{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T11:12:01Z","timestamp":1788520321592,"version":"build-2803163510"},"reference-count":21,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2016,2,9]],"date-time":"2016-02-09T00:00:00Z","timestamp":1454976000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Midwife Womens Health"],"published-print":{"date-parts":[[2016,3]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>The termination of unwanted pregnancies up to 12 weeks\u2019 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\u2010midwives (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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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\u201011).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>By the end of June 2014, medical abortion service had been expanded to 25 districts through 463 listed ANMs at 290 listed primary\u2010level 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>The Nepali experience demonstrates that safe induced abortion care can be provided by ANMs, even in remote primary\u2010level health facilities. Post\u2010training support for providers is critical in helping ANMs handle potential barriers to medical abortion service provision and build lasting capacity in medical abortion.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jmwh.12419","type":"journal-article","created":{"date-parts":[[2016,2,10]],"date-time":"2016-02-10T06:23:11Z","timestamp":1455085391000},"page":"177-184","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Expansion of Safe Abortion Services in Nepal Through Auxiliary Nurse\u2010Midwife Provision of Medical Abortion, 2011\u20102013"],"prefix":"10.1111","volume":"61","author":[{"given":"Kathryn L.","family":"Andersen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indira","family":"Basnett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirgha Raj","family":"Shrestha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meena Kumari","family":"Shrestha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mukta","family":"Shah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shilu","family":"Aryal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,2,9]]},"reference":[{"issue":"7","key":"e_1_2_8_2_1","first-page":"1742","article-title":"Implementation of legal abortion in Nepal: a model for rapid scale\u2010up of high\u2010quality care","volume":"9","author":"Samandari G","year":"2012","journal-title":"Reprod Health"},{"key":"e_1_2_8_3_1","volume-title":"A Comprehensive Report on Implementatoin of Medical Abortion Services in Six Pilot Districts of Nepal","author":"Ipas Nepal","year":"2009"},{"key":"e_1_2_8_4_1","unstructured":""},{"key":"e_1_2_8_5_1","volume-title":"Essential Facts About Midwives","author":"American College of Nurse\u2010Midwives","year":"2014"},{"issue":"36","key":"e_1_2_8_6_1","first-page":"260","article-title":"Increasing access to safe abortion services through auxiliary nurse midwives trained as skilled birth attendants","volume":"9","author":"KC NP","year":"2011","journal-title":"Kathmandu Univ Med J"},{"key":"e_1_2_8_7_1","first-page":"1","article-title":"The role of auxiliary nurse\u2010midwives and community health volunteers in expanding access to medical abortion in rural Nepal","volume":"43","author":"Puri M","year":"2014","journal-title":"Reprod Health Matters"},{"key":"e_1_2_8_8_1","unstructured":"Government of Nepal. Muluki Ain (Eleventh Amendment) 2059 No 28a Chapter on Life (unofficial translation on file with Center for Reproductive Rights).2002."},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2004.03.014"},{"key":"e_1_2_8_10_1","volume-title":"CAC Implementation Guideline","author":"Ministry of Health and Population","year":"2011"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12905-015-0175-4"},{"key":"e_1_2_8_12_1","unstructured":"RoweAK RoweSY PetersDH HollowayKA ChalkerJ Ross\u2010DegnanD.Early results of a systematic review of strategies to improve health worker performance in low\u2010 and middle\u2010 income countries.4th Annual NIH Conference on the Science of Dissemination & Implementation: Policy & Practice.Bethesda MD;2011."},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.9745\/GHSP-D-12-00026"},{"key":"e_1_2_8_14_1","volume-title":"COPE for Comprehensive Abortion Care Services: A Toolbook to Accompany the COPE\u00ae Handbook","author":"EngenderHealth, Ipas, Reducing Maternal Mortality and Morbidity Project Ghana","year":"2009"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2013.07.008"},{"key":"e_1_2_8_16_1","unstructured":"Ipas Nepal.Integrating Medical Abortion and Implant Training for ANMs in Nepal. Lessons Learned from a Pilot Project in Five Districts. 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September 2012."}],"container-title":["Journal of Midwifery &amp; Women's Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjmwh.12419","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjmwh.12419","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jmwh.12419","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T03:13:02Z","timestamp":1694747582000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jmwh.12419"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,2,9]]},"references-count":21,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2016,3]]}},"alternative-id":["10.1111\/jmwh.12419"],"URL":"https:\/\/doi.org\/10.1111\/jmwh.12419","archive":["Portico"],"relation":{},"ISSN":["1526-9523","1542-2011"],"issn-type":[{"value":"1526-9523","type":"print"},{"value":"1542-2011","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,2,9]]},"assertion":[{"value":"2016-02-09","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}