Safe Abortion

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.

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.

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.

Medical abortion care encompasses the management of various clinical conditions including spontaneous and induced abortion (both viable and non-viable pregnancies) incomplete abortion and intrauterine fetal demise as well as post-abortion contraception. Medical management of abortion generally involves either a combination regimen of mifepristone and misoprostol or a misoprostol-only regimen. Medical abortion care plays a crucial role in providing access to safe effective and acceptable abortion care. In both high- and low-resource settings the use of medical methods of abortion have contributed to task shifting and sharing and more efficient use of resources. Moreover many interventions in medical abortion care particularly those in early pregnancy can now be provided at the primary-care level and on an outpatient basis which further increases access to care. Medical abortion care reduces the need for skilled surgical abortion providers and offers a non-invasive and highly acceptable option to pregnant individuals.

"Now with a new afterword by the author"--Back cover.

This multidisciplinary review of abortion is invaluable reading for clinicians and other care providers in the area of women's health.

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.