Posted: Mar 31, 2011 10:23 AM ET


Trained nurses and midwives could provide early medical abortions as safely and effectively as doctors in developing countries, a study in Nepal finds.

Of the 22 million unsafe abortions each year, 98 per cent take place in developing countries, according to the World Health Organization.

Medical abortions using drugs are a safe and effective alternative to surgical abortions usually done by manual vacuum aspiration, WHO said. In many developing countries, only doctors are authorized to do either procedure, and they are often scarce.

To test whether government-trained, certified nurses and nurse midwives could provide medical abortions safely and effectively, researchers randomly assigned 535 Nepalese women seeking early abortion to a doctor and another 542 to the nurses and midwives.

Clinically, the results were similar, Dr. I.K. Warriner from the World Health Organization in Geneva and colleagues report in Thursday’s online issue of the medical journal The Lancet.

Abortions were performed by 96.1 per cent of the doctors and 97.3 per cent of the nurses and midwives, who are considered midlevel health-care providers.

No serious complications were found.

“In conclusion, nurses and auxiliary nurse midwives could have an important role in making life-saving abortion methods accessible to women living in remote areas of developing countries, as long as timely back-up manual vacuum aspiration is accessible if providers themselves are not trained in this technique,” the study’s authors concluded.

“Appropriately trained providers can administer safe, low-technology medical abortion services for women who might otherwise turn to unsafe abortion, exposing themselves to the risks of disabilities and death.”

Meeting maternal health goal

Using nurses and midwives is key to meeting the fifth UN Millennium Development Goal of providing safer care in pregnancy and reproductive health, Yap-Seng Chong from the National University of Singapore in Singapore and Eng-Kien Tan from The National University Hospital, in Singapore said in a journal commentary accompanying the study.

“Outcomes were remarkable, being similar or better than were results from other developed and developing countries, with less than 3 per cent incomplete abortions in either group and no serious complications. Warriner and co-workers have shown, unequivocally, that appropriately trained midlevel providers are able to do both surgical and medical abortions as competently as are doctors in relatively low-resource settings where the need is greatest,” the commentators wrote.

The commentary noted the nurses and midwives generally had more clinical experience than did the doctors in the study. But they said the imbalance in experience shouldn’t invalidate the findings since that’s often the real-world situation in developing countries.

In the study, male doctors made up 21 per cent of the physicians. All of the nurses and midwives were female. Two women recruited for the study chose not to participate when they learned they had been assigned to male doctors.

“For many routine but potentially life-saving medical services, the best health-care provider might not always be a doctor. Experience, commitment, training, and, most important, availability are often more crucial than is a medical qualification.”

Figures from Nepal’s health department suggest unsafe abortion is the third largest cause of maternal mortality in the country.