Who should perform medical abortion
Richard Burzelman, Richard Burzelman is an Assistant Director for Reproductive Health with the Provincial Government Western Cape Province in South Africa since 2002. His responsibilities include development of policies, guidelines and protocols for the reproductive health services in the Province. He has been involved with reproductive health since 1997 when he started managing an abortion service at a district health facility in Cape Town. This service became the referring facility for the Metropole Region giving access to all clients up to 20 gestational weeks. At the time access was limited as the “Choice on Termination of Pregnancy”, Act 92 of 1997 was just introduced and very controversial.
The Reproductive Health Sub-Directorate collaborates with the World Population Foundation (WPF) in the Netherlands, the Johns Hopkins University Centre for Communication Programs, and the Reproductive Health Research Unit in Johannesburg and the Women’s Health Research Unit at the University of Cape Town undertaking reproductive health research.
Qualifications:Registered Professional Nurse/Midwife (Accoucheur) with Diplomas in Psychiatric Nursing, Operating Room Nursing, Nursing Administration, a Certificate in Termination of Pregnancy and a post-graduate BA Nursing Degree.
Making safe, legal abortion services available to all women is likely to require that all levels of professional health care service providers i.e. the traditional gynecologist, trained physician, and mid-level health professionals participate in the services.
Medical doctors trained in abortion services are not available in many parts of the developing world. This necessitates training of mid-level providers who are not physicians to deliver quality abortion care.
These mid-level providers refers to a range of non-physician clinicians – midwifes, nurse practitioners, clinical officers, physician assistants, and others who are trained to provide basic, clinical procedures related to reproductive health, including bimanual pelvic examination to determine pregnancy and positioning of the uterus, uterine sounding, transcervical procedures, and who could be trained to provide early abortion services.
A previous study in the USA seemed to indicate that complication rates between physicians and other mid-level health care professionals show no difference in first trimester abortion procedures. A study in SA and Vietnam looking at whether there are any differences in medical outcomes between physicians and mid- level providers providing first trimester abortions is currently being completed.
Operations research being undertaken in SA to determine the acceptability and feasibility of medical abortion findings will be presented to policy makers later in the year.
In South Africa, the provision of first trimester surgical terminations have been delivered by registered midwifes since the implementation of the “Choice on Termination of Pregnancy Act” no 92 of 1996. An amendment to the Act later this year will include medical abortions as an added choice for women in the first trimester of pregnancy. In this talk, emphasis will be placed on the South African situation, as an example for other developing countries where there is a shortage of abortion care providers.