WHO Offers Guidance to Health Systems in Providing Safe Abortion

The World Health Organization recently issued a significant new publication containing guidance for health systems on actions to ensure access to good-quality abortion services as allowed by law.

The World Health Organization (WHO) recently issued a significant new publication containing guidance for health systems on actions to ensure access to good-quality abortion services as allowed by law. The release of the guidance is an important step in global efforts to reduce deaths of women from unsafe abortion. Globally, WHO estimates that about 20 million unsafe abortions occur every year.

Consistent with WHO’s mandate to develop norms and standards for health services, the 106-page publication, titled Safe Abortion: Technical and Policy Guidance for Health Systems, fills a critical gap in reliable, evidence-based information. It includes recommendations on:

• clinical aspects of abortion services, including pregnancy diagnosis, provision of information and counseling, selection of an appropriate abortion method, and postabortion care
• essential elements needed to put good-quality, legal abortion services in place at each level of the system, including needs assessment, national norms and standards, training and supervision of providers, monitoring and evaluation of service quality, and financing
• legal and policy considerations in ensuring access to safe abortion to the extent allowed by law, including clarifying legal grounds for abortion, creating an enabling policy environment to ensure service quality and access for legally eligible women, and removing unnecessary administrative and regulatory barriers to legal care.

Published in early 2003, the guidance document responds specifically to a 1999 call by a Special Session of the United Nations General Assembly, which stated that "in circumstances where abortion is not against the law, health systems should train and equip health-service providers and should take other measures to ensure that such abortion is safe and accessible." Governments also agreed that “Additional measures should be taken to safeguard women’s health.”

Almost every country in the world legally permits abortion for at least some indications, yet services are rarely available or accessible to the full extent of the law. As a result, women resort to unsafe abortions, defined by WHO as those performed by persons lacking necessary skills or in an environment lacking minimal medical standards, or both. Unsafe abortion accounts for about 13 percent of pregnancy-related deaths, claiming the lives of approximately 67,000 women every year, according to WHO. In addition, studies indicate that at least one in five women who have an unsafe abortion suffers a reproductive tract infection, which can lead to infertility.

By contrast, the document points out that “procedures and techniques for early induced abortion are simple and safe. When performed by trained health care providers with proper equipment, correct technique and sanitary standards, abortion is one of the safest medical procedures….Properly provided services for early abortion save women’s lives and avoid the often substantial costs of treating preventable complications of unsafe abortion.”

The document was several years in development and benefited from contributions of numerous international experts from the fields of medicine, law, ethics, and public health, including participants in a WHO Technical Consultation on Safe Abortion in Geneva in September, 2000.

Copies of the document can be obtained from Marketing and Distribution, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 2476; fax: +41 22 791 4857; e-mail: bookorders@who.int. A summary is available online at the Reproductive Health section of the WHO website. Ipas has a limited number of copies available for distribution to nongovernmental organizations in developing countries. For information contact policy@ipas.org.

For more information, contact:
Kirsten Sherk
Senior Associate, Media Relations
e-mail: sherkk@ipas.org
phone: 919.960.5612
fax: 919.929.0258