Auxiliary midwife prescription of oral contraceptives

Abstract In 1969, the Thai Ministry of Public Health initiated a study in which auxiliary midwives in 4 rural provinces were allowed to prescribe oral contraceptives without the requirement of a physician examination. A simple checklist was utilized to rule out contraindications; pelvic examination was not required. There was no increase noted in the incidence of either side effects or complications. There was a fourfold increase in the number of pill acceptors in the 4 study provinces in the 6 months following initiation of the study, as compared to the 6 months before. In these provinces, this resulted in both a larger number of pill acceptors and a higher percentage of the eligible female population who accepted the pill than in the 13 control provinces, in spite of the much larger number of eligible women, health personnel, and facilities in the control provinces. In addition, the continuation rates were higher for pills prescribed by midwives than for those prescribed by physicians. At the end of one year of study, the Ministry of Public Health ruled that the more than 3,000 auxiliary midwives throughout the country who had received basic family planning training could prescribe the pill, with a resultant threefold increase in the number of pill acceptors nationwide, from approximately 8,800 in April 1970, to almost 31,000 in December 1971. The importance of the effective use of nurses and other paraprofessional personnel in family planning programs is emphasized.