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Objectives
Rwanda expanded legal grounds for abortion in 2012, but limits provision to doctors
in hospitals, resulting in unequal access. This study illustrates how technologies
and infrastructure can bring first trimester medication abortion closer to more vulnerable
populations within a restricted legal context.
Methods
A SAFE (safety, acceptability, feasibility, and effectiveness) study was implemented
to assess a telemedicine model to enable primary care nurses to provide first-trimester
medication abortion by teleconsulting with district hospital doctors. The doctors
provided clinical guidance and authorized medication abortion remotely, while the
nurses consulted with the client, provided medication, and conducted follow-up. The
feasibility component of the study described the programmatic (service delivery protocol)
and policy changes (level of provision) needed to comply with the restrictive laws
while increasing access.
Results
Primary care nurses (two per health center) were successfully trained in medication
abortion provision using mifepristone-misoprostol combination and ultrasound. Teleconsultation
between doctors and nurses created a channel for doctors to provide remote authorization
and allowed clients to receive services in their communities. Between October 15,
2021 and May 15, 2022, 165 clients received medication abortion at the health centers.
Protocol ensured high adherence rates; all clients completed treatment. Referrals
to the hospital decreased as only those in the second trimester or < 15 years were
referred.
Conclusions
We successfully brought medication abortion services to communities by maximizing
available technologies and infrastructure. This research has applicability beyond
Rwanda: It provides a concrete example of how to design a task-shifting model to reach
vulnerable populations in a restricted legal environment.
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Copyright
© 2022 Published by Elsevier Inc.
