March 28, 2013 — "WHO Technical and Policy Guidance Emphasizes the Health Systems' Responsibility To Provide Safe Abortion Services," Kapp/Glasier, Contraception, February 2013.
While the rate of safe induced abortions worldwide has declined in recent years, the "rate of unsafe abortion has remained relatively constant since 2000 at around 14 per 1000 women," according to Nathalie Kapp of the World Health Organization's Department of Reproductive Health and Research, and Anna Glasier, an honorary professor at the University of Edinburgh's School of Clinical Sciences. Unsafe abortions result in the deaths of about 47,000 women annually and cause disabilities in an additional five million women, they note, emphasizing that "almost every one of these deaths and disabilities could have been prevented with the provision of safe abortion services."
WHO's Call for Safe Abortion Care
The second edition of WHO's Safe Abortion: Technical and Policy Guidance for Health Systems -- published in 2012 -- "reflects the evidence from clinical studies on methods and technologies, as well as the human rights rationale, for providing safe abortion care services," Kapp and Glasier write. The "recommendations focus primarily on ensuring good quality through use of appropriate technologies in abortion-related care," "ensuring good access by eliminating barriers and provision of affordable services," offering "pain medication to every woman" who has an abortion, and promptly providing information about and access to contraception after an abortion.
Kapp and Glasier continue that "what sets this guidance apart from other technical and clinical guidelines ... is the emphasis on both the global public health impact of abortion and the human rights imperative for safe abortion care." This framework is rooted in a concept of reproductive rights that has developed since the 1994 International Conference on Population and Development in Cairo. The concept "demands an approach to healthcare which is grounded in international human rights treaties and global consensus declarations," Kapp and Glasier write, adding that it calls on nations to protect and ensure women's ability to "decide freely and responsibly the number, spacing and timing of one's children and to have the information and means to do so; and the right to a sexual life free from coercion or violence." To that end, states should "ensure that health systems are equipped to provide safe abortion services within the extent of the law," "[v]igorously pursu[e] decriminalization of abortion-related laws" and ensure equitable access to abortion services, Kapp and Glasier write.
"[H]uman rights have been increasingly applied by international and regional human rights bodies and regional and national courts in the context of abortion," Kapp and Glasier continue, noting that United Nations treaty monitoring bodies have called for member states to reform laws that criminalize medical care that is only needed by women and "make all efforts to ensure" a minimum level of safe, legal abortion services are available.
"Unsafe abortion and its associated mortality and disability are avoidable," the authors conclude, writing, "The WHO guidance provides a framework for policy-makers and service providers to improve dramatically the health and well-being of the world's women."