Feasibility of Expanding the Medication Abortion Provider Base in India to Include Ayurvedic Physicians and Nurses

Sj, Jejeebhoy; Kalyanwala, Shveta; Mundle, Shuchita; Tank, Jaydeep; Aj, Zavier; Kumar, Rajesh; Acharya, Rajib; Jha, Nisha

doi:10.1363/3813312

Cited by 30 publications

(40 citation statements)

References 11 publications

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“…One RCT included ANMs and nurses, one RCT included nurse‐midwives (NMWs), and a third RCT included nurses, all compared with doctors. The prospective cohort study from India reported on the provision of medical abortion by Ayurvedic doctors (non‐conventional therapies doctors in the Indian system of medicine) or nurses, compared with doctors . The results from one RCT comparing midwife treatment of incomplete miscarriage with treatment by doctors were reported in two publications, covering effectiveness and safety, and satisfaction and acceptability outcomes, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…The specific medical TOP or medical treatment of incomplete miscarriage regimens used differed across studies, but within each study all providers offered the same treatment regimens. Three RCTs, and one prospective cohort study, reported on treatment with combined mifepristone and misoprostol regimens for induced TOP with maximum gestational age of 63–70 days (mean 6.4–7.6 weeks of gestation). One RCT used 600 micrograms of oral misoprostol to treat incomplete miscarriage when uterine size was assessed to be below 12 weeks of gestation (mean 8.8 weeks of gestation) (Table ) .…”

Section: Resultsmentioning

confidence: 99%

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Effectiveness, safety, and acceptability of first‐trimester medical termination of pregnancy performed by non‐doctor providers: a systematic review

Sjöström

Fønhus

Ganatra

et al. 2017

BJOG

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BackgroundPrevious systematic reviews have concluded that medical termination of pregnancy (TOP) performed by non‐doctor providers may be as effective and safe as when provided by doctors. Medical treatment of incomplete miscarriage by non‐doctor providers and the treated women's acceptance of non‐doctor providers of TOP has not previously been reviewed.ObjectivesTo review the effectiveness, safety, and acceptability of first‐trimester medical TOP, including medical treatment for incomplete miscarriage, by trained non‐doctor providers.Search strategy and selection criteriaA search strategy using appropriate medical subject headings was developed. Electronic databases (PubMed, Popline, Cochrane, CINAHL, Embase, and ClinicalTrials.gov) were searched from inception through April 2016. Randomised controlled trials and comparative observational studies were included.Data collection and analysisMeta‐analyses were performed for included randomised controlled trials regarding the outcomes of effectiveness and acceptability to women. Certainty of evidence was established using the GRADE approach assessing study limitations, consistency of effect, imprecision, indirectness and publication bias.Main resultsSix papers were included. Medical TOP and medical treatment of incomplete miscarriage is probably equally effective when performed by non‐doctor providers as when performed by doctors (RR 1.00; 95% CI 0.99–1.01). Women's acceptance, reported as overall satisfaction with the allocated provider, is probably equally high between groups (RR 1.00; 95% CI 1.00–1.01).ConclusionMedical TOP and medical treatment of incomplete miscarriage provided by trained non‐doctor providers is probably equally as effective and acceptable to women as when provided by doctors.Tweetable abstractMedical termination of pregnancy performed by doctors and non‐doctors can be equally effective and acceptable

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Effectiveness, safety, and acceptability of first‐trimester medical termination of pregnancy performed by non‐doctor providers: a systematic review

Sjöström

Fønhus

Ganatra

et al. 2017

BJOG

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“…Several studies conclude that even though abortion providers discuss contraception with their patients, it is common for patients to refuse any form of contraception following an abortion 25 26. The quality of provider counselling and patient education is important for the successful integration of new hormonal methods of contraception into clinical practice 27.…”

Section: Discussionmentioning

confidence: 99%

Medical students’ knowledge, attitudes and perceptions towards contraceptive use and counselling: a cross-sectional survey in Maharashtra, India

et al. 2013

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Objectives This study aimed to investigate the knowledge, attitudes and perceptions towards contraceptive use and counselling among medical students in Maharashtra, India. Setting Considerable global maternal mortality and morbidity could be avoided through the use of effective contraception. In India, contraception services are frequently unavailable or there are obstacles to obtaining modern, reversible contraceptives. Participants A cross-sectional descriptive study using a self-administered questionnaire was conducted among 1996 medical students in their fifth year of study at 27 medical colleges in the state of Maharashtra, India. Descriptive and analytical statistics interpreted the survey instrument and significant results were presented with 95% CI. Results Respondents expressed a desire to provide contraceptive services. A few students had experienced training in abortion care. There were misconceptions about modern contraceptive methods and the impact of sex education. Attitudes towards contraception were mainly positive, premarital counselling was supported and the influence of traditional values and negative provider attitudes on services was recognised. Gender, area of upbringing and type of medical college did not change the results. Conclusions Despite mostly positive attitudes towards modern contraceptives, sex education and family planning counselling, medical students in Maharashtra have misconceptions about modern methods of contraception. Preservice and in-service training in contraceptive counselling should be implemented in order to increase women's access to evidence-based maternal healthcare services.

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“…Studies in India have shown that provision of medical abortion services by nurses and Ayurved physicians is equally safe, effective and acceptable to women as provided by certified MBBS physicians, 9 but there is little evidence about whether such provision is acceptable to a range of providers, from trained physicians to nurses and AYUSH physicians themselves. This paper contributes to this unexplored dimension.…”

Section: Discussionmentioning

confidence: 99%

Physicians’ and non-physicians’ views about provision of medical abortion by nurses and AYUSH physicians in Maharashtra and Bihar, India

Acharya

Kalyanwala²

2014

Reproductive Health Matters

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There is only limited evidence on whether certified and uncertified health care providers in India support reforming the Medical Termination of Pregnancy (MTP) Act to expand the abortion provider base to allow trained nurses and AYUSH physicians (who are trained in Indian systems of medicine) to provide medical abortion. To explore their views, we conducted a survey of 1,200 physicians and other health care providers in Maharashtra and Bihar states and in-depth interviews with 34 of them who had used medical abortion in their practices. Findings indicate that obstetrician-gynaecologists and other allopathic physicians were less supportive than non-physicians of nurses and AYUSH physicians providing early medical abortion. The physicians did not think that these providers would be able to assess women's eligibility for medical abortion correctly. In contrast, the majority of non-physicians found task shifting of medical abortion provision to trained nurses and AYUSH physicians acceptable, and they were confident that these providers would be able to provide medical abortion as safely and effectively as trained physicians. Assuming the reforms are passed, efforts will need to be made by government and medical professional bodies to train these new providers to undertake this role, prepare the health infrastructure to include them, and create an environment, including among physicians, that is conducive to enabling non-physicians to provide medical abortion.

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Feasibility of Expanding the Medication Abortion Provider Base in India to Include Ayurvedic Physicians and Nurses

Abstract: Findings support amending existing laws to improve women's access to medication abortion by expanding the provider base to include ayurvedic physicians and nurses.

Cited by 30 publications

References 11 publications

Effectiveness, safety, and acceptability of first‐trimester medical termination of pregnancy performed by non‐doctor providers: a systematic review

Effectiveness, safety, and acceptability of first‐trimester medical termination of pregnancy performed by non‐doctor providers: a systematic review

Medical students’ knowledge, attitudes and perceptions towards contraceptive use and counselling: a cross-sectional survey in Maharashtra, India

Physicians’ and non-physicians’ views about provision of medical abortion by nurses and AYUSH physicians in Maharashtra and Bihar, India

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