Clinical Updates in Reproductive Health

Appendix: World Health Organization recommendations for health worker roles in abortion care

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.

About Us

We work with partners around the world to advance reproductive justice by expanding access to abortion and contraception.

Ipas Sustainable Abortion Care

Our Work

The global movement for legal, accessible abortion is growing. Our staff and partners in countries as diverse as Bolivia, Malawi and India are working to ensure all people can access high-quality abortion care.

Where We Work

The global movement for legal, accessible abortion is growing. Our staff and partners in countries as diverse as Bolivia, Malawi and India are working to ensure all people can access high-quality abortion care.

Resources

Our materials are designed to help reproductive health advocates and professionals expand access to high-quality abortion care.

For health professionals

For advocates and decisionmakers

Training
resources

For humanitarian settings

Abortion VCAT resources

For researchers and program implementors