The World Health Organisation’s offering, Safe abortion: Technical and policy guidance for health systems, is a panoramic view comprising comprehensive guidelines to govern all the technical and policy requirements of health systems looking to incorporate safe abortion mechanisms in their domain.
The guidance indicates that health evidence, technologies and the human rights rationale towards providing safe, comprehensive abortion care have evolved considerably over the past twenty years or so. However, notwithstanding these advances, there is an estimated amount of as many as 22 million abortions being performed unsafely on an annual basis, culminating in the death of as many as 47 000 women and disabilities for an additional 5 million women. These deaths are preventable – had there been some sexuality education, family planning, access to safe and legally induced abortions, and care for complications arising out of abortion.
The guidance explains that safe abortions are legally available in most developed countries, upon request or under the ambit of broad social and economic grounds. In that milieu, services are generally easily accessible and available. But in countries where abortion is either legally banned or restricted heavily, safe abortions become something that remains accessible only within the domain of the affluent. Poor women are largely left with next to no choice. This causes them to resort to unsafe providers – ultimately leading to their death, or other complications. These deaths invariably become the “social and financial responsibility of the public health system”. Considering the need for evidence-based best practices for providing safe abortion care in order to protect the health of women, the WHO updated its 2003 publication.
The guidance acknowledges the differences in the legal, regulatory, policy and service delivery mechanisms in each country from the other, but builds uniform practices that can help create strongly informed decision-making initiatives towards accessing and availing safe abortion. The guidance details the following elements:
Recommendations related to specific methods of surgical abortion
Recommendations for medical abortion
Recommendations for the surgical or medical methods preferred beyond 12 weeks of gestation.
Recommendations related to clinical care prior to induced abortion, including consideration of cervical preparation, use of diagnostic ultrasonography, use of antibiotics and pain-management options.
Recommendations related to post-abortion care, including initiation of contraception, treatment of incomplete abortion and whether there is a medical need for routine follow-up visits after induced abortion.
Recommendations related to application of the clinical guidance in establishing and strengthening abortion services, including the development of national standards and guidelines; training and equipping of service providers; assessing, prioritizing and financing of health-system needs; introducing and scaling-up of interventions; and monitoring and evaluation.
Recommendations concerning legal, policy and human rights dimensions
The core principles on which his guidance was built on the acknowledgment of the need to fill important information gaps using primary research, and on the need to build research towards de-medicalising abortion care. It also details some observations for the future, concerning safe abortions.
To download the report, click here.
 Ahman E, Shah IH. New estimates and trends regarding unsafe abortion mortality. International Journal of Gynecology and Obstetrics, 2011, 115:121–126.