By Dr Munyaradzi Murwira
According to World Health Organisation (WHO), six out of 10 unintended pregnancies end up in induced abortions, with 45 percent of all abortions estimated to be unsafe globally. Thus, strengthening access to comprehensive abortion care (CAC) within the health care system is fundamental to meeting the sustainable development goals (SDGs) relating to good health and wellbeing, and gender equality.
In 2022, the WHO launched the new Abortion Care Guidelines to provide guidance for provision of comprehensive abortion care services (CAC) globally. Priority aspects of the new WHO guidelines include elimination of unsafe abortion, and provision of quality post abortion care services. Addressing the challenge of unsafe abortions will ultimately reduce the maternal mortality rate as unsafe abortion contributes up to 15 percent of all maternal deaths in the developing world.
The three cornerstones of an enabling environment for abortion care include:
- Respect for human rights including a supportive legal and policy framework
- Availability and accessibility of information
- A supportive, universally accessible affordable and well-functioning health system
Adaptation of WHO Guidelines at Country Level
Following the launch of the WHO global guidelines on comprehensive abortion care (CAC), many countries including Zimbabwe embarked on a process to review existing guidelines with a view to adopt best practices in provision of services. Adapting WHO guidelines to local settings (at country level) will improve access to safe, affordable, timely and respectful abortion care, including information, and post abortion care (PAC).
Ministries of Health with support from World Health Organization (WHO) have reviewed existing guidelines and developed updated comprehensive abortion care (CAC) guidelines. The biggest challenge with existing guidelines in many countries is that they are outdated and not fully disseminated to all key stakeholders. In the Zimbabwean case, the existing guidelines had been last reviewed in 2007. The new WHO guidelines offers a strategic opportunity for countries to improve access to abortion care services and promote medical abortion in many developing countries.
Guideline Development and Implementation
The CAC guideline development process is through a multi-sectoral approach. This in country process in mainly supported by WHO and other key SRHR stakeholders. It usually involves the recruitment of a consultant working through the technical guidance and oversight of a national Technical Working Group (TWG) and an Expert Panel of Specialists. The TWG should include technical partner agencies, donors, implementing partners, professional associations (doctors, midwives and nurses), programme managers, service providers, and Civil Society Organizations (CSOs) among others.
The Expert Panel and the TWG provides oversight of the process, reviews the draft guideline document, and make recommendations to the consultant based on local evidence and the policy framework context. Consultative meetings with all key stakeholders are essential before submission of the final document to the Ministries of Health for approval.
Ideally, the TWG should coordinate the dissemination of the guidelines under the guidance of the Ministry of Health. Dissemination must involve orientation of providers at all levels, including in-service and pre-service training. Existing fora for continuous professional development in the relevant professional associations are key in dissemination of revised guidelines.
Quality sexual reproductive health & rights (SRHR) services must be both accessible (timely, affordable, geographically reachable, provided in a setting with skills and supplies for the health need); and acceptable (incorporating the preferences and the values of individual users and their cultures of the communities).
At country level, the development of comprehensive abortion care guidelines can significantly improve access to abortion care services including medical options. Medical abortion has revolutionarised access to quality abortion care globally. It is now easy and safe to administer medical products for effective management of women requiring abortion care.
Better dissemination and adequate orientation on the new CAC guidelines will empower health providers and capacitate them to provide quality services. The new guidelines will align service and treatment protocols with current best practices thereby supporting service providers to offer comprehensive services in a conducive and safe environment. Incorporating the WHO abortion care best practices into the revised country guidelines will ensure the necessary essential commodities are included into the minimum standard of care package. The CAC guidelines will also promote the updating of training curricula for health care providers across the board. The review of guidelines is an opportunity to strengthen advocacy efforts towards removing administrative and legal barriers in provision of comprehensive abortion care (CAC).
Adaptation of the new WHO abortion care guidelines by countries will ensure universal access to SRHR services including post abortion care. The development and implementation of comprehensive abortion care guidelines is an opportunity for many developing countries including Zimbabwe to improve access to services and provision of medical options. The revision and dissemination of new guidelines will provide an advocacy platform to address administrative and policy barriers for improved access to abortion care services thereby reducing the impact of unsafe abortions on women’s health.
Dr M Murwira is a Public Health Expert with special interest in Sexual Reproductive Health, and Population & Development.