title: Nurse versus physician-provision of early medical abortion in Mexico: a randomized controlled non-inferiority trial.
abstract: OBJECTIVE
  To examine the effectiveness, safety, and acceptability of nurse provision of early medical abortion compared to physicians at three facilities in Mexico City.
  
  
  METHODS
  We conducted a randomized non-inferiority trial on the provision of medical abortion and contraceptive counselling by physicians or nurses. The participants were pregnant women seeking abortion at a gestational duration of 70 days or less. The medical abortion regimen was 200 mg of oral mifepristone taken on-site followed by 800 μg of misoprostol self-administered buccally at home 24 hours later. Women were instructed to return to the clinic for follow-up 7-15 days later. We did an intention-to-treat analysis for risk differences between physicians' and nurses' provision for completion and the need for surgical intervention.
  
  
  RESULTS
  Of 1017 eligible women, 884 women were included in the intention-to-treat analysis, 450 in the physician-provision arm and 434 in the nurse-provision arm. Women who completed medical abortion, without the need for surgical intervention, were 98.4% (443/450) for physicians' provision and 97.9% (425/434) for nurses' provision. The risk difference between the group was 0.5% (95% confidence interval, CI: -1.2% to 2.3%). There were no differences between providers for examined gestational duration or women's contraceptive method uptake. Both types of providers were rated by the women as highly acceptable.
  
  
  CONCLUSIONS
  Nurses' provision of medical abortion is as safe, acceptable and effective as provision by physicians in this setting. Authorizing nurses to provide medical abortion can help to meet the demand for safe abortion services.
authors.affiliation: Instituto Nacional de Salud Pública, Septima Cerrada de Fray Pedro de Gante No 50, Col Seccion XVI, Tlalpan, Mexico City, 14000, Mexico .
authors.forename: Claudia Diaz
authors.initials: CD
authors.lastname: Olavarrieta
authors.affiliation: Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland .
authors.forename: Bela
authors.initials: B
authors.lastname: Ganatra
authors.affiliation: Population Council Mexico, Mexico City, Mexico .
authors.forename: Annik
authors.initials: A
authors.lastname: Sorhaindo
authors.affiliation: Population Council Mexico, Mexico City, Mexico .
authors.forename: Tahilin S
authors.initials: TS
authors.lastname: Karver
authors.affiliation: Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland .
authors.forename: Armando
authors.initials: A
authors.lastname: Seuc
authors.affiliation: Instituto Nacional de Salud Pública, Septima Cerrada de Fray Pedro de Gante No 50, Col Seccion XVI, Tlalpan, Mexico City, 14000, Mexico .
authors.forename: Aremis
authors.initials: A
authors.lastname: Villalobos
authors.affiliation: Population Council Mexico, Mexico City, Mexico .
authors.forename: Sandra G
authors.initials: SG
authors.lastname: García
authors.affiliation: Mexico City Ministry of Health, Reproductive Health Program, Mexico City, Mexico .
authors.forename: Martha
authors.initials: M
authors.lastname: Pérez
authors.affiliation: Population Council Mexico, Mexico City, Mexico .
authors.forename: Manuel
authors.initials: M
authors.lastname: Bousieguez
authors.affiliation: Mexico City Ministry of Health, Reproductive Health Program, Mexico City, Mexico .
authors.forename: Patricio
authors.initials: P
authors.lastname: Sanhueza
mesh_terms: D000028:Abortion, Induced / Q000379:methods / Q000523:psychology / Q000592:standards*; D000029:Abortion, Legal; D000328:Adult; D003695:Delivery of Health Care / Q000379:methods / Q000592:standards*; D004501:Education, Medical; D004506:Education, Nursing; D005260:Female; D006801:Humans; D008297:Male; D008800:Mexico; D009726:Nurses / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data*; D011247:Pregnancy; D055815:Young Adult