SOUTH AFRICA: Accuracy of gestational age estimation from last menstrual period among women seeking abortion in South Africa, with a view to task sharing: a mixed methods study

by Deborah Constant, Jane Harries, Jennifer Moodley, Landon Myer

Reproductive Health (2017) 14:100. DOI 10.1186/s12978-017-0365-7  Open access

Plain English abstract

Medical abortion was introduced in 2011 in South Africa, is very effective and safe for abortion up to 9 weeks and does not require specialized surgical skills. However, introductory protocols required an ultrasound examination be done to date the pregnancy using equipment and expertise not widely available, especially in more remote rural areas. If women can remember the first day of their last menstrual period (LMP), this can be used to work out their pregnancy duration, and if community health workers (CHWs) can ascertain pregnancy duration from women’s LMP, this could assist expansion of medical abortion services into primary care public health facilities across the country.

This study identified women for whom LMP dating would suffice to ensure a safe and effective medical abortion , and gauged nurses’ and CHWs’ opinions on how they could share responsibility for this activity.

CHWs recorded LMP among women seeking abortion at reproductive health clinics in South Africa, and pregnancy duration was calculated. Thereafter, providers performed an ultrasound examination. Proportions were calculated for women incorrectly assessed as eligible for medical abortion from LMP overall, and according to different LMP cut –off dates. Providers and CHWs were also interviewed.

A small percentage (3%) of women underestimated their LMP such that the chances of continuing a pregnancy may increase and women may experience more side effects. In general, providers and CHWs favored sharing responsibility for establishing gestational age eligibility for medical abortion, but were doubtful that women reported accurate LMP dates. They also had different perspectives on ways to implement this. Future implementation of task sharing gestational age estimation for medical abortion should meet women’s privacy needs as well as health-care workers’ concerns about possible health risks.