Back to Browse Journals » International Journal of Women's Health » Volume 5

Safety and effectiveness of termination services performed by doctors versus midlevel providers: a systematic review and analysis

Authors Ngo TD, Park MH, Free C

Published Date January 2013 Volume 2013:5 Pages 9—17

DOI http://dx.doi.org/10.2147/IJWH.S39627

Received 27 October 2012, Accepted 21 November 2012, Published 4 January 2013

Thoai D Ngo,1,2 Min Hae Park,1 Caroline Free2

1Research, Monitoring and Evaluation Team, Health System Department, Marie Stopes International, UK; 2Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK

Objective: Training midlevel providers (MLPs) to conduct surgical abortions and manage medical abortions has been proposed as a way to increase women's access to safe abortion. This paper reviews the evidence that compares the effectiveness and safety of abortion procedures administered by MLPs versus doctors.
Methods: A systematic search was conducted of published trials and comparison studies assessing the effectiveness and/or safety of abortion provided by MLPs compared to doctors. The Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, and Popline were searched. The primary outcomes of interest were: (1) incomplete or failed abortion; and (2) measures of safety (adverse events and complications) of abortion procedures administered by MLPs and doctors. Odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated for each study. Data were synthesized in a narrative fashion.
Findings: Five studies were included in this review (n = 8539 women), comprising two randomized controlled trials (RCTs) (n = 3821) and three prospective cohort studies (n = 4718). In total, 4198 women underwent a procedure administered by an MLP, and 4341 women underwent a physician-administered procedure. Studies took place in the US, Nepal, South Africa, Vietnam, and India. Four studies used surgical abortion with maximum gestational ages ranging from 10 to 16+ weeks, while a medical abortion study had gestational ages up to 9 weeks. In RCTs, the effect estimates for incomplete or failed abortion for procedures performed by MLPs compared with doctors were OR = 2.00 (95% CI 0.85–4.68) for surgical abortion, and OR = 0.69 (95% CI 0.34–1.37) for medical abortion. Complications were rare among both provider types (1.2%–3.1%; OR = 1.80, 95% CI 0.83–3.90 for surgical abortions), and no deaths were reported.
Conclusion: There were no statistical differences in incomplete abortion and complications for first trimester surgical and medical abortion up to 9 weeks performed by MLPs compared with physicians. Further studies are required to establish more precise effect estimates.

Keywords: abortion, misoprostol, manual vacuum aspiration, medical abortion

Download Article [PDF] View Full Text [HTML] 

Creative Commons License This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php

Other articles by this author:

Readers of this article also read:

Women’s awareness and periconceptional use of folic acid: data from a large European survey

Bitzer J, von Stenglin A, Bannemerschult R

International Journal of Women's Health 2013, 5:201-213

Published Date: 26 April 2013

Changes in cervical cancer screening behavior for women attending Pap Test Week clinics

Poliquin V, Decker K, Altman AD, Lotocki R

International Journal of Women's Health 2013, 5:141-148

Published Date: 8 April 2013

Serum vitamin D3 level inversely correlates with uterine fibroid volume in different ethnic groups: a cross-sectional observational study

Sabry M, Halder SK, Ait Allah AS, Roshdy E, Rajaratnam V, Al-Hendy A

International Journal of Women's Health 2013, 5:93-100

Published Date: 27 February 2013

Feasibility of abdominoplasty with Cesarean section [Retraction]

Thabet WN, Hossny AS, Sherif NA

International Journal of Women's Health 2013, 5:43-44

Published Date: 24 January 2013

Usefulness of serum mass spectrometry to identify women diagnosed with higher grades of cervical intraepithelial neoplasia may differ by race

Matthews R, Azuero A, Asmellash S, Brewster E, Partridge EE, Piyathilake CJ

International Journal of Women's Health 2011, 3:185-192

Published Date: 12 July 2011