Of the estimated 45 million pregnancies worldwide that are terminated
by abortion every year, perhaps 19 million involve unsafe procedures
performed by women themselves, by unskilled providers, or in settings
lacking the minimal medical standards. An estimated 68,000 women die
unnecessarily from complications resulting from unsafe abortion and
countless others suffer from infections, infertility, and other damage
to the reproductive tract. These deaths account for 13 percent of all
pregnancy-related deaths globally and over one-quarter in some
countries. Yet, evidence from countries where women have full access to
safe services shows that abortion-related deaths and disability can be
virtually eliminated with appropriate policies and programs.
Research and data
WHO has also sponsored social science investigations into the determinants and consequences of abortion in a number of developing countries. Edited by Axel Mundigo and Cynthia Indriso, Abortion in the Developing World (1998) includes country case studies of practices of safe and unsafe abortion, the relation between contraceptive use and pregnancy termination, adolescent risk-taking behaviors, clients' and providers' attitudes, legal frameworks and clandestine sources of information and services, indigenous methods of inducing menstruation and miscarriage, and the effect of restricted access to safe services on women's health and lives. A final chapter proposes additional research topics with policy and program recommendations.
Guidelines for providers
Safe Abortion: Technical and Policy Guidance for Health Systems (2003) offers an excellent set of clinical, program and policy recommendations for improving abortion safety and quality of care. Because abortion is permitted by law under some conditions in virtually all countries and is allowed on health and social grounds or on request in most, this is an indispensable tool for learning how to incorporate safe services into primary healthcare and family planning programs in accordance with the policy guidelines of each country. Chapters address unsafe abortion as a public health problem and the challenges of making safe services available; identify standards of clinical care for women undergoing abortion; describe health system and training requirements for putting services in place; and analyze legal and policy considerations necessary for providing safe abortion care. Aimed at policy makers, program administrators, health care providers and individuals and groups interested in eliminating unsafe procedures, the guidance is also available in French, Polish, Portuguese, Russian and Spanish.
An earlier publication, Complications of Abortion: Technical and Managerial Guidelines for Prevention and Treatment (1995), sets out guidelines for essential emergency services for reducing the high levels of maternal morbidity and mortality associated with spontaneous or improperly induced abortions. The English version is out of print, although some copies are still available in French and Spanish. The 2003 Guidance serves as an excellent resource for this purpose, however, and also updates the information from Post-abortion Family Planning: A Practical Guide for Programme Managers (1997) on how to counsel and support the post-abortion client in her contraceptive and reproductive decision- making and how to link family planning services with post-abortion care.
Policies and strategic plans