Auxiliary Midwives Research Articles

Auxiliary midwife prescription of oral contraceptives: An experimental project in Thailand

In 1969, the Thai Ministry of Public Health initiated a study in which auxiliary midwives in 4 rural provinces were allowed to prescribe oral contraceptives without the requirement of a physician examination. A simple checklist was utilized to rule out contraindications; pelvic examination was not required. There was no increase noted in the incidence of either side effects or complications. There was a fourfold increase in the number of pill acceptors in the 4 study provinces in the 6 months following initiation of the study, as compared to the 6 months before. In these provinces, this resulted in both a larger number of pill acceptors and a higher percentage of the eligible female population who accepted the pill than in the 13 control provinces, in spite of the much larger number of eligible women, health personnel, and facilities in the control provinces. In addition, the continuation rates were higher for pills prescribed by midwives than for those prescribed by physicians. At the end of one year of study, the Ministry of Public Health ruled that the more than 3,000 auxiliary midwives throughout the country who had received basic family planning training could prescribe the pill, with a resultant threefold increase in the number of pill acceptors nationwide, from approximately 8,800 in April 1970, to almost 31,000 in December 1971. The importance of the effective use of nurses and other paraprofessional personnel in family planning programs is emphasized.

Thailand: Family Planning Activities 1968 to 1970

Thailands family planning program administered through the Ministry of Public Health between 1968 and 1970 was initiated without official government approval or public information campaign but simply added to the health service clinics. 412958 acceptors participated in the program over the 3 years receiving oral contraceptives and intrauterine devices and showed a continuation rate of over 70% at 12 months. Clinic records showed that most of the acceptors are agricultural workers from rural areas under 30 years of age with 4 or less years of schooling and less than 4 pregnancies. Most acceptors were apparently using contraception for the first time and for the purpose of limiting rather than spacing their families. A postpartum program is operating in 15 hospitals in the country where 40%-85% of the maternity patients accept family planning services. Contraceptive services are rapidly expanding after a pilot study approved the use of auxiliary midwives for administering oral contraceptives. Though serious logistical cultural and educational problems remain in the family planning program in Thailand a new program is being launched with massive public information increased emphasis on sterilization and expanded services in the rural areas to reach a target reduction in the annual population growth rate from 3.0% to 2.5%.