Evaluation of Nurse Provision of Induced Abortion with Manual Vacuum Aspiration in Nepal

Although Nepal's maternal mortality ratio has fallen over the past decade, unsafe abortion remains a leading cause of maternal morbidity and mortality. To increase accessibility of safe abortion services, the Family Health Division of the Ministry of Health trained an initial cohort of 96 nurses to provide first trimester comprehensive abortion care (CAC) services using manual vacuum aspiration (MVA) between September 2006 and July 2009. This study evaluates the acceptability and quality of CAC services provided by nurses; 92 nurses from 50 facilities participated in the evaluation. Among the 96 nurses who received CAC training, all achieved clinical competency, and at follow-up, 86% (n=79) were providing CAC services in their facility. Overall, 5,600 women received CAC services from 42 facilities where nurses were providing services. Complications were experienced by 68 surgical abortion clients (1.6%) and 12 medical abortion clients (1.2%); one woman died. All nurses reported that clients were happy to receive care from them, and 67% of facility managers reported that clients preferred nurse providers over physicians or had no preference. Facility managers had positive opinions about nurse providers: 97% agreed that trained nurses provide high quality CAC services and 90% felt that nurses provide first trimester services of the same quality as doctors. Trained nurses provide high quality CAC services in Nepal; to date 225 nurses have been trained in MVA. Additional support in the form of facilitative supervision and training should be considered to strengthen CAC service provision by nurses in Nepal.