Effectiveness, safety, and acceptability of first‐trimester medical termination of pregnancy performed by non‐doctor providers: a systematic review

Abstract

BackgroundPrevious systematic reviews have concluded that medical termination of pregnancy (TOP) performed by non‐doctor providers may be as effective and safe as when provided by doctors. Medical treatment of incomplete miscarriage by non‐doctor providers and the treated women's acceptance of non‐doctor providers of TOP has not previously been reviewed.ObjectivesTo review the effectiveness, safety, and acceptability of first‐trimester medical TOP, including medical treatment for incomplete miscarriage, by trained non‐doctor providers.Search strategy and selection criteriaA search strategy using appropriate medical subject headings was developed. Electronic databases (PubMed, Popline, Cochrane, CINAHL, Embase, and ClinicalTrials.gov) were searched from inception through April 2016. Randomised controlled trials and comparative observational studies were included.Data collection and analysisMeta‐analyses were performed for included randomised controlled trials regarding the outcomes of effectiveness and acceptability to women. Certainty of evidence was established using the GRADE approach assessing study limitations, consistency of effect, imprecision, indirectness and publication bias.Main resultsSix papers were included. Medical TOP and medical treatment of incomplete miscarriage is probably equally effective when performed by non‐doctor providers as when performed by doctors (RR 1.00; 95% CI 0.99–1.01). Women's acceptance, reported as overall satisfaction with the allocated provider, is probably equally high between groups (RR 1.00; 95% CI 1.00–1.01).ConclusionMedical TOP and medical treatment of incomplete miscarriage provided by trained non‐doctor providers is probably equally as effective and acceptable to women as when provided by doctors.Tweetable abstractMedical termination of pregnancy performed by doctors and non‐doctors can be equally effective and acceptable

Development of medical termination of pregnancy: a review

“…This is true in both low‐ and high‐income settings and where the ultrasound dating of gestational age is part of the protocol. This approach has been found to be well accepted and cost‐effective in the high‐income setting of Sweden …”

“…A recent systematic review showed that MTOP provided by trained non-doctors healthcare providers is as effective and as acceptable to women when compared with that provided by doctors. 33 Therefore, in countries where there is a shortage of medical staff, the MTOP service can be provided by trained midlevel non-doctors, thus making safe TOP more accessible to women. This is true in both lowand high-income settings and where the ultrasound dating of gestational age is part of the protocol.…”

“…This approach has been found to be well accepted and cost-effective in the high-income setting of Sweden. 33,34 Over the last decade there has been a move to simplify the regimen of MTOP. The first step is to give the women the misoprostol tablets to be administered by herself at home.…”

Medical termination of pregnancy service delivery in the context of decentralization: social and structural influences

“…Unsafe abortion results in preventable morbidity and mortality; in women of childbearing age 22,800 deaths worldwide are estimated to occur annually [ 1 ]. An important reproductive health service, medical termination of pregnancy (MToP) is an acceptable and safe option for women seeking abortion in the first and second trimesters of pregnancy [ 2 , 3 ].…”

WHO essential medicines for reproductive health

“…WHO guidelines recommend that they can be provided at primary care level and by non-physician providers. Specialised investigations are not needed and the process can be managed outside of a facility and without the direct supervision of the provider 8–15. Service delivery with limited medical supervision can improve privacy, convenience and acceptability of the abortion process without compromising safety and effectiveness.…”