Determination of medical abortion success by women and community health volunteers in Nepal using a symptom checklist

• Main Authors: Kathryn L. Andersen (Author), Mary Fjerstad (Author), Indira Basnett (Author), Shailes Neupane (Author), Valerie Acre (Author), Sharad Sharma (Author), Emily Jackson (Author)
• Format: Book
• Published: BMC, 2018-05-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 10.1186/s12884-018-1804-3; 1471-2393
• Keywords: Medical abortion; Abortion; Nepal; Self-assessment; Community health volunteers; Gynecology and obstetrics; RG1-991
• Source: BMC Pregnancy and Childbirth, Vol 18, Iss 1, Pp 1-6 (2018)

Abstract Background We sought to determine if female community health volunteers (FCHVs) and literate women in Nepal can accurately determine success of medical abortion (MA) using a symptom checklist, compared to experienced abortion providers. Methods Women undergoing MA, and FCHVs, independently assessed the success of each woman's abortion using an 8-question symptom checklist. Any answers in a red-shaded box indicated that the abortion may not have been successful. Women's/FCHVs' assessments were compared to experienced abortion providers using standard of care. Results Women's (n = 1153) self-assessment of MA success agreed with abortion providers' determinations 85% of the time (positive predictive value = 90, 95% CI 88, 92); agreement between FCHVs and providers was 82% (positive predictive value = 90, 95% CI 88, 92). Of the 92 women (8%) requiring uterine evacuation with manual vacuum aspiration (n = 84, 7%) or medications (n = 8, 0.7%), 64% self-identified as needing additional care; FCHVs identified 61%. However, both women and FCHVs had difficulty recognizing that an answer in a red-shaded box indicated that the abortion may not have been successful. Of the 453 women with a red-shaded box marked, only 35% of women and 41% of FCHVs identified the need for additional care. Conclusion Use of a checklist to determine MA success is a promising strategy, however further refinement of such a tool, particularly for low-literacy settings, is needed before widespread use.