Establishing Second Trimester Abortion Services: Experiences in Nepal, Viet Nam and South Africa

Hyman, Alyson; Baird, Traci L.; Basnett, Indira

doi:10.1016/s0968-8080(08)31387-1

Cited by 5 publications

(15 citation statements)

References 4 publications

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“…It provided clinical standards for dilatation and evacuation and medical induction abortion and specified facility eligibility requirements (namely, hospitals with emergency obstetric care services). The MOHP's formal endorsement of the plan in April 2007 led to implementation of second-trimester services [16]. …”

Section: Introductionmentioning

confidence: 99%

“…Later, after successful pilot studies [16,21-27], training strategies and curricula were revised to include nurses and auxiliary nurse midwives and to incorporate medical and second-trimester abortion [28]. After its introduction in 2009, medical abortion coverage rapidly increased, eventually eclipsing the rate of MVA scale-up; establishment of MA services has been particularly successful in peripheral facilities, with 50% of primary health centers now having a listed provider for MA.…”

Section: Introductionmentioning

confidence: 99%

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Implementation of legal abortion in Nepal: a model for rapid scale-up of high-quality care

Samandari¹,

Wolf²,

Basnett³

et al. 2012

Reprod Health

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113

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Unsafe abortion's significant contribution to maternal mortality and morbidity was a critical factor leading to liberalization of Nepal's restrictive abortion law in 2002. Careful, comprehensive planning among a range of multisectoral stakeholders, led by Nepal's Ministry of Health and Population, enabled the country subsequently to introduce and scale up safe abortion services in a remarkably short timeframe. This paper examines factors that contributed to rapid, successful implementation of legal abortion in this mountainous republic, including deliberate attention to the key areas of policy, health system capacity, equipment and supplies, and information dissemination. Important elements of this successful model of scaling up safe legal abortion include: the pre-existence of postabortion care services, through which health-care providers were already familiar with the main clinical technique for safe abortion; government leadership in coordinating complementary contributions from a wide range of public- and private-sector actors; reliance on public-health evidence in formulating policies governing abortion provision, which led to the embrace of medical abortion and authorization of midlevel providers as key strategies for decentralizing care; and integration of abortion care into existing Safe Motherhood and the broader health system. While challenges remain in ensuring that all Nepali women can readily exercise their legal right to early pregnancy termination, the national safe abortion program has already yielded strong positive results. Nepal's experience making high-quality abortion care widely accessible in a short period of time offers important lessons for other countries seeking to reduce maternal mortality and morbidity from unsafe abortion and to achieve Millennium Development Goals.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Implementation of legal abortion in Nepal: a model for rapid scale-up of high-quality care

Samandari¹,

Wolf²,

Basnett³

et al. 2012

Reprod Health

Self Cite

113

View full text Add to dashboard Cite

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“…In South Africa, Ethiopia and Nepal, some specialist and non-specialist doctors, facility managers and other health workers were reported as feeling uncomfortable with the provision of second-trimester abortions [ 21 , 47 , 48 ], often because they found it traumatic to deal with the foetus [ 12 , 21 , 24 ]. In one South African report, midwives involved in second-trimester medical abortions described feeling emotionally unprepared and alone as they were often left unsupported after the doctor had prescribed the drug [ 39 ].…”

Section: Resultsmentioning

confidence: 99%

“…In Ethiopia, midwives or nurses taking care of the expelled foetus and the mother were typically accompanied by another health worker or other member of staff, including cleaning staff [ 12 ]. Based on challenges with the implementation of second-trimester abortion services experienced in other countries, programme planners in Nepal intentionally delayed the introduction of second-trimester abortion services, both to ensure that providers had good first-trimester abortion skills, and to prepare providers and garner support for second-trimester services, for instance through values clarification workshops (see below) [ 6 , 47 , 49 ]. They also used staff rotation to avoid burnout because of the emotional burden related to second-trimester abortions [ 47 ].…”

Section: Resultsmentioning

confidence: 99%

“…These workshops aimed to educate participants about current abortion legislation; allow them to clarify their values and attitudes; encourage change in their attitudes and behaviour towards women seeking an abortion; and ultimately achieve support for the provision of abortion services [ 20 , 21 , 26 , 49 ]. Participants suggested that these workshops had been useful in giving them a better understanding of abortion [ 23 ] and helped them to acknowledge clients’ rights and needs [ 47 ]; assisting those opposed to abortion in “viewing things differently” [ 21 ], and helping them to feel comfortable when talking about abortion [ 12 ]. However, one report from South Africa pointed out that these workshops were not mandatory and there seemed to be little done to encourage attendance [ 21 ].…”

Section: Resultsmentioning

confidence: 99%

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Implementation considerations when expanding health worker roles to include safe abortion care: a five-country case study synthesis

et al. 2017

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BackgroundAllowing a broader range of trained health workers to deliver services can be an important way of improving access to safe abortion care. However, the expansion of health worker roles may be challenging to implement. This study aimed to explore factors influencing the implementation of role expansion strategies for non-physician providers to include the delivery of abortion care.MethodsWe conducted a multi-country case study synthesis in Bangladesh, Ethiopia, Nepal, South Africa and Uruguay, where the roles of non-physician providers have been formally expanded to include the provision of abortion care. We searched for documentation from each country related to non-physician providers, abortion care services and role expansion through general internet searches, Google Scholar and PubMed, and gathered feedback from 12 key informants. We carried out a thematic analysis of the data, drawing on categories from the SURE Framework of factors affecting the implementation of policy options.ResultsSeveral factors appeared to affect the successful implementation of including non-physician providers to provide abortion care services. These included health workers’ knowledge about abortion legislation and services; and health workers’ willingness to provide abortion care. Health workers’ willingness appeared to be influenced by their personal views about abortion, the method of abortion and stage of pregnancy and their perceptions of their professional roles. While managers’ and co-workers’ attitudes towards the use of non-physician providers varied, the synthesis suggests that female clients focused less on the type of health worker and more on factors such as trust, privacy, cost, and closeness to home. Health systems factors also played a role, including workloads and incentives, training, supervision and support, supplies, referral systems, and monitoring and evaluation. Strategies used, with varying success, to address some of these issues in the study countries included values clarification workshops, health worker rotation, access to emotional support for health workers, the incorporation of abortion care services into pre-service curricula, and in-service training strategies.ConclusionsTo increase the likelihood of success for role expansion strategies in the area of safe abortion, programme planners must consider how to ensure motivation, support and reasonable working conditions for affected health workers.Electronic supplementary materialThe online version of this article (10.1186/s12889-017-4764-z) contains supplementary material, which is available to authorized users.

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Abortion Care Beyond 13 Weeks’ Gestation: A Global Perspective

Cohen

Kapp²,

Edelman

2021

Clinical Obstetrics &Amp; Gynecology

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The majority of abortions are performed early in pregnancy, but later abortion accounts for a large proportion of abortion-related morbidity and mortality. People who need this care are often the most vulnerablethe poor, the young, those who experience violence, and those with significant health issues. In settings with access to safe care, studies demonstrate significant declines in abortion-related morbidity and mortality. This review focuses on evidence-based practices for induced abortion beyond 13 weeks' gestation and post-abortion care in both high-and low-resource settings. We also highlight key programmatic issues to consider when expanding the gestational age for abortion services.

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Establishing Second Trimester Abortion Services: Experiences in Nepal, Viet Nam and South Africa

Cited by 5 publications

References 4 publications

Implementation of legal abortion in Nepal: a model for rapid scale-up of high-quality care

Implementation of legal abortion in Nepal: a model for rapid scale-up of high-quality care

Implementation considerations when expanding health worker roles to include safe abortion care: a five-country case study synthesis

Abortion Care Beyond 13 Weeks’ Gestation: A Global Perspective

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