Nurses and midwives ‘could carry out early abortions’

The move could help save some of the estimated 47,000 women worldwide who die as a result of unsafe abortions, the study published in The Lancet said.

Early first-trimester medical abortions are currently underused in many developing countries due in part to only doctors being authorised to administer medical abortion services.

Nearly all (98%) of the 22 million unsafe abortions each year take place in developing countries.

However, utilising midwives and nurses could expand access to low-cost, life-saving abortion services in developing countries, where abortion is legally permitted and doctors are scarce.

Dr I K Warriner, from the World Health Organisation, and colleagues designed a trial in Nepal to establish whether medical abortions can be provided as safely and effectively by mid-level healthcare workers as doctors.

The clinical outcomes were similar, with 97.3% complete abortions performed by mid-level healthcare workers and 96.1% by doctors, with no serious complications recorded.

The report’s authors said: “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.”

• Warriner IK, et al. Can midlevel health-care providers administer early medical abortion as safely and effectively as doctors? A randomised controlled equivalence trial in Nepal. The Lancet 2011; Advance online publication

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