WHO launches new guideline to help health-care workers ensure safe medical abortion care
8 January 2019: When women and girls can access effective contraception and safe abortion services, they are better able to safeguard their health and well-being.
Abortions are safe if they are done with a WHO-recommended method that is appropriate to the pregnancy duration, and if the person providing or supporting the abortion is trained. Such abortions can be done either as a simple outpatient procedure, using vacuum aspiration, or by using medical abortion, the use of pharmacological drugs to terminate pregnancy.
WHO has today launched new guidance, Medical management of abortion. These new guidelines provide healthcare workers with evidence-based recommendations to help ensure high-quality healthcare for all pregnant individuals who seek a medical abortion.
About unsafe abortion
Recent evidence has shown that too many women and girls continue to suffer and die due to a lack of access to safe abortion and post-abortion care. Approximately 25 million unsafe abortions (45% of all abortions) took place every year between 2010 and 2014. Following unsafe abortion, women may experience a range of harms that affect their quality of life and well-being, with some women even experiencing life-threatening complications.
Medical abortion plays a crucial role in the provision of access to safe, effective and acceptable abortion care. Mifepristone and misoprostol in combination or, where mifepristone is unavailable, misoprostol alone, are the recommended medications to induce abortion, and to manage incomplete abortion, or ‘intrauterine fetal demise’ – the clinical term used to describe the death of a fetus in the uterus.
Improving access, improving well-being
It is hoped that by supporting healthcare workers with accurate and evidence-based information on the medical management of abortion, more pregnant individuals who seek abortion will receive high-quality and effective healthcare.
There are many potential advantages of medical abortion. Task sharing, and more efficient use of resources in both high- and low-resource settings, are documented benefits. Medical abortion care reduces the need for skilled surgical abortion providers and offers a non-invasive and highly acceptable option to pregnant individuals.
A number of studies have recently been published which give new evidence related to the timing, dosage, dosing intervals and routes of administration of medications to manage abortion, as well as the timing of contraception initiation following a medical abortion. In recognition of these developments, WHO reviewed the evidence and has now updated its recommendations.
Focus of the guideline
The guideline focuses exclusively on the medical management of abortion, and provides new recommendations related to the following indications:
- medical management of incomplete abortion at ≥ 13 weeks of gestation;
- medical management of intrauterine fetal demise at ≥ 14 to ≤ 28 weeks of gestation;
- timing of post-abortion hormonal contraception initiation; and
- timing of post-abortion intrauterine device (IUD) placement.
In addition, this guideline includes updated recommendations related to the following indications:
- medical management of incomplete abortion at < 13 weeks of gestation; and
- medical management of induced abortion at < 12 weeks, and at ≥ 12 weeks.