Population growth and advances in contraceptive technology are discussed in relation to changes in birth control attitudes and practices and the expansion of public family planning programs. The literature describing training, utilization, and effectiveness of non-physicians in providing family planning services is reviewed. Studies comparing physician and non-physician provision of oral contraceptives and IUD insertions are discussed. On the basis of extensive supporting data, the author concludes that many functions which formerly were in the physician's province are as safely and perhaps more appropriately performed by persons with less medical sophistication. Recommendations are made regarding the present and future role of nurses as primary care providers in family planning.
PIP: Literature on the effectiveness of non-physicians in providing family planning services is reviewed and the conclusion drawn that many tasks traditionally performed by physicians can be performed just as adequately by non-physicians. Furthermore the nurturant role played by many non-physicians may actually enhance the well-being of the patients. Many investigators have stressed the desirability of increasing the role of trained midwives and non-physicians in the delivery of family planning services both in developing and developed countries. The U.S. government had gradually increased funding for training nurses and other non-physician personnel in the delivery of primary health care for women. Several studies have investigated the effectiveness of graduates of these training programs. Most of the studies report positive results; however, relevant comparative data is frequently lacking in these studies. A number of case control IUD studies report similar or higher rates of acceptance and continuation for insertions performed by non-physicians when compared to those performed by physicians. In many of these studies, however, non-physicians referred complicated insertions to physicians and the results may be biased. The role of non-physicians in prescribing oral contraceptives is controversial. A physical examination prior to prescribing oral contraceptives has been traditionally required. The results of several studies lend support to the contention that pelvic exams for most women are probably an unnecessary prerequisite for prescribing oral contraceptives. Future investigations should attempt to compare the effectiveness of physicians and non-physicians in terms of 1) long term physical outcomes; 2) the degree of education, counseling, and emotional support given to patients; and 3) cost-effectiveness.