Trained midwives and physician assistants can provide first-trimester abortions as safely as doctors in developing countries, a new study has found.

Every year, more women die from illegal abortions than were killed in the atomic bombing of Hiroshima, Japan. A woman dies every eight minutes from an unsafe abortion, according to a commentary that accompanies the study, which will appear in Wednesday's issue of The Lancet.

Ina Warriner of the World Health Organization and her colleagues compared rates of complications from abortions performed either by doctors or by trained and government-accredited mid-level providers such as midwives.

Using the trained alternatives to doctors "provides women with more accessible and less costly means of safely terminating unintended pregnancies, freeing doctors for more complicated procedures," the researchers concluded.

In the study, 1,734 consenting women in Vietnam and 1,160 in South Africa were randomly assigned to a doctor or to a non-physician for their abortion. The procedures were done with modern but simple equipment in outpatient clinics.

In South Africa, the rate of complications was 1.4 per 100 women for the non-physicians and zero for doctors. In Vietnam, the rate was the same for both providers: 1.2 per 100 women.  

None of the patients treated for complications were admitted to hospital and there were no deaths.

"If all unsafe abortions were by trained and accredited providers, physicians or otherwise, there would be at least an 80 per cent reduction in complications … and far fewer deaths," Yap-Seng Chong and Citra Nurfarah Mattar of the obstetrics and gynaecology department at National University of Singapore wrote in their commentary.

Hiring non-physicians would also ease the shortage of trained professionals due to international migration, unwillingness to do abortions or reluctance to work in rural areas, the pair said.