In their Abortion Care Guideline (2022), the World Health Organization (WHO) provides evidence-based guidance on how to involve a wider range of health workers and pregnant people themselves in the provision or self-management of abortion care, in order to “encourage optimization of the available health workforce, address health system shortages of specialized health-care professionals, reduce costs and improve affordability, improve equity and equality in access to health care and increase the acceptability of health services for those who need them.” The recommendations made by WHO are intended for all resource settings, refer to a range of types of health workers who can safely, effectively and satisfactorily perform some or all of the specific abortion-related tasks. It is assumed that any health worker discussed has the basic training required of that type of health worker and that they will have received the appropriate task-specific training and information prior to performing that task.
Individual/ Self
Provision of information on abortion care: No recommendation made
Provision of abortion counselling: No recommendation made
Cervical priming with medication prior to surgical abortion at any gestational age: No recommendation made
Vacuum aspiration for induced abortion at < 14 weeks*: No recommendation made
Medical management of induced abortion at gestational ages < 12 weeks: Recommend
Cervical priming with osmotic dilators prior to D&E at gestational ages ≥ 12 weeks: No recommendation made
D&E for surgical abortion at gestational ages ≥ 14 weeks: Recommend against: No recommendation made
Medical management of induced abortion at gestational ages ≥ 12 weeks: No recommendation made
Vacuum aspiration for management of uncomplicated incomplete abortion at gestational ages < 14 weeks: No recommendation made
Medical management of uncomplicated incomplete abortion with misoprostol at gestational ages < 14 weeks: No recommendation made
Medical management of intrauterine fetal demise at gestational ages ≥ 14 to ≤ 28 weeks: No recommendation made
Insertion and removal of intrauterine devices (IUDs): No recommendation made
Insertion and removal of implants: No recommendation made
Administration of injectable contraceptives: Recommend
Tubal ligation: No recommendation made
Initial management of non-life-threatening post-abortion hemorrhage or infection: No recommendation made
Community health worker
Provision of information on abortion care: Recommend
Provision of abortion counselling: Recommend
Cervical priming with medication prior to surgical abortion at any gestational age: Suggest (3)
Condition: Health worker ensures continuity of care from the time of cervical priming to the abortion procedure
Vacuum aspiration for induced abortion at < 14 weeks*: Recommend against
Medical management of induced abortion at gestational ages < 12 weeks: Recommend
Cervical priming with osmotic dilators prior to D&E at gestational ages ≥ 12 weeks: Recommend against
D&E for surgical abortion at gestational ages ≥ 14 weeks: Recommend against: Recommend against
Medical management of induced abortion at gestational ages ≥ 12 weeks: Recommend against
Vacuum aspiration for management of uncomplicated incomplete abortion at gestational ages < 14 weeks: Recommend against
Medical management of uncomplicated incomplete abortion with misoprostol at gestational ages < 14 weeks: Recommend
Medical management of intrauterine fetal demise at gestational ages ≥ 14 to ≤ 28 weeks: Recommend against
Insertion and removal of intrauterine devices (IUDs): Recommend against
Insertion and removal of implants: Suggest (7)
Condition: In the context of rigorous research
Administration of injectable contraceptives: Recommend
Tubal ligation: Recommend against
Initial management of non-life-threatening post-abortion hemorrhage or infection: Recommend against
Pharmacy workers
Provision of information on abortion care: Suggest (1)
Condition: In contexts where the pharmacy worker is under the direct supervision of a pharmacist and there is access or referral to appropriate health services
Provision of abortion counselling: Suggest (2)
Condition: Both medical and surgical abortion counselling is provided and there is access or referral to appropriate health services should the client choose a surgical abortion method
Cervical priming with medication prior to surgical abortion at any gestational age: Suggest (3)
Condition: Health worker ensures continuity of care from the time of cervical priming to the abortion procedure
Vacuum aspiration for induced abortion at < 14 weeks*: Recommend against
Medical management of induced abortion at gestational ages < 12 weeks: Recommend
Cervical priming with osmotic dilators prior to D&E at gestational ages ≥ 12 weeks: Recommend against
D&E for surgical abortion at gestational ages ≥ 14 weeks: Recommend against: Recommend against
Medical management of induced abortion at gestational ages ≥ 12 weeks: Recommend against
Vacuum aspiration for management of uncomplicated incomplete abortion at gestational ages < 14 weeks: Recommend against
Medical management of uncomplicated incomplete abortion with misoprostol at gestational ages < 14 weeks: Recommend
Medical management of intrauterine fetal demise at gestational ages ≥ 14 to ≤ 28 weeks: Recommend against
Insertion and removal of intrauterine devices (IUDs): Recommend against
Insertion and removal of implants: Recommend against
Administration of injectable contraceptives: Recommend
Tubal ligation: Recommend against
Initial management of non-life-threatening post-abortion hemorrhage or infection: Recommend against
Pharmacists
Provision of information on abortion care: Recommend
Provision of abortion counselling: Suggest (2)
Condition: Both medical and surgical abortion counselling is provided and there is access or referral to appropriate health services should the client choose a surgical abortion method
Cervical priming with medication prior to surgical abortion at any gestational age: Suggest (3)
Condition: Health worker ensures continuity of care from the time of cervical priming to the abortion procedure
Vacuum aspiration for induced abortion at < 14 weeks*: Recommend against
Medical management of induced abortion at gestational ages < 12 weeks: Recommend
Cervical priming with osmotic dilators prior to D&E at gestational ages ≥ 12 weeks: Recommend against
D&E for surgical abortion at gestational ages ≥ 14 weeks: Recommend against: Recommend against
Medical management of induced abortion at gestational ages ≥ 12 weeks: Recommend against
Vacuum aspiration for management of uncomplicated incomplete abortion at gestational ages < 14 weeks: Recommend against
Medical management of uncomplicated incomplete abortion with misoprostol at gestational ages < 14 weeks: Recommend
Medical management of intrauterine fetal demise at gestational ages ≥ 14 to ≤ 28 weeks: Recommend against
Insertion and removal of intrauterine devices (IUDs): Recommend against
Insertion and removal of implants: Recommend against
Administration of injectable contraceptives: Recommend
Tubal ligation: Recommend against
Initial management of non-life-threatening post-abortion hemorrhage or infection: Recommend against
Traditional/ Complementary medicine professionals
Provision of information on abortion care: Recommend
Provision of abortion counselling: Recommend
Cervical priming with medication prior to surgical abortion at any gestational age: Recommend
Vacuum aspiration for induced abortion at < 14 weeks*: Recommend
Medical management of induced abortion at gestational ages < 12 weeks: Recommend
Cervical priming with osmotic dilators prior to D&E at gestational ages ≥ 12 weeks: Suggest (3)
Condition: Health worker ensures continuity of care from the time of cervical priming to the abortion procedure
D&E for surgical abortion at gestational ages ≥ 14 weeks: Recommend against: Suggest (5)
Condition: In contexts where established health system mechanisms involve these health workers in other tasks related to maternal and reproductive health
Medical management of induced abortion at gestational ages ≥ 12 weeks: Suggest (6)
Condition: In contexts where access to appropriate surgical backup and proper infrastructure is available to address incomplete abortion or other complications
Vacuum aspiration for management of uncomplicated incomplete abortion at gestational ages < 14 weeks: Recommend
Medical management of uncomplicated incomplete abortion with misoprostol at gestational ages < 14 weeks: Recommend
Medical management of intrauterine fetal demise at gestational ages ≥ 14 to ≤ 28 weeks: Suggest (6)
Condition: In contexts where access to appropriate surgical backup and proper infrastructure is available to address incomplete abortion or other complications
Insertion and removal of intrauterine devices (IUDs): Suggest (5)
Condition: In contexts where established health system mechanisms involve these health workers in other tasks related to maternal and reproductive health
Insertion and removal of implants: Suggest (5)
Condition: In contexts where established health system mechanisms involve these health workers in other tasks related to maternal and reproductive health
Administration of injectable contraceptives: Recommend
Tubal ligation: Recommend against
Initial management of non-life-threatening post-abortion hemorrhage or infection: Recommend
Auxiliary nurses/ Auxiliary nurse midwives
Provision of information on abortion care: Recommend
Provision of abortion counselling: Recommend
Cervical priming with medication prior to surgical abortion at any gestational age: Recommend
Vacuum aspiration for induced abortion at < 14 weeks*: Suggest (4)
Condition: In contexts where established health system mechanisms involve these health workers in providing other basic emergency obstetric care
Medical management of induced abortion at gestational ages < 12 weeks: Recommend
Cervical priming with osmotic dilators prior to D&E at gestational ages ≥ 12 weeks: Recommend
D&E for surgical abortion at gestational ages ≥ 14 weeks: Recommend against
Medical management of induced abortion at gestational ages ≥ 12 weeks: Suggest (6)
Condition: In contexts where access to appropriate surgical backup and proper infrastructure is available to address incomplete abortion or other complications
Vacuum aspiration for management of uncomplicated incomplete abortion at gestational ages < 14 weeks: Suggest (4)
Condition: In contexts where established health system mechanisms involve these health workers in providing other basic emergency obstetric care
Medical management of uncomplicated incomplete abortion with misoprostol at gestational ages < 14 weeks: Recommend
Medical management of intrauterine fetal demise at gestational ages ≥ 14 to ≤ 28 weeks: Suggest (6)
Condition: In contexts where access to appropriate surgical backup and proper infrastructure is available to address incomplete abortion or other complications
Insertion and removal of intrauterine devices (IUDs): Suggest (7)/ Recommend
Condition: In the context of rigorous research
Insertion and removal of implants: Suggest (8)
Condition: In the contest of targeted monitoring and evaluation
Administration of injectable contraceptives: Recommend
Tubal ligation: Recommend against
Initial management of non-life-threatening post-abortion hemorrhage or infection: Recommend
Nurses
Provision of information on abortion care: Recommend
Provision of abortion counselling: Recommend
Cervical priming with medication prior to surgical abortion at any gestational age: Recommend
Vacuum aspiration for induced abortion at < 14 weeks*: Recommend
Medical management of induced abortion at gestational ages < 12 weeks: Recommend
Cervical priming with osmotic dilators prior to D&E at gestational ages ≥ 12 weeks: Recommend
D&E for surgical abortion at gestational ages ≥ 14 weeks: Recommend against
Medical management of induced abortion at gestational ages ≥ 12 weeks: Suggest (6)
Condition: In contexts where access to appropriate surgical backup and proper infrastructure is available to address incomplete abortion or other complications
Vacuum aspiration for management of uncomplicated incomplete abortion at gestational ages < 14 weeks: Recommend
Medical management of uncomplicated incomplete abortion with misoprostol at gestational ages < 14 weeks: Recommend
Medical management of intrauterine fetal demise at gestational ages ≥ 14 to ≤ 28 weeks: Suggest (6)
Condition: In contexts where access to appropriate surgical backup and proper infrastructure is available to address incomplete abortion or other complications
Insertion and removal of intrauterine devices (IUDs): Recommend
Insertion and removal of implants: Recommend
Administration of injectable contraceptives: Recommend
Tubal ligation: Sugggest (7)
Condition: In the context of rigorous research
Initial management of non-life-threatening post-abortion hemorrhage or infection: Recommend
Midwives
Provision of information on abortion care: Recommend
Provision of abortion counselling: Recommend
Cervical priming with medication prior to surgical abortion at any gestational age: Recommend
Vacuum aspiration for induced abortion at < 14 weeks*: Recommend
Medical management of induced abortion at gestational ages < 12 weeks: Recommend
Cervical priming with osmotic dilators prior to D&E at gestational ages ≥ 12 weeks: Recommend
D&E for surgical abortion at gestational ages ≥ 14 weeks: Suggest (5)
Condition: In contexts where established health system mechanisms involve these health workers in other tasks related to maternal and reproductive health
Medical management of induced abortion at gestational ages ≥ 12 weeks: Suggest (6)
Condition: In contexts where access to appropriate surgical backup and proper infrastructure is available to address incomplete abortion or other complications
Vacuum aspiration for management of uncomplicated incomplete abortion at gestational ages < 14 weeks: Recommend
Medical management of uncomplicated incomplete abortion with misoprostol at gestational ages < 14 weeks: Recommend
Medical management of intrauterine fetal demise at gestational ages ≥ 14 to ≤ 28 weeks: Suggest (6)
Condition: In contexts where access to appropriate surgical backup and proper infrastructure is available to address incomplete abortion or other complications
Insertion and removal of intrauterine devices (IUDs): Recommend
Insertion and removal of implants: Recommend
Administration of injectable contraceptives: Recommend
Tubal ligation: Sugggest (7)
Condition: In the context of rigorous research
Initial management of non-life-threatening post-abortion hemorrhage or infection: Recommend
Associate/ Advanced associate clinicians
Provision of information on abortion care: Recommend
Provision of abortion counselling: Recommend
Cervical priming with medication prior to surgical abortion at any gestational age: Recommend
Vacuum aspiration for induced abortion at < 14 weeks*: Recommend
Medical management of induced abortion at gestational ages < 12 weeks: Recommend
Cervical priming with osmotic dilators prior to D&E at gestational ages ≥ 12 weeks: Recommend
D&E for surgical abortion at gestational ages ≥ 14 weeks: Suggest (5)
Condition: In contexts where established health system mechanisms involve these health workers in other tasks related to maternal and reproductive health
Medical management of induced abortion at gestational ages ≥ 12 weeks: Suggest (6)
Condition: In contexts where access to appropriate surgical backup and proper infrastructure is available to address incomplete abortion or other complications
Vacuum aspiration for management of uncomplicated incomplete abortion at gestational ages < 14 weeks: Recommend
Medical management of uncomplicated incomplete abortion with misoprostol at gestational ages < 14 weeks: Recommend
Medical management of intrauterine fetal demise at gestational ages ≥ 14 to ≤ 28 weeks: Suggest (6)
Condition: In contexts where access to appropriate surgical backup and proper infrastructure is available to address incomplete abortion or other complications
Insertion and removal of intrauterine devices (IUDs): Recommend
Insertion and removal of implants: Recommend
Administration of injectable contraceptives: Recommend
Tubal ligation: Recommend
Initial management of non-life-threatening post-abortion hemorrhage or infection: Recommend
Generalist/ Specialist medical practitioners
Provision of information on abortion care: Recommend
Provision of abortion counselling: Recommend
Cervical priming with medication prior to surgical abortion at any gestational age: Recommend
Vacuum aspiration for induced abortion at < 14 weeks*: Recommend
Medical management of induced abortion at gestational ages < 12 weeks: Recommend
Cervical priming with osmotic dilators prior to D&E at gestational ages ≥ 12 weeks: Recommend
D&E for surgical abortion at gestational ages ≥ 14 weeks: Recommend
Medical management of induced abortion at gestational ages ≥ 12 weeks: Recommend
Vacuum aspiration for management of uncomplicated incomplete abortion at gestational ages < 14 weeks: Recommend
Medical management of uncomplicated incomplete abortion with misoprostol at gestational ages < 14 weeks: Recommend
Medical management of intrauterine fetal demise at gestational ages ≥ 14 to ≤ 28 weeks: Recommend
Insertion and removal of intrauterine devices (IUDs): Recommend
Insertion and removal of implants: Recommend
Administration of injectable contraceptives: Recommend
Tubal ligation: Recommend
Initial management of non-life-threatening post-abortion hemorrhage or infection: Recommend
Adapted from World Health Organization. (2022). Abortion care guideline. Geneva: World Health Organization.
World Health Organization definition of health worker categories and roles
Description of qualifications and tasks
Community health worker
A person who performs functions related to health-care delivery/information provision and has been trained in some way in the context of the task, but has received no formal professional or paraprofessional certificate or tertiary education degree.
Pharmacy worker
Technicians and assistants who perform a variety of tasks associated with dispensing medicinal products under the guidance of a pharmacist. They inventory, prepare and store medications and other pharmaceutical compounds and supplies, and may dispense medicines and drugs to clients and instruct on their use as prescribed by health professionals. Technicians typically receive two or three years of training in a pharmaceutical school, with an award not equivalent to a university degree. Assistants have usually also been through two or three years of secondary school, with a subsequent period of on-the-job training or apprenticeship.
Pharmacist
A health-care practitioner who dispenses medicinal products. A pharmacist can counsel on the proper use and adverse effects of drugs and medicines following prescriptions issued by medical doctors/health-care professionals. Education includes university-level training in theoretical and practical pharmacy, pharmaceutical chemistry or a related field.
Traditional and complementary medicine professionals
A professional of traditional and complementary systems of medicine (non-allopathic physician) whose training includes a four- or five-year university degree that teaches human anatomy, physiology, management of normal labor and the pharmacology of modern medicines used in obstetrics and gynecology, in addition to their systems of medicine.
Auxiliary nurse midwife and auxiliary nurse
An auxiliary nurse is someone trained in basic nursing skills, but not in nursing decision making. An auxiliary nurse midwife has basic nursing skills and some midwifery competencies but is not fully qualified as a midwife. The duration of training may vary from a few months up to three years. A period of on-the-job training may be included, and this is sometimes formalized in apprenticeships.
Nurse
A person who has been legally authorized (registered) to practice after examination by a state board of nurse examiners or similar regulatory authority. Education includes three or more years in nursing school, and leads to a university or postgraduate university degree or the equivalent.
Midwife
A person who has been registered by a state midwifery or similar regulatory authority and has been trained in the essential competencies for midwifery practice. Training typically lasts three or more years in nursing or midwifery school, and leads to a university degree or the equivalent. A registered midwife has the full range of midwifery skills, which include abortion.
Advanced associate clinician and associate clinician
A professional clinician with basic competencies to diagnose and manage common medical and surgical conditions, and also to perform some types of surgery. Training generally requires three or four years post-secondary education in an established higher education institution. The clinician is registered and their practice is regulated by a national or subnational regulatory authority.
Generalist medical practitioner
A medical doctor who holds a university-level degree in basic medical education but does not have a specialization in obstetrics and gynecology.
Specialist medical practitioner
A medical doctor with postgraduate clinical training and specialization in obstetrics and gynecology.
Adapted from World Health Organization. (2022). Abortion care guideline. Geneva: World Health Organization.