Combating the trafficking of counterfeit medicines is a source of continual trouble not just in Botswana but the African continent. In the Global Surveillance and Monitoring System for Substandard and Falsified Medical Products report prepared by the World Health Organisation (WHO), the health agency highlighted that constrained access to quality, safe and effective medical products creates a vacuum that is too often filled by substandard and falsified products.
“In some senses, growing concern about the quality of medicines is the result of the world’s partial, and still inequitable, success in increasing access to medical care. Far too many people in the world still have no access at all to basic health care,” states part of the report.
Perhaps this is why there is now a perfect condition for a thriving illegal market of pharmaceutical products in Botswana. While a sizeable number of women used to travel to South Africa pre Covid-19 to procure an abortion, the resultant border closures of the past few months attracted some nefarious organised criminals who are now illegally importing substandard and counterfeit medicines and trying to cash in on people’s desperation.
In Botswana, abortion is illegal and severely restricted. It is only allowed if the abortion will save the woman’s life, if the pregnancy gravely endangers the woman’s physical or mental health, or if the pregnancy is as a result of rape or incest. But so brazen are some of these unlicensed pharmaceutical dealers that they are now openly advertising their contraband on social media without fretting too much over law enforcement.
However the discovery that counterfeit versions of Cytotec drugs are being widely circulated in Gaborone has raised concerns that the lucrative industry now has a foothold in the country. These findings were also confirmed years ago in a review prepared by Stephanie S. Smith prepared entitled “Reproductive Health and the Question of Abortion in Botswana”. The review stated that “complications of unsafe, illegal abortions are a significant cause of maternal mortality in Botswana. The stigma attached to abortion leads some women to seek clandestine procedures, or alternatively, to carry the foetus to term and abandon the infant at birth.”
Cytotec is often used to induce labour and slow post-partum bleeding (the period just after delivery). However, it is increasingly being used for self-induced abortions in Botswana’s underground abortion market, especially first trimester abortions. The current Cytotec tablets being sold on the black market are reported to be sophisticated counterfeits, often having the appearance of the original product. This has added a new and complex dimension and placed heightened concern on Botswana’s underground abortion market.
One of the dealers who sells Cytotec tablets spoke to this publication and indicated that most Batswana women used to travel to South Africa pre Covid-19 to procure an abortion. However, Covid-19 and the resultant border closures have attracted some rogue dealers who are now illegally importing phony medicines. “Covid-19 has resulted in women tracking down local underground providers and this has caused a surge in demand,” says the woman who only identified herself as Kagiso. Although she is aware that her line of business is illegal, she gave a vague answer when we inquired if her contraband is genuine.
Another dealer who spoke to The Telegraph indicated that he sells authentic pills and is simply capitalising on an unmet need for safe, legal and accessible abortion in Botswana. “The pills I sell are original and are smuggled through the border from South Africa,” said the dealer who would not disclose his name for obvious reasons. This publication could not verify his insinuations as he chose to withhold information regarding his sources.
The World Health Organisation (WHO) which is the specialised agency of the United Nations (UN) responsible for international public health says in Africa the statistics are acute and stark. One in 10 medications sold in Africa are either fake or substandard. At the Indo-African health summit held a few years ago, it was revealed that most of the imported fake and substandard drugs sold in Africa originate from India, China, Pakistan and Indonesia. Apart from abortion pills other counterfeit drugs which are circulating across Botswana include anti-malaria pills, weight loss pills, Viagra and sexual performance drugs; some of which are now being produced locally. The African continent also accounts for between 40-45% of all counterfeit medical products.
At the onset of Covid-19, the Botswana Medicines Regulatory Authority (BOMRA) whose mandate is to ensure that all medicines and related substances used in Botswana are in conformity with established criteria of quality, safety and efficacy warned consumers to desist from buying unproven products which claim to treat diseases or cure serious illnesses. The regulatory authority warned that counterfeit drugs could lead to “delays in getting proper diagnosis and treatment of potentially serious diseases and conditions.”
Public health expert and Psychotherapist Dr. Atang Abraham says consumers should avoid buying any form of medication whose origins they do not know. “Using fake drugs could result in your system not responding to authentic drugs as a result of resistance induced by previous intake of counterfeit drugs,” she says.
But in a market hidden behind an excess of counterfeit drugs, the issue of abortion will remain a battleground in Botswana between pro-lifers and pro-choice campaigners.
