title: Feasibility of expanding the medication abortion provider base in India to include ayurvedic physicians and nurses.
abstract: BACKGROUND
  The availability of trained abortion providers is limited in India. Allowing ayurvedic physicians and nurses to perform medication abortions may improve women's access to the procedure, but it is unclear whether these clinicians can provide these services safely and effectively.
  
  
  METHODS
  Allopathic physicians, ayurvedic physicians and nurses (10 of each), none of whom had experience in abortion provision, were trained to perform medication abortions. In 2008-2010, these providers performed medication abortions in five clinics in Bihar and Jharkhand for 1,225 women with a pregnancy of up to eight weeks' gestation. A two-sided equivalence design was used to test whether providers' assessments of client eligibility and completeness of abortion matched those of an experienced physician "verifier," and whether medication abortions performed by nurses and ayurvedic physicians were as safe and effective as those done by allopathic physicians.
  
  
  RESULTS
  Failure rates were low (5-6%), and those for nurses and ayurvedic physicians were statistically equivalent to those for allopathic physicians. Provider assessments of client eligibility and completeness of abortion differed from those of the verifier in only a small proportion of cases (3-4% for eligibility and 4-5% for completeness); these proportions, and rates of loss to follow-up, were statistically equivalent among provider types. No serious complications were observed, and services by all three groups of providers were acceptable to women.
  
  
  CONCLUSIONS
  Findings support amending existing laws to improve women's access to medication abortion by expanding the provider base to include ayurvedic physicians and nurses.
authors.affiliation: Population Council, New Delhi, India. sjejeebhoy@popcouncil.org
authors.forename: Shireen J
authors.initials: SJ
authors.lastname: Jejeebhoy
authors.forename: Shveta
authors.initials: S
authors.lastname: Kalyanwala
authors.forename: Shuchita
authors.initials: S
authors.lastname: Mundle
authors.forename: Jaydeep
authors.initials: J
authors.lastname: Tank
authors.forename: A J Francis
authors.initials: AJ
authors.lastname: Zavier
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kumar
authors.forename: Rajib
authors.initials: R
authors.lastname: Acharya
authors.forename: Nita
authors.initials: N
authors.lastname: Jha
mesh_terms: D000019:Abortifacient Agents; D000028:Abortion, Induced / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D000029:Abortion, Legal / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D000328:Adult; D016001:Confidence Intervals; D005240:Feasibility Studies; D005260:Female; D006291:Health Policy; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007194:India; D008515:Medicine, Ayurvedic; D009726:Nurses / Q000331:legislation & jurisprudence*; D005791:Patient Care / Q000706:statistics & numerical data; D010820:Physicians / Q000331:legislation & jurisprudence*; D011247:Pregnancy; D012449:Safety / Q000706:statistics & numerical data; D016387:Women's Health
chemical_list: D000019:Abortifacient Agents