title: Expansion of Safe Abortion Services in Nepal Through Auxiliary Nurse-Midwife Provision of Medical Abortion, 2011-2013.
abstract: BACKGROUND
  The termination of unwanted pregnancies up to 12 weeks' gestation became legal in Nepal in 2002. Many interventions have taken place to expand access to comprehensive abortion care services. However, comprehensive abortion care services remain out of reach for women in rural and remote areas. This article describes a training and support strategy to train auxiliary nurse-midwives (ANMs), already certified as skilled birth attendants, as medical abortion providers and expand geographic access to safe abortion care to the community level in Nepal.
  
  
  METHODS
  This was a descriptive program evaluation. Sites and trainees were selected using standardized assessment tools to determine minimum facility requirements and willingness to provide medical abortion after training. Training was evaluated via posttests and observational checklists. Service statistics were collected through the government's facility logbook for safe abortion services (HMIS-11).
  
  
  RESULTS
  By the end of June 2014, medical abortion service had been expanded to 25 districts through 463 listed ANMs at 290 listed primary-level facilities and served 25,187 women. Providers report a high level of confidence in their medical abortion skills and considerable clinical knowledge and capacity in medical abortion.
  
  
  CONCLUSIONS
  The Nepali experience demonstrates that safe induced abortion care can be provided by ANMs, even in remote primary-level health facilities. Post-training support for providers is critical in helping ANMs handle potential barriers to medical abortion service provision and build lasting capacity in medical abortion.
authors: Kathryn L
authors: KL
authors: Andersen
authors: Indira
authors: I
authors: Basnett
authors: Dirgha Raj
authors: DR
authors: Shrestha
authors: Meena Kumari
authors: MK
authors: Shrestha
authors: Mukta
authors: M
authors: Shah
authors: Shilu
authors: S
authors: Aryal
mesh_terms: D000028:Abortion, Induced; D002983:Clinical Competence; D005260:Female; D006268:Health Facilities; D006297:Health Services Accessibility; D006801:Humans; D008880:Midwifery / Q000193:education*; D009390:Nepal; D009721:Nurse Midwives / Q000193:education*; D011247:Pregnancy; D011320:Primary Health Care; D024382:Professional Role; D019035:Rural Health Services; D012424:Rural Population; D014932:Women's Health Services
keywords: Nepal; auxiliary nurse-midwives (ANMs); medical abortion; primary care