Abortion Care Services Provided by Registered Midwives in South Africa

Dickson-Tetteh, Kim; Billings, Deborah L.

doi:10.2307/3088257

Cited by 34 publications

(22 citation statements)

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“…The advantages of provision of PAC services at the primary level by trained midwives were demonstrated in Ghana (14). In a South African evaluation, midwives were documented as effective providers of abortion care services (15). A pilot project in Uganda to train midwives resulted in treatment of PAC patients at primary health centers and regional and district hospitals (16,17).…”

Section: Unanswered Questions and Knowledge Gapsmentioning

confidence: 99%

How research can affect policy and programme advocacy: example from a three-country study on abortion complications in sub-Saharan Africa

Kinoti¹,

Gaffikin²,

Benson³

2004

E Af Med Jrnl

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Objective: To provide a basis for continued policy dialogue and reform to address the problem of death due to abortion complications among the ECSA Health Community countries. The anticipated short-term outcome of this study was increased awareness among African health officials about the problem of incomplete abortion in SSA, especially CRHCS/ECSA countries. Design: The study undertaken in 1993/1994, involved primary data collection of abortionrelated morbidity and mortality statistics, the cost of treating patients with abortion complications and provider and abortion patient perspectives. Data were collected via one on one interviews and reviews of logbook data. A computerized literature review on abortion in the region covering the years 1980-1994 complemented the primary data collection. Study Setting: Primary data collection was conducted in three countries (Zambia, Uganda and Malawi) at selected districts and tertiary care hospitals. Subjects: Nurses and physicians providing care to women with complications of abortion in participating hospitals were interviewed as well as hospital administrators. Women receiving care in the selected hospitals during the data collection period also were interviewed. Main outcome measures: This analysis focused on cross-country comparisons of nurse and doctor attitudes and knowledge about abortion and family planning-related issues. Interventions: At a 1994 CHRCS conference, Health Ministers from 12 Commonwealth countries reviewed and endorsed the results of this study. In a 1995 ECSA Director Joint Consultative Committee meeting, participants discussed the study findings and developed regional action plans which were subsequently endorsed by the Health Ministers' at their 1995 annual conference. Results: Abortion complication patients in the three countries were on average 24-26 years old with two children. Patients experienced long hospital stays while receiving care for complications. The average monthly number of post-abortion patients was substantially higher in urban facilities as compared to mixed/rural ones. Opinions regarding factors that led to the abortion, access to abortion services and the legal provisions surrounding abortion were inconsistent between doctors and nurses. Patients were aware that complications of abortion were a major cause of maternal mortality. Overall, provider opinion about access to family planning (FP) information among abortion complication patients was also inconsistent between doctors and nurses but there was agreement on factors influencing use of FP. Opinions regarding access to FP services both before and after the abortion varied from easy to very difficult to obtain. Conclusions: These data represent the situation as it was in the region some years ago and the paper describes important implications of the findings for policy and programme development. This research provided some impetus for stakeholders in these countries to put safe abortion and management of abortion complications on their health agenda. Ensuring that ...

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Section: Unanswered Questions and Knowledge Gapsmentioning

confidence: 99%

How research can affect policy and programme advocacy: example from a three-country study on abortion complications in sub-Saharan Africa

Kinoti¹,

Gaffikin²,

Benson³

2004

E Af Med Jrnl

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“…6 The technical and clinical interventions needed to provide safe, accessible and high quality abortion and menstrual regulation services are well known and include using vacuum aspiration or medication abortion instead of dilation and curettage for uterine evacuation; providing services in outpatient facilities, rather than in operating theaters; having midlevel providers instead of specialists provide care; and providing contraceptive counseling and services. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Each of these interventions has been shown to reduce the cost of care at the individual, facility or health system levels. 9,12,15,[17][18][19][20][21] Despite the advantages of these interventions in terms of safety and cost, they are often not implemented or are used inconsistently, preventing measurement of costs of services at facility or health system levels.…”

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confidence: 99%

Health System Costs of Menstrual Regulation and Care For Abortion Complications in Bangladesh

Johnston

Oliveras²,

Akhter³

et al. 2010

IPSRH

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Abortion-related mortality and morbidity result in significant health system costs. Approximately 42 million induced abortions occur around the world each year, 1 of which an estimated 22 million are conducted under unsafe conditions-that is, by an unqualified provider, in unsanitary conditions or both. 2 At least 65,000 women die annually from complications of unsafe abortion, and close to five million suffer temporary or permanent disability. 3 A recent analysis suggests that in Africa and Latin America, the annual cost of caring for women with complications of unsafe abortion ranges from US$159 million to US$333 million. 4 According to studies from a number of countries where the incidence of unsafe abortion is high, treatment of abortion complications can account for as much as 50% of hospital budgets for obstetrics and gynecology. 5 Abortion-related mortality and morbidity-and their associated health system costs-can largely be avoided through the prevention of unwanted pregnancy and through the provision of safe abortion services and menstrual regulation. 6 The technical and clinical interventions needed to provide safe, accessible and high quality abortion and menstrual regulation services are well known and include using vacuum aspiration or medication abortion instead of dilation and curettage for uterine evacuation; providing services in outpatient facilities, rather than in operating theaters; having midlevel providers instead of specialists provide care; and providing contraceptive counseling and services. 7-21 Each of these interventions has been shown to reduce the cost of care at the individual, facility or health system levels. 9,12,15,[17][18][19][20][21] Despite the advantages of these interventions in terms of safety and cost, they are often not implemented or are used inconsistently, preventing measurement of costs of services at facility or health system levels.Savings-an abortion-oriented costing spreadsheet-was developed by Ipas to generate estimates of the costs of different strategies of providing abortion care. The initial application of the Savings model used published data primarily from Uganda; 22 however, because the abortion law in Uganda is restrictive, some data from other African countries were used to project costs of providing safe and legal abortion-related care. Results suggest that use of recommended technical interventions would substantially reduce costs of providing abortion care.In Bangladesh, the abortion law is also restrictive; however, menstrual regulation-defined as the evacuation of the uterus of a woman at risk of being pregnant to ensure a state of nonpregnancy-is provided by the government as a backup to contraception for women up to 10 weeks from the beginning of their last menstrual period. The procedure is sanctioned by the government and available at all levels of the public health care system. The Bangladesh menstrual regulation program has had many of the recommended best practices for abortion- Health System Costs of Menstrual Regulation and Care For Ab...

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“…12 In South Africa, it was found that midwives can provide high-quality abortion services in the absence of physicians. 9 Similarly, early abortion provided by female welfare volunteers without formal midwifery training was found to be safe in Bangladesh. 14 Warriner, et al performed a randomized, controlled trial comparing rates of abortion complications among women who were treated by government-trained mid-level providers versus physicians in South Africa and Vietnam.…”

Section: Discussionmentioning

confidence: 99%

“…Based on international evidence about the safety and efficacy of medical abortion Original Article in the absence of physicians. 9 In Nepal, a randomized equivalence study by WHO in five district hospitals in [2009][2010], showed that appropriately trained auxiliary nurse midwives (ANMs) could provide safe, effective MA services independent of doctors. 10 In 2010, FHD and Ipas, initiated implementation research as a pilot project to test the feasibility of having ANMs, who had received skilled birth attendant (SBA) training, deliver MA services at PHCs and health posts (HPs).…”

Section: Introductionmentioning

confidence: 99%

Increasing Access to Safe Abortion Services Through Auxiliary Nurse Midwives Trained as Skilled Birth Attendants

Basnett²,

Sharma³

et al. 2012

Kathmandu Univ. Med. J.

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Background The use of medical abortion methods was approved by Department of Health Services in 2009 and introduced in hospitals and a few primary health centres (PHCs). Access would increase if services were available at health post level and provided by auxiliary nurse midwives trained as skilled birth attendants. Evidence from South Africa, Bangladesh, Nepal and Vietnam show that mid-level health workers can provide medical abortion safely. Objectives To determine the best way to implement the new strategies of medical abortion into the existing health system of Nepal; and to facilitateits full-scale implementation, monitoring and evaluation. Methods An implementation research involving a baseline study, implementation phase and end line study was done in ten districts covering five development regions from July 2010 to June 2011. Both qualitative and quantitative methods were used. Results Of 1,799 medical abortion clients who received service, 46% were disadvantaged Janjati, 14% were Dalit, 42% were upper caste groups and rest were advantaged Janjati (7%), Muslim (1%) and others. 14% were referred by female community health volunteers and 56% were referred by others. Complication rate of 0.3% was well below acceptable levels. Condom use increased from 8% to 28% by the end of study. Use of Pills, Depo, intra uterine devices and Implants also increased, but use of long acting family planning methods was negligible. Conclusions This model should be replicated nationwide at health posts and sub-health posts where auxiliary nurse milwifes are available 24 hours/day. Focus should be given first to those areas where access is difficult, time consuming and costly.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6341 Kathmandu Univ Med J 2011;9(4):260-66

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Abortion Care Services Provided by Registered Midwives in South Africa

Cited by 34 publications

References 0 publications

How research can affect policy and programme advocacy: example from a three-country study on abortion complications in sub-Saharan Africa

How research can affect policy and programme advocacy: example from a three-country study on abortion complications in sub-Saharan Africa

Health System Costs of Menstrual Regulation and Care For Abortion Complications in Bangladesh

Increasing Access to Safe Abortion Services Through Auxiliary Nurse Midwives Trained as Skilled Birth Attendants

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