KUMJ | VOL. 9 | NO. 4 | ISSUE 36 | OCT-DEC, 2011

Increasing Access to Safe Abortion Services Through Auxiliary Nurse Midwives Trained as Skilled Birth Attendants
KC NP, Basnett I, Sharma SK, Bhusal CL, Parajuli RR, Andersen KL

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.