Safe Abortion Print E-mail
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.

Safe Abortion

Research and data

Procedures for collecting data on unsafe abortion at the community, district or national level can be found in Studying Unsafe Abortion: A Practical Guide (1996). This manual shows how to collect and analyze data from hospitals and other health facilities and from community-based investigations. Estimates of unsafe abortions for countries and regions can be obtained from Unsafe Abortion: Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in 2000 (fourth edition, 2004), which addresses the global problem of unsafe abortion; identifies data sources and methods; reports incidence by region, and calculates the risks women face of dying from improperly performed procedures.

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

WHO has long been working to improve the quality of services for voluntary pregnancy termination and the humane treatment of complications resulting from improperly performed procedures or from spontaneous abortion. WHO-supported clinical research in over 20 countries has demonstrated the effectiveness of using reduced drug doses to induce early terminations of pregnancy, for example. Studies are currently examining the relative advantages of vacuum aspiration and medical (drug-induced) methods from providers' and clients' perspectives in different settings and the feasibility of using mid-level health workers to broaden women's access to manual vacuum aspiration services. The Reproductive Health Database of the RHL includes several reviews and commentaries relating to improving the safety of abortion practices.

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

The Technical and Policy Guidance (2003) described above is the key publication for policy makers on safe abortion.  More broadly, WHO's Considerations for Formulating Reproductive Health Laws (2000) elaborates the ways in national laws can advance and protect sexual and reproductive health and rights and facilitate the provision of (and access to) comprehensive services, including safe abortion. The discussion covers human rights justifications for comprehensive programs and supportive policy and regulatory frameworks based on the rights to health, to non-discrimination, and to reproductive self-determination. Legal principles governing provider-patient relations are described, as well as approaches to enforcing legal standards and human rights obligations at the national and international levels.

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