This International Year must include abortion care as an essential competency of nurses and midwives

The World Health Assembly has designated 2020 as the International Year of the Nurse and the Midwife. They write: Nurses and midwives play a vital role in providing health services. They are often, the first and only point of care in their communities. Globally, 70% of the health and social workforce are women. Nurses and midwives represent a large portion of this. WHO and partners – including the International Confederation of Midwives, International Council of Nurses, Nursing Now and the United Nations Population Fund in a year-long effort to celebrate the work of nurses and midwives, highlight the challenging conditions they often face, and advocate for increased investments in the nursing and midwifery workforce. The world needs 9 million more nurses and midwives if it is to achieve universal health coverage by 2030.

They continue: “Midwifery, where care includes proven interventions for maternal and newborn health as well as for family planning, could avert over 80% of all maternal deaths, stillbirths and neonatal deaths.” They fail to mention averting almost 100% of deaths from unsafe abortions.

Furthermore, as announced at ICPD+25 in Nairobi in November 2019, “Zero avoidable maternal deaths” is the goal of UNFPA. Almost every death and complications from unsafe abortion would be avoided if safe abortion were available and accessible across the world.

Lastly, the importance of task-sharing for provision of abortion care – i.e. involving nurses and midwives (and pharmacists) does not make an appearance, although it is policy of WHO via the 2015 guideline by the Department of Reproductive Health and Research: Health worker roles in providing safe abortion care and post-abortion contraception.

In the Campaign newsletter of 5 May 2017, we shared the text on abortion provision from the 2013 handbook of the International Confederation of Midwives (ICM) – Essential Competencies for Basic Midwifery Practice. Abortion-related care was mentioned in two main places, first at the end of the section on Competency #5 Post-partum care = “Perform manual vacuum aspiration of the uterus for emergency treatment of late post-partum haemorrhage.” Thus, abortion is important as a form of emergency obstetric care, which should be available in case of need for every pregnant woman. Competency #7 in the handbook is devoted to abortion-related care. The handbook says: “Midwives provide a range of individualised, culturally sensitive abortion-related care services for women requiring or experiencing pregnancy termination or loss that are congruent with applicable laws and regulations and in accord with national protocols.”

In the October 2019 version of the Competencies, however, abortion is addressed on page 16 under the heading “Provide care to women with unintended and unwanted pregnancies”. Providing abortion care itself – i.e. providing pills or MVA – is described as an “additional skill”, not an essential competency.

We call on WHO, UNFPA, ICM and their partners to draw attention to the importance of nurses and midwives in ensuring the right to safe abortion for those with unwanted pregnancies during this year of the midwife and nurse, and to reinstate the competency to provide abortions as both essential care and emergency obstetric care for those who are pregnant within that competency.

WHO SOURCE + PHOTO: WHO News Room, January 2020