Comprehensive abortion care: WHO guideline update
M3 Global Newsdesk Jun 21, 2022
The new guidelines released by World Health Organization WHO recently on abortion care in an effort to prevent the 25 million unsafe abortions that occur each year worldwide are penned down in this article.
- WHO released new recommendations on abortion care in an effort to reduce unsafe abortions worldwide.
- For the first time, WHO is recommending telemedicine to support those needing medication for abortions.
- To reach WHO’s goal of decreasing unsafe abortions, policy barriers that limit access to abortion care need to be removed.
WHO made over 50 evidence-based recommendations focusing on clinical practice, health service delivery, and legal and policy interventions. As our country reacts to the leak of a Supreme Court draft opinion that could overturn Roe v. Wade, and pivot the abortion ruling to state governments—prompting passionate discussion and protest from both sides of the argument—the WHO position on this issue has never been more relevant.
Barriers to safe abortions
Abortion is a common procedure worldwide, with 60% of unintended pregnancies and 30% of all pregnancies ending this way. However, estimates suggest that 45% of abortions are not performed safely, with 97% of unsafe abortions occurring in developing countries.
Women who face barriers to safe abortions may resort to attempting to induce abortion themselves, using unsafe methods, or seeking help from untrained providers. While abortion is legal in almost all countries, there often are restrictions placed on the circumstances under which a woman can access a legal abortion.
In many countries, abortion is regulated not only through healthcare laws but also through criminal laws. This could deter pregnant women from seeking such care out of fear of possible legal repercussions.
As per Craig Lissner, Acting Director for Sexual and Reproductive Health and Research at WHO:
“Being able to obtain a safe abortion is a crucial part of health care. Acting Director for Sexual and Reproductive Health and Research at WHO, in a press release. Nearly every death and injury that results from unsafe abortion are entirely preventable. That’s why we recommend women and girls can access abortion and family planning services when they need them."
Improving access to quality abortion care
The WHO guidelines aim to improve the quality of abortion care available to women and girls. Recommendations include task sharing by different health care providers, making medical abortion pills easily accessible, and ensuring access to accurate abortion care information.
The recommendations also include, for the first time, guidelines on the use of telemedicine to ensure access to abortion care and family planning services.
New pain management guidelines
While WHO previously recommended NSAIDs for routine pain management for a surgical abortion at any gestational age, the latest recommendations include the use of a paracervical block for surgical abortions at < 14 weeks. The organization also suggests a paracervical block for pain management when cervical priming with osmotic dilators is used prior to surgical abortion at ≥ 14 weeks.
In addition to clinical and service delivery recommendations, the WHO recommends that policy barriers that stand in the way of safe abortions be removed. These include criminalization, mandatory wait times, requirements for approval by other individuals (eg, partners or family members), and time-limit restrictions on when during pregnancy an abortion can be performed. Such barriers can ultimately delay access to treatment and may put women and girls at increased risk of unsafe abortions, stigmatization, and health complications.
Research shows that instead of decreasing the number of abortions, limiting access is more likely to drive women and girls to seek unsafe abortion procedures. In countries where abortion is legal, 90% of abortions are safe. In countries with the most restrictions on abortions, only 25% of abortions are safe.
To Dr Bela Ganatra, Head of WHO’s Prevention of Unsafe Abortion Unit, who also is a member of the Guideline Steering Group, the evidence is quite clear:
“If you want to prevent unintended pregnancies and unsafe abortions, you need to provide women and girls with a comprehensive package of sexuality education, accurate family planning information and services, and access to quality abortion care.”
Upon release of these guidelines, WHO vowed to offer support to interested countries wishing to implement these new recommendations.
What this means for you
Recently released evidence-based guidelines from WHO on abortion care are aimed at reducing the number of unsafe abortions worldwide. These recommendations span clinical practice, service delivery, and policy interventions to support safe abortion practices. They also recommend task-sharing by healthcare providers and promote the use of telemedicine. Staying current on these guidelines will be especially helpful if the US legal landscape shifts on this hot-button issue.
Disclaimer: This story is contributed by Samar Mahmoud and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.
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