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

Abstract

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

The role of nurses and midwives in the provision of abortion care: A scoping review

“…Under‐resourced countries, such as Nepal, Bangladesh, Myanmar and Uganda, pragmatically extend the scope of nurses and midwives, as well as incorporate other auxiliary health professionals (such as auxiliary nurses and female paramedics) to provide abortion or postabortion care (Andersen et al, 2016; Cleeve et al, 2019; K C et al, 2011; Puri et al, 2015). Nonetheless, in some under‐resourced settings, such as areas of Uganda, midwives were forced to practice outside of their extended scope, with improvised equipment (Paul et al, 2014), in inadequate facilities and for low pay (Cleeve et al, 2019).…”

Prevalence and factors associated with abortion and unsafe abortion in Nepal: a nationwide cross-sectional study

“…Our study corroborates the findings of other studies, which have reported a higher rate of abortion among younger age groups [ 23 , 24 ]. Earlier study from Nepal reported that the rate of medical abortion is higher in younger age groups than among older women [ 25 ]. Our study contradicts the finding of some earlier studies, which have reported older age coincides with higher rates of abortion [ 16 , 17 , 26 ].…”

Determination of medical abortion eligibility by women and community health volunteers in Nepal: A toolkit evaluation

“…Based on strong clinical evidence, recognition of the need to improve access, and political support to do so, provision of MA up to 63 days gestation has already expanded in Nepal from doctors to nurses and auxiliary nurse midwives trained as birth attendants [ 19 , 20 ][ 19 , 20 ][ 19 , 20 ]. To explore the feasibility and safety of further expanding MA services to the community level, we evaluated the ability of literate women, and a cadre of minimally trained female community health volunteers (FCHVs) in Nepal to independently assess women’s eligibility for MA, based on: (1) determination of pregnancy duration using a gestational dating wheel, and (2) screening for MA drug contraindications using a checklist.…”