WHO's updated safe abortion guidance emphasizes health and rights

Thursday, June 21, 2012

WHO safe abortion guidance released

In the 2nd edition of its groundbreaking 2003 publication Safe abortion: technical and policy guidance for health systems, the World Health Organization (WHO) presents updated  recommendations for use by health ministries, program managers and providers around the world. The new 2012 guidance incorporates the evolving human rights rationale for providing safe, comprehensive abortion care, along with current clinical and public health evidence.

The guidance includes four main topics:

  • The latest estimates on unsafe abortion worldwide and the public health, economic and human rights rationale for urgently addressing unsafe abortion;
  • Clinical recommendations for care before, during and after abortion based on recent systematic reviews of the medical literature;
  • New recommendations for service delivery and scaling up services;
  • Application of a human rights framework for policymaking and legislation related to abortion.

Articulation of a strong rights-based policy framework for improving access to safe abortion care is an important feature of the new guidance.  The guidance summarizes international human rights standards that support access to safe abortion and identifies barriers that hinder access to and timely provision of services.  Such barriers include lack of access to information, unnecessary restrictions on the health-care providers and facilities that can provide services, erosion of confidentiality and privacy, and unregulated conscientious objection on the part of health-care providers.

“Comprehensive abortion care is lifesaving,” says Ipas President and CEO Elizabeth Maguire. “We commend WHO’s respect for the essential role of abortion access in women’s health and their ability to fully exercise their human rights.”

The new guidance pays special attention to young women, who often experience greater delays in reaching care or inability to reach any care.  Barriers include legal restrictions, inability to pay, abortion stigma and lack of social support.  Where family planning services are available only to married women or where the incidence of non-consensual sex is high, young women are even more at risk. 

“Safe abortion services should be readily accessible and affordable to all women, including young women. We applaud WHO’s recommendations that services should be available at the primary-care level, with referral systems in place for all required higher-level care,” adds Maguire.

The new guidance also covers clinical recommendations to which Ipas’s medical director, Dr. Laura Castleman, contributed as part of the WHO technical consultation of experts convened last year to review the evidence for proposed changes.  The 2nd edition of the document addresses updated medical abortion regimens, the importance of safe methods of second-trimester abortion, appropriate pain management methods and the treatment of incomplete abortion and any complications.  WHO notes that mandatory laboratory tests, pre-abortion ultrasound scanning or follow-up visits after uncomplicated medical or surgical abortion are not necessary for the provision of safe abortion services. The guidance also urges that a woman’s decision to seek abortion care be respected without subjecting her to mandatory counseling.

The guidance also underscores that provision of contraceptive information, offers of counseling, methods and services is an essential part of abortion care, as it helps the woman avoid future unintended pregnancies.  WHO notes, however, that a woman’s acceptance of a contraceptive method must never be a precondition for providing her an abortion.

“The new guidance clearly draws from the most recent scientific evidence and emphasizes the importance of removing access barriers that have been proven medically unnecessary while emphasizing critical aspects of care such as pain management,” says Dr. Dalia Brahmi, Ipas Senior Clinical Advisor and former WHO Medical Officer who contributed to the guidance.

The guidance is designed to help reduce the nearly 22 million unsafe abortions that occur annually and result in death for roughly 47,000 women and disabilities for an additional 5 million.  Ninety-eight percent of the world’s unsafe abortions occur in developing countries – a proportion that has remained unchanged since 2000. Unsafe abortion estimates confirm that the legal status of abortion has little effect on a woman’s choice to seek an abortion but that legal restrictions on abortion dramatically reduce her access to safe abortion. In countries where abortion is highly restricted, unequal access to safe abortion has harmful results, and safe abortion is primarily a privilege of the rich.