A ccidental pregnancies result
from contraceptive failure worldwide. Even with a "perfect
use" of contraceptive method, 5.9 million pregnancies will
result, while with a "typical use" of methods, there are
almost 26.5 million accidental pregnancies occurring annually (WHO
2002). Several Technical Guidance have been published by WHO in1990s.
ICPD plus 5 took a decision that "in circumstances where abortion
is not against the law, health systems should train and equip health-service
providers and should take other measures to ensure that such abortion
is safe and accessible. Additional measures should be taken to safeguard
women’s health". (Key actions for the further implementation
of the Programme for Action of the International Conference on Population
and Development. United Nations, 1999, paragraph 63 iii).
Technical and Policy Guidance provided by WHO reviews clinical
aspects of providing high-quality abortion services, provides guidance
on essential elements needed to put good quality legal abortion
services in place and lays out a policy framework to ensure access
to safe abortion services to the extent of the law.
The Contents include
1. Safe Abortion Services: The Public Health Challenge
2. Clinical Care For Women Undergoing Abortion
3. Putting Services In Place
4. Legal And Policy Consideration
Policy considerations
Health systems and services:
These include having an enabling policy, provide guidance for curricula,
training, logistics, supervision and budget provision, emphasises
the importance of information and non-directive counselling and
referrals for treatment of complications
Methods of abortion
Manual vacuum aspiration is recommended for early abortion, even
in resource-constrained health systems. The need for having MVA
services widely available to treat women who have complications
of unsafe or incomplete abortion as well as "Medical"
methods of abortion are included.
Table 2.5.1
Methods for induction of abortion according to gestation period
|
| Length of amenorrhoea |
Technique |
| < 9 weeks |
antiprogestogen + PG or vacuum aspiration |
| 9-14 weeks |
vacuum aspiration (with cervical preparation particularly
after 12 weeks and in nulliparous women |
| > 14 weeks |
antiprogestogen + PG or dilatation + evacuation* (with cervical
preparation) PGs alone hypertonic saline, urea, ethacridine |
Range of providers
Providers to include licensed medical practitioners as well as
midlevel health-care providers.
Service fees
There should be no "informal" fees. If charges are made,
they should be as low as possible and subsidized for those unable
to pay. Of course, the costs are likely to be offset by savings
achieved by reducing unsafe abortion.
Public information
Women have the right to decide freely and responsibly. They should
be informed about the basic reproductive physiology - how pregnancy
happens, its signs and symptoms, how to prevent unwanted pregnancy
and where and how to obtain contraceptive methods.
Public information is also needed about circumstances in which
abortion is permitted, importance of seeking legal abortion services
as early as
possible, where and when safe abortion is available and cost, how
to recognise complications of miscarriage and unsafe abortion and
where to obtain treatment from and the importance of seeking treatment
immediately.
The guidelines emphasize on having respect for women's informed
decision-making, autonomy, confidentiality and privacy and pay special
attention to the needs of adolescents and of women who have suffered
rape or incest. |
