Population Council Research that makes a difference

In India, abortion is legal, but access to services is limited for many reasons, including a lack of trained providers and appropriate facilities. Manual vacuum aspiration (MVA) is recommended by the World Health Organization as the preferred surgical technique for induced first-trimester abortion. It can be used earlier in a pregnancy and is safer than other surgical methods. In settings where access to safe abortion facilities is limited, women tend to turn to unqualified providers or unsafe methods (or both) to terminate unwanted pregnancies; in these settings, expanded access to MVA could help women obtain safe abortions more easily. In several settings, projects have expanded access to MVA by enabling trained nurses and other nonphysicians to provide the service. In India, provision of MVA by trained nonphysicians is legally restricted, but there is considerable interest in relaxing this restriction. However, prior to any such review, evidence is needed that the provision of MVA by trained nurses is feasible, effective, safe, and acceptable.

The objectives of this Council study are to: (1) build evidence for expanding the MVA provider base to include providers who are not physicians, specifically staff nurses (holding B.Sc. or diplomas in nursing); and (2) with the emerging evidence, advocate for changing legislation so as to permit a wider array of providers to conduct MVA.

To date, eight doctors and five nurses have been trained and have conducted MVAs for a total of 486 women. Preliminary findings suggest nurses can conduct MVAs successfully and safely.