PLoS One. 2018 Jan 19;13(1):
Effectiveness and safety of early medication abortion provided in pharmacies by auxiliary nurse-midwives: A non-inferiority study in Nepal
Rocca CH, Puri M, Shrestha P, Blum M, Maharjan D, Grossman D, Regmi K, Darney PD and Harper CC
Abstract
Background: Expanding access to medication abortion through pharmacies is a promising avenue to reach women with safe and convenient care, yet no pharmacy provision interventions have been evaluated. This observational non-inferiority study investigated the effectiveness and safety of mifepristone-misoprostol medication abortion provided at pharmacies, compared to government-certified public health facilities, by trained auxiliary nurse-midwives in Nepal.
Methods: Auxiliary nurse-midwives were trained to provide medication abortion through twelve pharmacies and public facilities as part of a demonstration project in two districts. Eligible women were =63 days pregnant, aged 16-45, and had no medical contraindications. Between 2014-2015, participants (n = 605) obtained 200 mg mifepristone orally and 800 μg misoprostol sublingually or intravaginally 24 hours later, and followed-up 14-21 days later. The primary outcome was complete abortion without manual vacuum aspiration; the secondary outcome was complication requiring treatment. We assessed risk differences by facility type with multivariable logistic mixed-effects regression.
Results: Over 99% of enrolled women completed follow-up (n = 600). Complete abortions occurred in 588 (98•0%) cases, with ten incomplete abortions and two continuing pregnancies. 293/297 (98•7%) pharmacy participants and 295/303 (97•4%) public facility participants had complete abortions, with an adjusted risk difference falling within the pre-specified 5 percentage-point non-inferiority margin (1•5% [-0•8%, 3•8%]). No serious adverse events occurred. Five (1.7%) pharmacy and two (0.7%) public facility participants experienced a complication warranting treatment (aRD, 0.8% [-1.0%-2.7%]).
Conclusions: Early mifepristone-misoprostol abortion was as effective and safe when provided by trained auxiliary nurse-midwives at pharmacies as at government-certified health facilities. Findings support policy expanding provision through registered pharmacies by trained auxiliary nurse-midwives to improve access to safe care.
Comment: This is the last one of this set of abstracts about providing safe medical abortion products through health care workers, who are not necessarily doctors. Here from Nepal: well trained nurses/midwives do the same good job in providing safe medical abortion care as other health professionals. (HMV)
