Clinical Updates in Reproductive Health

Introduction

Ipas’s Clinical Updates in Reproductive Health contain up-to-date, evidence-based clinical recommendations on comprehensive abortion care, with new topics and resources added regularly. The Clinical Updates in Reproductive Health provide concise, easy-to-read information about abortion care, combining the latest evidence with lessons learned from health professionals globally to produce relevant clinical recommendations.

Who should use this resource

First published in 2013, the Clinical Updates in Reproductive Health were designed originally as an up-to-date, evidence-based clinical resource for Ipas staff. Over time, the publication has also been of use to:

  • clinicians providing abortion care
  • clinical and public health professionals working on patient care protocols in public health systems and the private sector
  • safe abortion advocates and policymakers creating laws and policies that fulfill women’s, girls’ and pregnant people’s right to health

What’s new in this revision

In this edition of the Clinical Updates in Reproductive Health, you will find updated, evidence-based recommendations on more than 40 abortion care topics. During the 2023 update, we reviewed newly published literature related to follow-up care after medical abortion; cervical preparation before a  procedural abortion; the use of telemedicine and other innovative service delivery mechanisms for abortion care; self-management of the component parts of medical abortion as well as the medical abortion process overall; and health worker roles in abortion care. We updated our recommendations accordingly. Additionally, we updated with supportive and informative data the sections on misoprostol quality, pain management, screening for ectopic pregnancy, recommended regimens for mifepristone and misoprostol, and misoprostol used alone, the addition of letrozole to misoprostol-only medical abortion, home use of medical abortion pills, inducing fetal demise prior to abortion at or after 13 weeks, treatment for incomplete abortion and intrauterine demise, and postabortion contraception. We also reviewed newly published global guidelines for abortion care from the World Health Organization (2022) and others, and brought our recommendations into alignment whenever possible.

New for this edition of the Clinical Updates, we have incorporated tips for clinical practice into the recommendations for some topics. These tips are intended to help guide the implementation and operationalization of the recommendations contained in the Clinical Updates. Titled “In practice,” these tips can be found in sections related to pain management, instrument processing, recommended medical abortion and postabortion care medication regimens, and contraception.

Similarly, we have incorporated links to a number of our clinical resources directly into the Clinical Updates topics where appropriate. These “resources” include clinical tools and job aids for clinicians, and, in a few cases, information to support self-managed abortion. The resources are drawn from the evidence and recommendations contained in the Clinical Updates in Reproductive Health, and are found at the end of selected topics just before the references. Some of these online resources replace several of the items that were in the Appendices in previous editions, while others are new additions.

The online Clinical Updates (www.ipas.org/clinicalupdates) contains the recommendations included in this manual along with easy-to-use drop-down menus to help readers navigate quickly to the information they need. Both online and print/PDF editions are also available in Spanish, French and Portuguese.

Finally, in recognition that people who identify as transgender, non-binary, gender-fluid, and additional gender identities can experience pregnancy and abortion, we have attempted to incorporate gender inclusive language in this revision of the Clinical Updates in Reproductive Health. Most available evidence about abortion care has been conducted in populations of cisgender women; where specific studies included in the Clinical Updates in Reproductive Health describe study participants as “women,” we also use the term “women” to be consistent with what is reported. In our discussions of abortion generally, and when referring to all the gender diverse individuals requiring abortion care, we use the terms “people,” “individuals,” “abortion seeker,” or other gender inclusive language.

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