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A simple toolkit that allows local health workers to ensure it is safe for women to have abortions has been tested successfully in Ethiopia, India and South Africa.

The toolkit is designed to speed up the process of deciding whether women in rural areas can get an abortion — because the procedure is less invasive and dangerous in the first nine weeks of pregnancy.

The kit includes a questionnaire to help health workers evaluate risk factors, including pre-existing medical conditions, and a urine pregnancy test to determine women’s eligibility for an early termination.

An international research team led by the World Bank and the World Health Organization tested the toolkit and compared its results with physical exams of women seeking an abortion.

They found that the toolkit was accurate in more than 90 per cent of cases in which the women knew the date of their last menstrual period.

“While [our toolkit] is not an intervention ready for scale up as yet, it will help pave the way for health workers to play a more important and effective role in reducing the burden of unsafe abortion,” says Bela Ganatra, a WHO scientist and joint lead author of the study, published in PLOS One earlier this month (5 January).

The researchers adapted the toolkit to local calendars and languages, but it was still inconclusive for the 2.5 per cent of patients who could not recall the date of their last period. After ten weeks of pregnancy, more invasive methods have to be used to safely terminate the pregnancy.

The kit’s accuracy also relied heavily on health worker training. In Ethiopia, where community health workers received more training than those in the other two countries did, the toolkit’s accuracy was 92 per cent, compared with 80 per cent in India and 77 per cent in South Africa.

Ganatra says the small risk of women being falsely deemed eligible for an early abortion by the toolkit is not a problem. “The kit is meant to facilitate referrals to safe abortion facilities, where a trained abortion provider would confirm the eligibility before actually providing a woman with care,” she says. According to Ellen Israel, a senior advisor for women’s health with Pathfinder International, a sexual health NGO that supports abortion, stigma and discrimination continue to drive women towards dangerous abortions. This often involves unsafe providers or happens when a pregnancy is too advanced for simpler intervention methods.

“Working with sensitised community health workers can encourage women [to assess] their options and rights regarding unwanted pregnancy,” Israel says. “This checklist is just one example of the many steps needed to expand health worker roles to increase access to safe abortion care.”


Heidi Bart Johnston and others Accuracy of assessment of eligibility for early medical abortion by community health workers in Ethiopia, India and South Africa (PLOS One, 5 January 2016)

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