Experiences of lay and auxiliary health care workers providing safe abortion in Latin America

Background:

98% of abortions in developing countries are unsafe.  WHO recommends providing abortion at the lowest appropriate level of health care.  Globally, many lay and auxiliary health care workers (LAHCW) provide misoprostol for gynecological indications, including safe abortion.  However, little is known about their experiences providing abortion.

Objective:

To understand the experience of LAHCW providing safe abortion in Latin America and the implications of those experiences.

Methods:

Investigators collected data through semi-structured qualitative interviews with a convenience sample of LAHCW in Latin America.  Interviews were conducted in a private and neutral space away from providers’ communities. No identifying information was included in recordings, transcriptions, or analysis.

Results:

Providing abortion places a heavy personal burden on LAHCW in rural and legally-restricted settings.  Providers fear exposure as abortion providers, and the work is labor intensive.  Self-care among providers is rare, but despite fear and anxiety, providers demonstrate commitment to supporting women.  With training and support, providers develop confidence in their skills and in misoprostol.  When complications arise, providers consult higher level providers and refer clients as necessary.  Providers’ requests for support include commodity chain management, legal support, strengthening referral and support network, and technical skills updates.

Conclusion:

LAHCW are extremely committed to supporting women, but at a high personal cost.  Providers can benefit from personal and technical support.  With support, access to safe abortion can be expanded, and the impact of unsafe abortion reduced.