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A conference statement from

Expanding Access

Advancing the Roles of Midlevel Providers in
Menstrual Regulation and Elective Abortion Care

2 - 6 December 2001
Kwa Maritane Lodge, Pilanesberg National Park, South Africa

Worldwide, nearly 80,000 women die every year and millions more suffer serious complications and disabilities from unsafe abortion, which is wholly preventable. Even in countries where abortion-related maternal mortality is low, women still often lack access to abortion care and other reproductive health services that they want and need.

Increasing the accessibility of menstrual regulation (MR) and/or safe abortion care is a key strategy in reducing unacceptably high rates of maternal mortality and morbidity, and in ensuring women’s ability to exercise their sexual and reproductive rights. Since midlevel health care providers are more numerous and tend to be closer to women than physicians, they have a critical role to play in meeting women’s needs for postabortion care, MR and — in circumstances where it is legal — termination of pregnancy.

Experience in Bangladesh, South Africa and several other countries demonstrates that authorizing, training and equipping midlevel providers to deliver MR and/or abortion care can make an important difference in improving women’s access to needed services.

Creating an enabling environment to expand and strengthen midlevel providers’ scope of practice is especially important in situations where they are the principal or only health care providers in the communities where women live.

As health care providers, researchers, policymakers and representatives of technical agencies, we, the participants in the first-ever international meeting exploring midlevel providers’ role in MR and abortion care, strongly believe:

  • that women deserve prompt access to high-quality MR and/or abortion care,
  • that it is essential for health systems to create policy and service-delivery environments that enable MR and/or abortion care to be as accessible as possible to women, and
  • that women’s access to such care can be greatly enhanced by better integrating these services into midlevel providers’ scope of practice.

All of us who are committed to enhancing women’s health and lives have a responsibility to facilitate women’s access to the reproductive health care they want and need, including menstrual regulation and abortion care.

This conference has strengthened our commitment to fulfill this critical mandate – an effort in which midlevel providers clearly play a key role. As a network of concerned professionals, we call on governments, health policymakers, nongovernmental organizations, international organizations, donors and others to take action in support of advancing the role of midlevel providers in menstrual regulation and safe abortion care.

The 50 conference delegates included teams from 10 countries as well as representatives from the African Midwives Research Network, the International Confederation of Midwives, Partners in Population and Development, the Reproductive Health Alliance and the World Health Organization.

Ipas and IHCAR, the coordinating agencies, would like to express appreciation for financial support from the Danish International Development Assistance (Danida), the Norwegian Agency for Development Cooperation (NORAD), the Swedish International Development Cooperation Agency (Sida), the Swedish Ministry for Foreign Affairs and the David and Lucile Packard Foundation.

Ipas/IHCAR Conference report