SUGGESTED READING
Bale HE. Consumption and trade in off-patented medicines. Commission on Macroeconomics
and Health, 2001. Available at: http://www.cmhealth.org/docs/wg4_paper3.pdf
Levison L. Policy and programming options for reducing the procurement costs of essential
medicines in developing countries. Concentration Paper, Department of International Health,
Boston University School of Public Health, 2003. Available at:
http://dcc2.bumc.bu.edu/richardl/IH820/Resource_materials/Web_Resources/Levison-
hiddencosts.doc
World Health Organization. Counterfeit drugs: report of a joint WHO/IFPMA workshop.
Geneva: WHO, 1992 (unpublished document WHO/DMP/CFD/92).
World Health Organization. Globalization, TRIPS and access to pharmaceuticals. WHO
Policy Perspectives on Medicines No.3. Geneva, WHO, 2001.
World Health Organization. How to develop and implement a national drug policy. 2nd ed.
Geneva: WHO, 2001.
World Health Organization. World health report 2000: health systems – measuring
performance. Geneva: WHO, 2000.

RECOMMENDED WEBSITES
The Cochrane Collaboration
http://www.cochrane.org
Ecumenical Pharmaceutical Network
http://www.epnetwork.org
EssentialDrugs.org
http://www.essentialdrugs.org
Health Action International (HAI) Africa
http://www.haiafrica.org
World Health Organization – Department of Medicines Policy and Standards
http://www.who.int/medicines
World Health Organization – Essential Drugs Monitor
http://www.who.int/medicines/publications/monitor
Women and Health Learning Package: Use of Medicines by Women Tutor’s Notes
The overall goal of this module is to increase awareness of women and students about key
issues and problems involving medicine use, and to help them identify ways of dealing with
the problems. By the end of the session, students should be able to:
1. Explain what medicines are.
2. Discuss the problems associated with medicine use.
3. Understand the national drug policy in their country.
4. Outline information they need when getting medicines from any source.
5. Suggest ways in which women and women’s groups can address the problem of irrational
Advance preparation may be necessary. 1. Share information on women and medicine issues using the fact sheet 2. The activity sheet can be used in two ways. If you are working directly with women’s groups, it can be used to test understanding on whether women “agree” or “disagree” with the statements. It can also be used to help students test their own perceptions about medicines, and to teach them how to discuss the issue of medicine use with women. 3. Discuss issues raised in the case studies. Let the women or students share their own stories/experiences with medicine and discuss possible lessons. The stories should highlight some of the realities that exist today. Possible issues to be raised may include: • How women are often the target for medicine promotion • Why women need to know the benefits and harms of medicine use
Note: Encourage the women or students to add to the list other ways they think medicines can
be harmful to them. From the answers, discuss and highlight the major issues. Allow time for
more questions and help them dispel myths and misconceptions. Those pertinent issues raised
will help promote personal responsibility among women, and the idea of personal
consequences resulting from personal actions.
Notes on Activity Sheet
Objectives: To document students’ and women’s perception and attitude towards medicine
use and to establish baseline data where they do not exist.
Women’s issues highlighted in this activity:
• Medicines can benefit or harm women. • Women need to be aware of the country’s drug policy. • It is a good idea for women to know the expiry date of medicines, and where to get • Getting women to respond to the statements provides a learning process as well as insight to what they know and need to know about medicine use. • Women’s involvement in research related to medicine use is necessary for a Women and Health Learning Package: Use of Medicines by Women Activity Sheet
The activity sheet below is developed to help us understand what students and women know
about medicine use.
Indicate “Agree,” “Disagree” or “Don’t Know” for each statement below.
Statement Agree
Disagree
2. The sale and use of medicines are no problem 3. It is necessary to know the identity and qualifications of anyone giving or selling medicines to me. 4. I am aware of the National Drug Policy. 5. I don’t know how to check the expiry date of 6. Vitamin supplements are necessary whether or 7. Women buy from medicine hawkers because they are cheap, not because they are good. 8. Women are more likely to misuse medicines 9. It doesn’t really matter where I get my medicines, be it in a bus, chemist store or clinic. 10. The main aim of the medicine seller is to make 11. It is not my business to bother about the 12. I think it is only the government that should check the issue of indiscriminate use and sale of medicines. 13. There is no harm in using herbal medicines. 14. Anybody can provide medicine for me as long 15. Women can buy from the medicine hawker as Women and Health Learning Package: Use of Medicines by Women long as they know the name of the medicine they want. 16. Friends from abroad can donate medicines to women’s groups, even if they are not asked. 17. Once women feel well, they can stop taking the medicines given to them by a health worker. 18. Women can report a health worker to the community leader for refusing to tell them more about the medicines he/she is giving them. 19. Not buying medicine from hawkers will surely 20. Women don’t need to read label/insert on medicine package as long as the health worker had told them what to do. 21. Once a doctor prescribes a medicine, women can buy it again on their own when next they have the same illness. 22. There is nothing wrong with women giving 23. It is good to keep medicines where everybody

Questions for students

1. Is it important to find out what women already know about medicine use in order to 2. Do the statements on the activity sheet help to elicit information on women’s perspectives about medicine use? Are there statements that you consider unnecessary or redundant? 3. Are there statements that you would like to see added to the list? 4. Share your own experiences and perceptions regarding medicine use in your community: • Where do you, your family and friends get medicines? • In your community, are women involved in the sale of medicines on the street • How would you work with women groups in your community to help address the Women and Health Learning Package: Use of Medicines by Women Case Study: Sleeping pills
For days, a six-months-pregnant mother cannot sleep properly at night. Instead of going to
see the doctor, she goes to the nearest street medicine vendor and buys sleeping pills. She
continues using these pills till the last days of pregnancy. She develops complications, and at
birth she sees that the baby has become deformed.
Questions for students

1. Was it normal for the pregnant mother to have gone to the nearest street medicine 2. Was she aware that the medicine might affect her baby? If she knew, would she have 3. What would you have done if you were in her position? Women and Health Learning Package: Use of Medicines by Women Case Study: Sleeping pills – Tutor’s Notes

Objectives:
• To highlight the point that pregnancy may increase women’s demand for medicines • To help students understand the harms that may occur when we buy medicines from street vendors, especially during pregnancy. • To provide insight into the poisonous nature of medicines when they are misused. • To show that it costs more to patronize street medicine vendors than to seek help early Women’s issues highlighted in the case: • Pregnancy increases women’s risk of using medicine. • Women depend on medicine information given to them by unqualified street medicine vendors. During pregnancy, use of medicines should be strictly monitored by qualified health personnel. • Street medicine vendors are usually more accessible to women (in terms of availability and affordability) than the regular health system. • Due to limited education, women may not be aware that the medicine they use might Women and Health Learning Package: Use of Medicines by Women Case Study: Echidime

Echidime (a 7-year-old girl) develops a severe headache late at night (about 2am). Her
mother feels it is malaria. She gives her some malaria tablets she has at home. Echidime takes
two tablets. When she doesn’t feel better by 3am, she takes another two tablets. Before 6am,
she has consumed ten tablets of chloroquine. She becomes unconscious and is rushed to the
nearest hospital.
Questions for students

1. Was it normal for Echidime’s mother to have attempted to help Echidime herself? 2. Is it appropriate to stock some tablets at home in case of emergency? 3. Should she have taken more or less of the medicine? 4. What do you think happened to her after taking ten tablets of chloroquine? 5. What would you have done if you were in her mother’s position? Women and Health Learning Package: Use of Medicines by Women Case Study: Echidime – Tutor’s Notes

Objectives:
• To highlight the important role of women as ‘family doctors’. • To help students understand the benefits and harms of stocking medicines at home. • To provide insight on the poisonous nature of medicines when they are misused. • To show that it costs more to patronize street medicine vendors than to seek help early Women’s issues highlighted in the case: • Women desperately try to help when a family member is ill, and it’s usually with the best of intentions. No wonder Echidime’s mother attempted to help her daughter. She perhaps should have tried non-drug options first. For example, she could have given her daughter some water. It was very risky for her to have used chloroquine inappropriately. • Women have some knowledge of medicine use (based on past experiences). It may be appropriate to stock first aid medicines at home in case of an emergency. Knowledge of how and when to use them is, however, extremely important. The amount of medicines to be taken is often dependent on age and other parameters, which are often indicated on the packet insert. It is very important to read or have someone read the leaflet to know the correct amount and at what time to use it. • Echidime’s mother may not have had the money to take her daughter to the hospital • Unpleasant past experiences with the hospital system may be a reason for not taking her child to the hospital initially. Due to limited education, she may not be aware that more medicines may not mean quick cure (hence, the reason while she gave her daughter additional tablets on hourly basis). • The burden of Echidime’s illness rested on her mother. Women and Health Learning Package: Use of Medicines by Women

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