Comparative satisfaction of receiving medical abortion service from nurses and auxiliary nurse-midwives or doctors in Nepal: results of a randomized trial

Anand Tamang, Iqbal H Shah, Pragya Shrestha, I K Warriner, Duolao Wang, Kusum Thapa, N T My Huong, Olav Meirik, Anand Tamang, Iqbal H Shah, Pragya Shrestha, I K Warriner, Duolao Wang, Kusum Thapa, N T My Huong, Olav Meirik

Abstract

Background: Early first-trimester medical abortion (MA) service (≤ 63 days) has been provided by doctors and nurses under doctors' supervision since 2009 in Nepal. This paper assesses whether MA services provided by specifically trained and certified nurses and auxiliary nurse-midwives independently from doctors' supervision, is considered as satisfactory by women as those provided by doctors.

Methods: The data come from a multi-center, randomized, controlled equivalence trial conducted between April 2009 and March 2010 in five district hospitals in Nepal. Women seeking MA were randomly assigned to doctors or nurses and auxiliary nurse-midwives(ANMs).Eligible women were administered 200 mg mifepristone orally followed by 800 μg misoprostol vaginally two days later by their assigned providers and followed up 10-14 days later. At the follow-up visit women's reported satisfaction with MA service they received was measured.

Results: Of 1295 women screened for eligibility, 535 were randomly assigned to a doctor and 542 to a nurse or ANM. Nineteen women were lost-to-follow up in the former group and 27 were lost-to-follow up or did not complete the acceptability interview in the latter group. This study is, therefore, based on516womenin the doctor's group and 515 women in the nurse or ANM group. All women in the nurse or ANM group reported being satisfied or highly satisfied by MA compared to 99% in the doctor's group. Satisfaction was similar regardless of the type of provider; 38% among nurse or ANM and 35% among the doctor group were "highly satisfied", and 62% and 64%, respectively, were "satisfied". Women's experiences such as 'less than expected amount or duration of bleeding following MA', 'shorter than expected duration of the abortion process', and 'able to manage symptoms', were found to be associated with women's higher satisfaction with MA. Counseling and information on the method, potential complications of MA and post-abortion contraception was nearly universal. No statistically significant differences were found in the level of satisfaction by age, parity, marital status, education or occupation of women.

Conclusions: Women's satisfaction with MA service provided by trained nurses or auxiliary nurse-midwives was similar to that provided by doctors. The findings, therefore, provide support for extending safe and accessible medical abortion services by government-trained nurses and auxiliary nurse midwives to women seeking early first trimester pregnancy termination.

Trial registration: The trial was retrospectively registered with ClinicalTrials.gov (identifier: NCT01186302 ). Registered August 20, 2010.

Keywords: Auxiliary nurse-midwives; Doctors; Medical abortion; Nepal; Nurses; Satisfaction.

Conflict of interest statement

Competing interest

The authors declare that they have no competing interests.

Ethics approval and consent to participate

The study was developed and coordinated by the UNDP/UNFPA/WHO/World Bank Special Programme of Research Development and Research Training in Human Reproduction (HRP) at the World Health Organization (WHO), Geneva, Switzerland. A coordinating centre was established at the Centre for Research on Environment Health and Population Activities (CREHPA) in Kathmandu, Nepal. The study was reviewed and approved by the Scientific and Ethical Review Group of the Reproductive Health and Research Department (RHR) and the Research Ethics Review Committee of WHO in Geneva, Switzerland, and the National Health Research Council (NHRC) of Nepal. All study participants, both women and providers, gave written informed consent to participate in the study.

Consent for publication

Not applicable as no individual data in any form are presented here.

Consent for publication of this manuscript has been provided by all co-authors.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Proximate determinates of satisfaction with medical abortion method

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Source: PubMed

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