Provision of abortion by mid-level providers: international policy, practice and perspectives
Open accessAbstract
Based on articles found on the PubMed and Popline databases on the provision of first-trimester abortion by mid-level providers, this article describes policies on type of abortion provider, comparative studies of different types of abortion provider, provider perspectives, and programmatic experience in Bangladesh, Cambodia, France, Mozambique, South Africa, Sweden, the United States of America and Viet Nam. It shows that it is safe and beneficial for suitably trained mid-level health-care providers, including nurses, midwives and other non-physician clinicians, to provide first-trimester vacuum aspiration and medical abortions. Moreover, it finds that projects in Kenya, Myanmar and Uganda have successfully trained nurse-midwives to provide post-abortion care for incomplete abortion with manual vacuum aspiration, and that studies in Ethiopia and India have recommended that providers such as auxiliary nurse-midwives should be trained in abortion service delivery to ensure that they provide safe abortions for low-income women. The paper recommends the authorization of all qualified mid-level health-care providers to carry out first-trimester abortions, and it also recommends the integration of training in providing first-trimester abortion care into basic education and clinical training for all mid-level providers and medical students interested in obstetrics and gynaecology. Finally, it calls for documentation of the role of mid-level providers in managing second-trimester medical abortions to further inform policy and practice.
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Studies from Kenya and Uganda have documented that nurse-midwives can be successfully trained to carry out postabortion care for complications of incomplete abortion using MVA.
“Studies from Kenya and Uganda have documented that nurse-midwives can be successfully trained to carry out postabortion care for complications of incomplete abortion using MVA (66)”
From Unsafe abortion and postabortion care - an overview (2011) · cites this paper as [66]
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de Moel‐Mandel, C., Taket, A. R., & Graham, M. (2021) · Australian journal of advanced nursing · doi:10.37464/2020.381.144 · Cited by 6 · see citing works
Khan, N. N. (2017) · Asian Journal of Medical and Biological Research · doi:10.3329/ajmbr.v3i3.34517 · Cited by 6 · see citing works
Harries, J. (2010) · Open University of Cape Town (University of Cape Town) · Cited by 6 · see citing works
Patil, E., Darney, B. G., Orme‐Evans, K., Beckley, E. H., Bergander, L., Nichols, M. D. N., & Bednarek, P. H. (2016) · Journal of Midwifery & Women s Health · doi:10.1111/jmwh.12412 · Cited by 5 · see citing works
Kapp, N., Dijkerman, S., Getachew, A., Eckersberger, E., Pearson, E., Abubeker, F. A., & Birara, M. (2024) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.15392 · Cited by 5 · see citing works
Wängborg, A., Schmidt, J., Mattison, C. A., Bourret, K., & Klingberg‐Allvin, M. (2025) · Sexual & Reproductive Healthcare · doi:10.1016/j.srhc.2025.101071 · Cited by 3 · see citing works
Abortion Training and Integration in the United Kingdom
Lohr, P. A., & Regan, L. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108884709.036 · Cited by 3 · see citing works
The benefits and limitations of establishing the PA profession globally
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Paul, M., Gemzell‐Danielsson, K., Essén, B., & Klingberg‐Allvin, M. (2015) · Global Health Action · doi:10.3402/gha.v8.27512 · Cited by 3 · see citing works
Proposed amendments in the Medical Termination of Pregnancy Act in a nutshell
Phanjoubam, M. (2017) · Journal of Medical Society · doi:10.4103/0972-4958.198421 · Cited by 3 · see citing works
Moulton, J. E., Botfield, J. R., Arefadib, N., Freilich, K., & Mazza, D. (2025) · Journal of Advanced Nursing · doi:10.1111/jan.16777 · Cited by 2 · see citing works
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Midwifery students willingness to provide manual vacuum aspiration in Ghana
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The costs of drugs and medical care for pregnancy termination. How much is the abortion?
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Comparison between Nursing Performance and Standard of Care for Aborted Woman at Mansoura Hospitals
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Access to medical abortion and abortion care in Japan
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The Historical Influence of Politics and Society on Women's Experiences of Abortion
Schumacher, S. R. (2013) · UWM Digital Commons (University of Wisconsin–Milwaukee)
- Authors
- Berer, M.
- Corresponding author
- Berer, Marge
- ORCID
- Berer, Marge
- Venue
- Bulletin of the World Health Organization
- Publisher
- WHO Press
- Published
- 2009-01-01
- Volume
- 87
- Issue
- 1
- Pages
- 58-63
- ISSN
- 0042-9686 (ISSN-L)
- PMC
- PMC2649591
- OpenAlex
- W2127362470
- Cited by
- 112
- References
- 29
- Citations by year
- 2025: 4 · 2024: 3 · 2023: 3 · 2022: 3 · 2021: 3 · 2020: 12 · 2019: 9 · 2018: 5 · 2017: 7 · 2016: 5 · 2015: 14 · 2014: 10 · 2013: 8 · 2012: 5
- FWCI
- 8.40
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Bulletin of the World Health Organization (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health and Surgery
- Keywords
- abortion provision, mid-level providers, first-trimester abortion, vacuum aspiration, abortion pills, nurse-midwives, auxiliary nurse midwives, post-abortion care, incomplete abortion, abortion policy, abortion training, low-income women
- MeSH terms
- Abortion, Induced, Developing Countries, Female, Health Policy, Health Services Accessibility, Humans, Pregnancy, Developed Countries, Internationality
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