Road map to scaling-up: translating operations research study's results into actions for expanding medical abortion services in rural health facilities in Nepal.

Mahesh Puri,Shophika Regmi,Prabhakar Shrestha,Anand Tamang

doi:10.1186/1478-4505-12-24

Mahesh Puri, Shophika Regmi + Show 2 more

Open Access

https://doi.org/10.1186/1478-4505-12-24

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Abstract

BackgroundIdentifying unsafe abortion among the major causes of maternal deaths and respecting the rights to health of women, in 2002, the Nepali parliament liberalized abortion up to 12 weeks of pregnancy on request. However, enhancing women’s awareness on and access to safe and legal abortion services, particularly in rural areas, remains a challenge in Nepal despite a decade of the initiation of safe abortion services.MethodsBetween January 2011 and December 2012, an operations research study was carried out using quasi-experimental design to determine the effectiveness of engaging female community health volunteers, auxiliary nurse midwives, and nurses to provide medical abortion services from outreach health facilities to increase the accessibility and acceptability of women to medical abortion. This paper describes key components of the operations research study, key research findings, and follow-up actions that contributed to create a conducive environment and evidence in scaling up medical abortion services in rural areas of Nepal.ResultsIt was found that careful planning and implementation, continuous advocacy, and engagement of key stakeholders, including key government officials, from the planning stage of study is not only crucial for successful completion of the project but also instrumental for translating research results into action and policy change. While challenges remained at different levels, medical abortion services delivered by nurses and auxiliary nurse midwives working at rural outreach health facilities without oversight of physicians was perceived to be accessible, effective, and of good quality by the service providers and the women who received medical abortion services from these rural health facilities.ConclusionsThis research provided further evidence and a road-map for expanding medical abortion services to rural areas by mid-level service providers in minimum clinical settings without the oversight of physicians, thus reducing complications and deaths due to unsafe abortion.

Highlights

Identifying unsafe abortion among the major causes of maternal deaths and respecting the rights to health of women, in 2002, the Nepali parliament liberalized abortion up to 12 weeks of pregnancy on request
Medical abortion services were available from all 4 outreach health facilities selected for this study in the control area while this was not the case in the treatment area
This study showed that safe abortion services can be provided by trained nurses and auxiliary nurse midwives at the higher level health facilities where physician oversight is available, but to rural lower level health facilities where such support and oversight are not

Summary

Introduction

Identifying unsafe abortion among the major causes of maternal deaths and respecting the rights to health of women, in 2002, the Nepali parliament liberalized abortion up to 12 weeks of pregnancy on request. Unsafe abortion was found to be the third leading direct cause of maternal deaths in Nepal [5]. The identification of unsafe abortion among the major causes of maternal deaths, along with the emergence of national and international women’s rights movements and active coordination of and support from local non-government organizations, civil societies, and public sectors to ensure safe motherhood and rights of women [6], in 14 March 2002 and under the 11th amendment to the Country Code, the Nepali parliament approved legalization of abortion after nearly three decades of the reform efforts [7]. Abortion is permitted on request up to 12 weeks of pregnancy for any reason, up to 18 weeks of pregnancy in the case of rape or incest, and up to any gestation in case of risk to the woman’s health and life or if the fetus is deformed or incompatible with life [11]

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