The role of midwives in the provision of safe abortion care : a systematic review

Abstract

Background: Most cases of morbidity or mortality due to abortion are preventable. Midwives are more or less involved in the provision of abortion care, depending on national health sys-tems. The question arises as to how the involvement of midwives in abortion care influences the provision of pregnant people. Methods: A systematic search was carried out in the databases PubMed, CINAHL and Web of Science. 10 studies (RCTs, Meta-Analyses and Systematic Reviews) were included. CASP checklists were used for quality appraisal. Results: The syntheses of the results were done using thematic analysis. The following themes emerged: improvement of access to abortion care, abortion care – the midwife’s choice, midwives’ scope of practice in abortion care, barriers to high-quality care and structures supporting midwives’ involvement. Discussion: The expertise of midwives could be used to extend their role improving the pro-vision of safe abortion care. It is important to prioritise the de-stigmatisation of abortion. There is a need for evidence-based practice guidelines by and for midwives. Necessary health policy measures are listed, and an insight is given into how abortion care could be adapted to the reality and needs of pregnant people. The evidence on abortion care by midwives is low. De-pending on the comparability of settings, results can be implemented. Conclusion: Midwives can be involved in a variety of abortion-related practices to work au-tonomously from pre-abortion counselling to postabortion care. To fulfil this role as a primary caregiver, they require a supportive work environment and opportunities to receive additional support. Legal, political, organisational, and financial barriers as well as poor material supply and human resources that prevent midwives from offering care must be improved. More re-search is needed on the best ways to educate and support midwives in abortion care, and on challenges for midwives and patients.