Nurse and midwife interventions to improve access to contraception and abortion in primary care: a systematic review

OBJECTIVES: Amid the unmet need for contraception and safe abortion care globally, harnessing the capabilities of primary care nurses and midwives is vital for facilitating equitable access to these critical healthcare services. We aimed to evaluate the impact of interventions delivered by primary care nurses and/or midwives on facilitating access to contraception and abortion care. STUDY DESIGN: framework for access to healthcare. RESULTS: Twenty-three articles met the inclusion criteria; 20 related to contraception and three to abortion care. Access to contraception and abortion care was predominantly focused on addressing consumer-related factors such as perception of healthcare needs and support to engage with services. Findings suggested home visiting, telehealth and reproductive counselling interventions by primary care nurses and midwives can be effective at increasing women's access to contraception. There was some evidence these clinicians could be acceptable providers of medical abortion; however, there were no articles on procedural abortion. CONCLUSIONS: Primary care nurses and midwives have the potential to improve women's access to contraception care, particularly through the use of home visiting or telehealth strategies. However, evidence on how nurses and midwives can support access to abortion care is scarce and more research is needed, particularly for procedural abortion. Further research should also target under-studied access factors, including the acceptability of nurses and midwives providing contraception and abortion care and consumers' ability to reach and pay for this healthcare.