Safe abortion:

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and abdominal organs (20). About 20–30% of unsafe abortions cause reproductive tract infections and 20–40% of these result in infection of the upper genital tract (21). One in four women who undergo unsafe abortion is likely to develop temporary or lifelong disability requiring medical care (22). For every woman seeking post-abortion care at a hospital, there are several who have had an unsafe abortion but who do not seek medical care, because they consider the complication as not serious, or because they may not have the required financial means, or because they fear abuse, ill-treatment or legal reprisal (23–30). Evidence shows that major physiological, financial and emotional costs are incurred by women who undergo unsafe abortion. The burdens of unsafe abortion and of maternal deaths due to unsafe abortion are disproportionately higher for women in Africa than in any other developing region (31). For example, while Africa accounts for 27% of global births annually and for only 14% of the women aged 15–49 years in the world, its share of global unsafe abortions was 29% and, more seriously, 62% of all deaths related to unsafe abortion occurred in Africa in 2008 (see Figure 1.1). The risk of death due to unsafe abortion varies among developing regions. The case–fatality rate for unsafe abortion is 460 per 100 000 unsafe abortion procedures in Africa and 520 per 100 000 in sub-Saharan Africa, compared with 30 per 100 000 in Latin America and the Caribbean and 160 per 100 000 in Asia (2). Figure 1.1 The percentage distribution of women, births, unsafe abortions and related deaths, by developing region, 2008 % of total for each indicator 70 60 50 40 30 20 10 0 14 62 9 27 56 8 Women (15–49) years Births Unsafe abortions Unsafe abortion deaths Reproduced from reference 31. Africa Asia Latin America & Caribbean 20 Safe abortion: technical and policy guidance for health systems Safe abortion care: the public health and human rights rationale 29 50 20 62 36 2
When performed by skilled providers using correct medical techniques and drugs, and under hygienic conditions, induced abortion is a very safe medical procedure. In the United States of America (USA), for example, the case–fatality rate is 0.7 per 100 000 Safe abortion care: the public health and human rights rationale 30 30 160 220 legal abortions (32). Late second-trimester legal abortion has a case–fatality rate (33) that is much lower than the lowest rate of unsafe abortion procedures (see Figures 1.2 and 1.3). Figure 1.2 Case–fatality rates of legal induced abortions, spontaneous abortions or term deliveries, per 100 000 procedures, USA Reproduced, with permission, from reference 32. Term delivery Surgical >20 weeks Surgical 16–20 weeks Surgical 13–15 weeks 1st trimester spontaneous Surgical 11–12 weeks Surgical 9–10 weeks Surgical
Page 1: Safe abortion: technical and policy
Page 4 and 5: ii Acknowledgements WHO is grateful
Page 6 and 7: iv Definitions used in this documen
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Page 12 and 13: 2 her clinical status and the speci
Page 14 and 15: 4 box 2 continued Recommended metho
Page 16 and 17: 6 box 4 continued Recommendations f
Page 18 and 19: 8 BOX 6 Recommendations for health
Page 20 and 21: 10 Process of guideline development
Page 22 and 23: 12 Decision-making during the techn
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Page 26 and 27: chapter 1 Safe 16abortion Safe care
Page 28 and 29: Unsafe abortion is defined by the W
Page 32 and 33: 1.5 Contraceptive use, accidental p
Page 34 and 35: In addition to the legal restrictio
Page 36 and 37: 1.7 Economic costs of unsafe aborti
Page 38 and 39: 21. Unsafe abortion: global and reg
Page 40 and 41: chapter 2 Clinical 30 care Safe for
Page 42 and 43: - dilatation and evacuation (D&E),
Page 44 and 45: could be due to a pregnancy that is
Page 46 and 47: 2.1.8 Information and counselling T
Page 48 and 49: Methods up to 12-14 weeks since the
Page 50 and 51: who remains conscious and able to c
Page 52 and 53: forceps. Depending on the duration
Page 54 and 55: Medical methods of abortion have pr
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Page 58 and 59: although they may be indicated with
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Page 62 and 63: Some manufacturers produce aspirato
Page 64 and 65: 2.3.2 Medical methods of abortion D
Page 66 and 67: 25. Honkanen H et al., WHO Research
Page 68 and 69: 70. Trussell J, Ellertson C. Estima
Page 70 and 71: 113. Medical methods for terminatio
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Page 74 and 75: effectiveness on a small scale; and
Page 76 and 77: BOX 3.1 Types of service suitable t
Page 78 and 79: adolescents (18). These human right
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Table 3.1 Drugs, supplies and equip
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3.4.2 Ensuring provider skills and
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3.5.1 Monitoring Monitoring oversee
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BOX 3.3 Questions and issues to con
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ox 3.3 continued Is an adequate ref
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system. WHO recommends that payment
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3.7.2 Introducing interventions to
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22. Billings D et al. Constructing
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chapter 4 Legal 86and Safe policy a
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inhuman and degrading treatment, an
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Given the clear link between access
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4.2.1 Understanding legal grounds f
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In addition, some service-delivery
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placed them on their national list
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y The practice of extracting confes
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10. Committee on Economic Social an
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29. Millennium development goals in
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104 Annexes Safe abortion: technica
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106 aNNEx 2 Final GRADE questions a
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108 10. What methods of pain contro
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110 aNNEx 4 Participants in the tec
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112 Dr Helena von Hertzen Researche
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114 recommendation 2.3 For vaginal,
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116 - For pregnancies beyond 24 wee
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118 y This recommendation is extrap
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120 aNNEx 6 Post-abortion medical e
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122 aNNEx 7 Core international and
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