WHO's new guidelines on abortions call for better care, fewer barriers
The WHO, which views safe abortion as a crucial part of healthcare, recently issued 50 recommendations to prevent unsafe abortions
Unsafe abortions cause around 39,000 deaths globally every year and result in millions more women getting hospitalised with complications. These tragic deaths occur largely in lower-income countries – and developing countries bear the burden of 97 per cent of unsafe abortions, said the World Health Organisation (WHO) on its website.
The WHO, which views safe abortion as a crucial part of healthcare, recently issued new guidelines on abortion care to enable countries to deliver life-saving care. The purpose of the guidelines, which contain a set of 50 recommendations and best practices, is to prevent over 25 million unsafe abortions that happen annually around the world. Based on the latest scientific evidence, these recommendations involve clinical practice, health service delivery, and legal and policy interventions to support quality abortion care.
Quality abortion care is described by WHO as care that is effective – delivered by health workers with the right skills, resources, and information; safe; accessible to all those that need it; timely, and respectful of women and girls’ needs and rights.
According to Craig Lissner, acting director for sexual and reproductive health and research at WHO, “Nearly every death and injury that results from unsafe abortion is entirely preventable.”
Most of these deaths are concentrated in lower-income countries – with over 60 per cent in Africa and 30 per cent in Asia – and among those living in the most vulnerable situations. Interestingly, the proportion of abortions that are unsafe is also significantly higher in countries with highly restrictive abortion laws than in those with less restrictive laws.
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The new guidelines include recommendations on many simple interventions at the primary care level that improve the quality of abortion care provided to women and girls. These include task-sharing by a wider range of health workers; ensuring women get access to medical abortion pills, which can ultimately translate to more women getting safe abortion services; and making sure that accurate information on care is available to all those who need it.
For the first time, the guidelines also include recommendations to use telemedicine wherever suitable. Telemedicine had helped support access to abortion and family planning services during the COVID pandemic.
Removing policy barriers
The guidelines also suggest removing needless medical policy barriers to safe abortion, such as criminalising abortions, mandatory waiting times, need for approval by other people (e.g., partners or family members) or institutions, and placing limits on when during pregnancy an abortion can take place.
These kind of barriers can lead to critical delays in accessing treatment and put women and girls at greater risk of unsafe abortion, stigmatisation, and health complications, WHO said. They also increase the chances of disruptions to their education and their ability to work.
While most countries allow abortion under specified circumstances, about 20 countries have no legal grounds for abortion, said the WHO. It added that more than three in four countries have legal penalties for abortion, which can include lengthy prison sentences or heavy fines for people having an abortion or assisting with the procedure.
Also read: Gender inequality, patriarchy skewed India’s sex ratio
Giving respect to a woman’s decision
Meanwhile, Dr Bela Ganatra, Head of WHO’s Prevention of Unsafe Abortion Unit, emphasised on the fact that besides medical safety, it is absolutely necessary for abortion care to respect the decisions and needs of women and girls, ensuring that they are treated with dignity and without stigma or judgment.
“No one should be exposed to abuse or harms like being reported to the police or put in jail because they have sought or provided abortion care,” pointed out Ganatra.
Evidence shows that countries that restrict access to abortions are not able to lower the number of abortions that take place. In fact, restrictions are more likely to drive women and girls towards unsafe procedures. In countries where abortion is most restricted, only 1 in 4 abortions are safe, compared to nearly 9 in 10 in countries where the procedure is broadly legal.
The legislation in India
In India, though abortion is legal under the Medical Termination of Pregnancy Act, 1971 but there is not much awareness about the Act. A news report published in July 2021 said that nearly 13 women die in India everyday due to unsafe abortion. Unsafe abortion is strongly linked to maternal complications such as hemorrhage, sepsis, and trauma and is the fourth leading cause of maternal death in India.
According to Ganatra, if you want to prevent unintended pregnancies and unsafe abortions, you need to provide women and girls with a comprehensive package of sexuality education, accurate family planning information and services, and access to quality abortion care.
WHO will support interested countries to implement these new guidelines and strengthen national policies and programmes related to contraception, family planning and abortion services, helping them provide the highest standard of care for women and girls.
