In most countries where abortion is legal on request, only doctors are authorised to do first-trimester abortions. In areas where abortion is legal and doctors are scarce, access to safe abortion services can therefore be limited. To address this problem some countries have trained mid-level providers (MLPs) - health-care providers that are not doctors. However, until now there has been no comparison of trained MLP- and doctor-performed first-trimester abortions in developing countries.
Ina Warriner (World Health Organization) and colleagues compared rates of complications in first-trimester manual vacuum aspiration abortions done by doctors and MLPs in South Africa and Vietnam. 1734 consenting women in Vietnam and 1160 in South Africa were randomly assigned to a doctor or an MLP for their abortion. The investigators found that overall complication rates were low. In South Africa the rate of complications was 1.4 per 100 women for the MLPs and 0 for doctors. In Vietnam, the rate was 1.2 per 100 women for MLPs and the same for doctors. In both countries, rates of complications fell within a predetermined statistical margin for equivalence - meaning MLP- and doctor-performed abortions are equally safe. Women reported equal satisfaction, as measured by pain management, clarity of explanation, and opportunity to ask questions before, during, and after the procedure.
The authors conclude: "The provision of first-trimester manual vacuum aspiration abortion by trained and accredited MLPs at the primary-care level provides women with more accessible and less costly means of safely terminating unintended pregnancies, freeing doctors for more complicated procedures."
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See also accompanying Online/Comment.
Contact: Christopher Powell
Contact: Joe Santangelo