Bimanual exam may not be essential for safe medication abortion by trained clinicians

pharmacy in Nepal
Efforts to increase access to safe medication abortion worldwide have included broadening the base of providers and expanding facilities where people can seek care. Such efforts have been effective in Nepal, where abortion was decriminalized in 2002. Still, many women continue to obtain unsafe abortion care.

New research from the Bixby Center and the Center for Research on Environment Health and Population Activities in Nepal offers a promising approach to expand access. The study looked at whether gestational age can be accurately calculated from a woman’s last menstrual period, or if a bimanual exam yields more accurate results.

The research team found that for those who could report their last menstrual period, there was more than 99% agreement between the assessments auxiliary nurse midwives made based just on the last menstrual period and the assessments based on bimanual exam. Relying only on the last menstrual period, fewer than 1 out of 200 women in the study would have obtained medication abortion past the legal gestational limit. Fewer than 1 out of 600 would have been incorrectly denied medication abortion for being over the gestational limit. It’s unlikely any woman would have received medication abortion outside of the evidence-based standard of care.

This study supports the idea that trained auxiliary nurse midwives could assess gestational age at pharmacies without a bimanual exam. This model could lead to significantly expanded access for women in their communities in Nepal and around the world. Expanding medication abortion access has the potential to reduce maternal health problems and mortality, particularly in low-resource settings like Nepal.