Abortion Care Guideline

The objective of this guideline is to present the complete set of all WHO recommendations and best practice statements relating to abortion. While legal, regulatory, policy and service-delivery contexts may vary from country to country, the recommendations and best practices described in this document aim to enable evidence-based decision-making with respect to quality abortion care. This guideline updates and replaces the recommendations in all previous WHO guidelines on abortion care.

The Clinical practice handbook for safe abortion care is intended to facilitate the practical application of the clinical recommendations from the second edition of Safe abortion: technical and policy guidance for health systems (World Health Organization [WHO] 2012). While legal, regulatory, policy and service-delivery contexts may vary from country to country, the recommendations and best practices described in both of these documents aim to enable evidence-based decision-making with respect to safe abortion care.

At a UN General Assembly Special Session in 1999, governments recognised unsafe abortion as a major public health concern, and pledged their commitment to reduce the need for abortion through expanded and improved family planning services, as well as ensure abortion services should be safe and accessible. This technical and policy guidance provides a comprehensive overview of the many actions that can be taken in health systems to ensure that women have access to good quality abortion services as allowed by law.

Abortion is a legal medical procedure that has been provided to millions of American women. Since the Institute of Medicine first reviewed the health implications of national legalized abortion in 1975, there has been a plethora of related scientific research, including well-designed randomized clinical trials, systematic reviews, and epidemiological studies examining abortion care. This research has focused on examining the relative safety of abortion methods and the appropriateness of methods for different clinical circumstances. With this growing body of research, earlier abortion methods have been refined, discontinued, and new approaches have been developed. The Safety and Quality of Abortion Care in the United States offers a comprehensive review of the current state of the science related to the provision of safe, high-quality abortion services in the United States. This report considers 8 research questions and presents conclusions, including gaps in research.

Sets out guidelines that can help reduce the high levels of maternal morbidity and mortality associated with abortion whether spontaneous or induced. Recommendations and advice are backed by extensive practical experience and rooted in the principle that emergency care for the complications of abortion should be available 24 hours a day in every health care system. In view of the need to prevent life-threatening complications the book also establishes standards of safe abortion practice for use in those countries where abortion is permitted by law. Prevention of abortion through education and family planning is likewise discussed. Addressed to health managers administrators and care providers the book follows a step-by-step approach to the provision of emergency and preventive care. The first three chapters describe the magnitude of mortality and morbidity caused by unsafe abortions define the essential components of abortion care at each level in the health system and discuss the ways in which legal and societal factors affect abortion behaviour and care. Against this background the remaining eleven chapters provide technical and managerial guidelines for each component of service at each level of the health system needed to ensure that all women have access to care 24 hours a day. A chapter on planning is followed by three chapters outlining the clinical elements of emergency abortion care. Of particular value is a chapter on patient information and counselling which emphasizes the importance of providing information in a supportive manner. Other chapters offer detailed guidance on the facilities equipment and drugs needed for abortion care on the training and supervision of staff and on ways to overcome several obstacles that make it difficult for women in remote rural areas to receive timely care.

In view of the need for evidence-based best practices for providing safe abortion care in order to protect the health and human rights of women, the World Health Organization (WHO) has updated its 2003 publication Safe Abortion: Technical and Policy Guidance for Health Systems. In this process, the WHO standards for guideline development have been followed, including: identification of priority questions and outcomes; retrieval, assessment and synthesis of evidence; formulation of recommendations; and planning for dissemination, implementation, impact evaluation and updating. For the clinical recommendations presented in Chapter 2, evidence profiles related to the prioritized questions were prepared, based upon recent systematic reviews, most of which are included in the Cochrane Database of Systematic Reviews. In addition, Chapters 1, 3 and 4 of the original 2003 publication were reviewed and updated to reflect the latest estimates on unsafe abortion worldwide, new literature on the topic of service delivery, and new developments in international, regional and national human rights law. A guideline development group, comprising members of an international panel of experts, reviewed and revised the draft recommendations based on the evidence profiles, through a participatory, consensus-driven process. The target audience for this guidance is policy-makers, program managers and providers of abortion care. In general, the use of the recommendations should be individualized to each woman, with emphasis on her clinical status and the specific method of abortion to be used, while considering each woman s preferences for care.

Planned and regulated task shifting and task sharing can have a range of benefits. It can ensure a rational optimization of the available health workforce, address health system shortages of specialized health-care professionals, improve equity in access to health care and increase the acceptability of health services for those receiving them. This guideline provides a range of options for expanding of health worker roles in the provision of safe abortion care, the management of complications of abortion (also known as post-abortion care in some settings and provided as part of emergency obstetric care) and for post-abortion contraception provision.

The main aim of this practical Handbookis to strengthen counselling and communication skills of skilled attendants (SAs) and other health providers, helping them to effectively discuss with women, families and communities the key issues surrounding pregnancy, childbirth, postpartum, postnatal and post-abortion care. Counselling for Maternal and Newborn Health Careis divided into three main sections. Part 1 is an introduction which describes the aims and objectives and the general layout of the Handbook. Part 2 describes the counselling process and outlines the six key steps to effective counselling. It explores the counselling context and factors that influence this context including the socio-economic, gender, and cultural environment. A series of guiding principles is introduced and specific counselling skills are outlined. Part 3 focuses on different maternal and newborn health topics, including general care in the home during pregnancy; birth and emergency planning; danger signs in pregnancy; post-abortion care; support during labor; postnatal care of the mother and newborn; family planning counselling; breastfeeding; women with HIV/AIDS; death and bereavement; women and violence; linking with the community. Each Session contains specific aims and objectives, clearly outlining the skills that will be developed and corresponding learning outcomes. Practical activities have been designed to encourage reflection, provoke discussions, build skills and ensure the local relevance of information. There is a review at the end of each session to ensure the SAs have understood the key points before they progress to subsequent sessions.