Safe abortion:

ExEcutivE summary
Over the past two decades, the health evidence,
technologies and human rights rationale for providing
safe, comprehensive abortion care have evolved
greatly. Despite these advances, an estimated
22 million abortions continue to be performed
unsafely each year, resulting in the death of an
estimated 47 000 women and disabilities for an
additional 5 million women (1). Almost every one
of these deaths and disabilities could have been
prevented through sexuality education, family
planning, and the provision of safe, legal induced
abortion and care for complications of abortion.
In nearly all developed countries, safe abortions are
legally available upon request or under broad social
and economic grounds, and services are generally
easily accessible and available. In countries where
induced abortion is legally highly restricted and/or
unavailable, safe abortion has frequently become
the privilege of the rich, while poor women have little
choice but to resort to unsafe providers, causing
deaths and morbidities that become the social and
financial responsibility of the public health system.
In view of the need for evidence-based best practices
for providing safe abortion care in order to
protect the health of women, the World Health
Organization (WHO) has updated its 2003 publication
Safe abortion: technical and policy guidance for
health systems (2). In this process, the WHO standards
for guideline development have been followed,
including: identification of priority questions and
outcomes; retrieval, assessment and synthesis of
evidence; formulation of recommendations; and planning
for dissemination, implementation, impact evaluation
and updating. For the clinical recommendations
presented in Chapter 2, evidence profiles related
to the prioritized questions were prepared, based
upon recent systematic reviews, most of which are
included in the Cochrane Database of Systematic
Reviews. In addition, Chapters 1, 3 and 4 of the original
2003 publication were reviewed and updated to
reflect the latest estimates on unsafe abortion worldwide,
new literature on the topic of service delivery,
and new developments in international, regional and
national human rights law. A guideline development
group, comprising members of an international panel
of experts, reviewed and revised the draft recommendations
based on the evidence profiles, through
a participatory, consensus-driven process.
The target audience for this guidance is policy-makers,
programme managers and providers of abortion
care. The use of the clinical recommendations should
be individualized to each woman, with emphasis on
Safe abortion: technical and policy guidance for health systems 1