Nurse versus physician-provision of early medical abortion in Mexico: a randomized controlled non-inferiority trial

Abstract

Objective: To examine the effectiveness, safety, and acceptability of nurse provision of early medical abortion compared to physicians at three facilities in Mexico City.

Methods: We conducted a randomized non-inferiority trial on the provision of medical abortion and contraceptive counselling by physicians or nurses. The participants were pregnant women seeking abortion at a gestational duration of 70 days or less. The medical abortion regimen was 200 mg of oral mifepristone taken on-site followed by 800 µg of misoprostol self-administered buccally at home 24 hours later. Women were instructed to return to the clinic for follow-up 7-15 days later. We did an intention-to-treat analysis for risk differences between physicians' and nurses' provision for completion and the need for surgical intervention.

Findings: Of 1017 eligible women, 884 women were included in the intention-to-treat analysis, 450 in the physician-provision arm and 434 in the nurse-provision arm. Women who completed medical abortion, without the need for surgical intervention, were 98.4% (443/450) for physicians' provision and 97.9% (425/434) for nurses' provision. The risk difference between the group was 0.5% (95% confidence interval, CI: -1.2% to 2.3%). There were no differences between providers for examined gestational duration or women's contraceptive method uptake. Both types of providers were rated by the women as highly acceptable.

Conclusion: Nurses' provision of medical abortion is as safe, acceptable and effective as provision by physicians in this setting. Authorizing nurses to provide medical abortion can help to meet the demand for safe abortion services.

Comment: To lower the threshold for women to have a medical abortion, to shift tasks to the lowest possible level and to free up time for doctors, it appears perfectly acceptable for nurses to provide safe abortion. (HMV)