Roles for non-physicians in fertility regulation: An international overview of legal obstacles and solutions

For more than a decade the roles of nonphysicians in fertility regulation have been expanding. The article discusses the relationship between law and the expansion of those roles. The laws and regulations which effect these roles fall into three basic categories: those controlling the medical and other health-related professions, those regulating drugs and devices, and those affecting specific fertility regulation services. These in turn may either inhibit or facilitate the expansion of roles for non-physicians. Where legal barriers arise, and no feasible legal solution is developed, expansion of roles is difficult, if not impossible, as the law invariably reflects the prevailing views on who should provide fertility regulation services. In many countries, however, as roles have been changing, the law has been changing too in a way which affords legal protection to non-physicians. The emphasis to date has been on permitting them to assume expanding roles in the provision of contraceptives. Non-physicians are authorized to prescribe the Pill in at least 10 countries and to re-supply the Pill after prescription in seven others. Non-physicians are permitted to insert IUDs in at least 10 countries. Pilot projects are presently testing the feasibility of permitting non-physicians to perform sterilizations and early abortions. The law has an impact, for good or ill, on all of these arrangements.