Abstract

PIP: 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 a physician examination. In rural areas in Thailand there is approximately 1 physician per 110,000 people. However, there is a relative abundance of auxiliary midwives. These women have 10 years basic education and receive an 18 month midwife and public health course. There is 1 such auxiliary midwife per 8000 rural inhabitants. In prescribing oral contraceptives, the auxiliary midwives used a simple checklist to rule out contraindications, and no pelvic examinations were performed. In addition to the 4 rural provinces studied, 13 control provinces were observed;y There was a 4 fold increase in the number of pill acceptors in the 4 study provinces in the 6 months following the initiation of the study in 1969 compared to the 6 months before. There was no increase noted in the incidence of side effects or complications. There was a larger number of pill acceptors and a higher percentage of the eligible female population who accepted the pill in the 4 study provinces than in the 13 control provinces. The continuation rates were higher for pills prescribed by midwives than for those prescribed by physicians. At the end of 1 year of study, the Minstry of Public Health ruled that the more than 3000 auxiliary midwives throughout the country who had received basic family planning training could prescribe the pill, with a resultant 3-fold increase in the number of pill acceptors nationwide, from approximately 8800 in April 1970 to almost 31,000 in December 1971. It is emphasized that the increased utilization of nursing and paramedical personnel is an absolute necessity in many parts of the world.