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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Pregnancy and Childbirth 1/2018

Determination of medical abortion success by women and community health volunteers in Nepal using a symptom checklist

BMC Pregnancy and Childbirth > Ausgabe 1/2018
Kathryn L. Andersen, Mary Fjerstad, Indira Basnett, Shailes Neupane, Valerie Acre, Sharad Sharma, Emily Jackson



We sought to determine if female community health volunteers (FCHVs) and literate women in Nepal can accurately determine success of medical abortion (MA) using a symptom checklist, compared to experienced abortion providers.


Women undergoing MA, and FCHVs, independently assessed the success of each woman’s abortion using an 8-question symptom checklist. Any answers in a red-shaded box indicated that the abortion may not have been successful. Women’s/FCHVs’ assessments were compared to experienced abortion providers using standard of care.


Women’s (n = 1153) self-assessment of MA success agreed with abortion providers’ determinations 85% of the time (positive predictive value = 90, 95% CI 88, 92); agreement between FCHVs and providers was 82% (positive predictive value = 90, 95% CI 88, 92). Of the 92 women (8%) requiring uterine evacuation with manual vacuum aspiration (n = 84, 7%) or medications (n = 8, 0.7%), 64% self-identified as needing additional care; FCHVs identified 61%. However, both women and FCHVs had difficulty recognizing that an answer in a red-shaded box indicated that the abortion may not have been successful. Of the 453 women with a red-shaded box marked, only 35% of women and 41% of FCHVs identified the need for additional care.


Use of a checklist to determine MA success is a promising strategy, however further refinement of such a tool, particularly for low-literacy settings, is needed before widespread use.
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