The role of auxiliary nurse-midwives and community health volunteers in expanding access to medical abortion in rural Nepal

Puri, Mahesh; Tamang, Anand; Shrestha, Prabhakar; Joshi, Deepak

doi:10.1016/s0968-8080(14)43784-4

Cited by 25 publications

(38 citation statements)

References 11 publications

(15 reference statements)

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“…3,23 Nevertheless, women continue to face barriers to obtaining such services, and illegal abortions continue to be performed by unapproved providers in potentially unsafe conditions. 6 In this study, our aim was to estimate total abortion incidence in Nepal as well as the number of illegal and potentially unsafe abortions that are performed.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, because the safety, efficacy and acceptability of medical abortion provided by trained auxiliary nurse-midwives (even at the sub–health post level) is now well established in Nepal, accrediting sub–health posts and staffing them with an auxiliary nurse-midwife trained in the provision of medical abortion could be an important step toward improving access to safe and legal abortion. 23,27 …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Abortion Incidence and Unintended Pregnancy in Nepal

Puri¹,

Singh²,

Sundaram³

et al. 2016

International Perspectives on Sexual and Reproductive Health

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CONTEXT Although abortion has been legal under broad criteria in Nepal since 2002, a significant proportion of women continue to obtain illegal, unsafe abortions, and no national estimates exist of the incidence of safe and unsafe abortions. METHODS Data were collected in 2014 from a nationally representative sample of 386 facilities that provide legal abortions or postabortion care and a survey of 134 health professionals knowledgeable about abortion service provision. Facility caseloads and indirect estimation techniques were used to calculate the national and regional incidence of legal and illegal abortion. National and regional levels of abortion complications and unintended pregnancy were also estimated. RESULTS In 2014, women in Nepal had 323,100 abortions, of which 137,000 were legal, and 63,200 women were treated for abortion complications. The abortion rate was 42 per 1,000 women aged 15–49, and the abortion ratio was 56 per 100 live births. The abortion rate in the Central region (59 per 1,000) was substantially higher than the national average. Overall, 50% of pregnancies were unintended, and the unintended pregnancy rate was 68 per 1,000 women of reproductive age. CONCLUSIONS Despite legalization of abortion and expansion of services in Nepal, unsafe abortion is still common and exacts a heavy toll on women. Programs and policies to reduce rates of unintended pregnancy and unsafe abortion, increase access to high-quality contraceptive care and expand safe abortion services are warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Abortion Incidence and Unintended Pregnancy in Nepal

Puri¹,

Singh²,

Sundaram³

et al. 2016

International Perspectives on Sexual and Reproductive Health

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show abstract

“…A systematic review of the safety and effectiveness of abortions performed by doctors compared to midlevel providers showed no statistical differences in incomplete abortion and complications for first trimester surgical and medical abortions (Ngo et al, 2013). Evidence from Nepal shows that midlevel abortion provision can be effective in reducing the levels of unsafe abortion (Puri, Tamang, Shrestha, & Joshi, 2015). The Zambian Standards and Guidelines (GRZ, 2009) makes provision for delivery of safe abortion services by midlevel providers.…”

Section: Discussionmentioning

confidence: 99%

Cost of abortions in Zambia: A comparison of safe abortion and post abortion care

Parmar

Leone

Coast

et al. 2015

Global Public Health

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Unsafe abortion is a significant but preventable cause of maternal mortality.Although induced abortion has been legal in Zambia since 1972, many women still face logistical, financial, social, and legal obstacles to access safe abortion services, and undergo unsafe abortion instead. This study provides the first estimates of costs of post abortion care (PAC) after an unsafe abortion and the cost of safe abortion in Zambia. In the absence of routinely collected data on abortions, we used multiple data sources: key informant interviews, medical records and hospital logbooks. We estimated the costs of providing safe abortion and PAC services at the University Teaching Hospital, Lusaka and then projected these costs to generate indicative cost estimates for Zambia. Due to unavailability of data on the actual number of safe abortions and PAC cases in Zambia, we used estimates from previous studies and from other similar countries, and checked the robustness of our estimates with sensitivity analyses. We found that PAC following an unsafe abortion can cost 2.5 times more than safe abortion care. The Zambian health system could save as much as US$0.4 million annually if those women currently treated for an unsafe abortion instead had a safe abortion.

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“…As per the national health policy of Nepal, all health care workers working below the district health office or district public health office such as primary health care centre (PHCC), health post (HP) and subhealth post (SHP) are known as primary level health care providers. [13][14][15] All three Primary Health Care Centers (PHCCs) and seven Health Posts (HPs) were included for the study whereas only 50% of the Sub Health Posts (SHPs) were randomly selected out of 77. From the selected health institutions all nurse midwives i.e.…”

Section: Methodsmentioning

confidence: 99%

Assessment of Critical Knowledge on Maternal and Newborn care Services among Primary Level Nurse Mid-wives in Kapilvastu District of Nepal

Acharya

Paudel

2017

Kathmandu Univ. Med. J.

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BackgroundDespite greater emphasis on maternal and neonatal health through policy and programming in Nepal, maternal and neonatal health is still not impressive. Health care providers' knowledge assessment on maternal and neonatal care has been well documented elsewhere, but it is very little understood in Nepal. ObjectiveThe primary objective of this study was to assess the critical knowledge of primary level nurse-midwives on maternal and newborn care in Kapilvastu District of Nepal. MethodThis was an Institution based cross-sectional study, conducted in Kapilvastu district, Nepal among sixty eight nurse-midwives. The participants were selected using simple random sampling technique. For collecting the data, health institutions were visited by enumerators for a month from 1 st October to 1 st November 2012. Data were entered into Microsoft Excel, cleaned and analyzed using SPSS version 17.0. Result More than 3/4th of the nurse-midwives had 10-20 years of experience. Majority of them (89.7%) had poor knowledge in taking action to prevent mother to child transmission for HIV positive women. More than half of them (54.4%) had some knowledge in performing the active management of third stage of labor whereas almost half (51.5%) had poor knowledge to actions needed on post-partum haemorrhage (PPH). Similarly, more than two third (69.1%) had poor knowledge in newborn care. ConclusionMajority of the nurse-midwives were found to have either poor or some level of knowledge in most of the components of maternal and newborn care services. So, greater emphasis should be given to upgrade the knowledge of nurse mid-wives. KEY WORDSKnowledge, maternal and newborn care services, nurse mid-wives

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The role of auxiliary nurse-midwives and community health volunteers in expanding access to medical abortion in rural Nepal

Cited by 25 publications

References 11 publications

Abortion Incidence and Unintended Pregnancy in Nepal

Abortion Incidence and Unintended Pregnancy in Nepal

Cost of abortions in Zambia: A comparison of safe abortion and post abortion care

Assessment of Critical Knowledge on Maternal and Newborn care Services among Primary Level Nurse Mid-wives in Kapilvastu District of Nepal

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