Despite the legalisation of abortion in many countries worldwide, access to abortion is often restricted in many ways. Lack of availability of trained and willing physicians, inadequate and poor infrastructure as well as affordability are issues that are still contributing to poor access to abortion for many women living in countries that have legalised abortion. Improving access to early abortion despite the declining number of doctors willing to provide abortions is being addressed in some countries by expanding the role of advanced nurse-midwife practitioners in this field. There is good evidence to suggest that the outcome of first-trimester abortions performed by suitably trained non-medical practitioners is comparable in terms of safety and efficacy to abortions performed by doctors. These mid-level practitioners also have a key role in providing post-abortion care and contraception to women. We need to address outdated laws and regulations as well as political challenges that restrict both the ability of advanced nurse-midwife practitioners to provide abortion care and the opportunities to train them appropriately.
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