Situation of preventing unsafe

abortion in SEAR
Mapping of clinical services
Dr Arvind Mathur
WHO-SEARO

Intercountry Orientation
Workshop on Clinical
Practice Handbook for Safe
Abortion
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion

Unsafe abortion
22 million abortions unsafe abortions
yearly, resulting in:
47,000 deaths (13% of pregnancy-
related deaths)
5 million disabilities
20% of total mortality & disability
burden due to pregnancy & childbirth

98% occur in developing countries
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion

Estimated Number of Unsafe Abortions,
Globally and by major region-2003 and 2008
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion

Regional Estimates of Mortality due to
unsafe abortion

Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion

Preventing Unsafe Abortion in SEAR
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion

Preventing Unsafe Abortion in SEAR

Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion

Grounds on which abortion is permitted in
SEAR countries

Mapping of Clinical
Services
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion

Policy or Legal Restrictions for Abortion/MR/PAC
Restrictions WHO India Bdesh
Gestational limits apply
Authorization of medical
professional(s) required. Please
indicate number of professionals who
need to authorize abortion provision
Parental or judicial consent required
for minors
Husbands consent required for
married women
By certified providers only
Authorized in licensed facilities only
Compulsory counselling or waiting
periods
Prohibition of sex-selective abortion
Any other (please specify)
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion

Place of provision of Abortion/MR/PAC
Setting/ facility WHO India Bdesh
Primary Health Centre
Secondary health center
including community level
and district level facilities
Any private facility
Only private facilities that are
registered as abortion care
facilities
Pharmacies
Other, please specify
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion

Health Care Provider
Health care personnel providing
abortion services
WHO (As per law
applicable)
India Bdesh
Specialist Ob/gyn
General practitioner
Only those general practitioners
who are trained in abortion
provision
Midlevel providers (Midwives,
Nurses, clinical officers,
physician assistants, Family
Welfare Visitors, and others)
trained in basic clinical
procedures
Any other personnel, specify
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion

Methods of Abortion: Surgical
WHO
Recommendation
(2012)
India Bangladesh
Up to 10
weeks

Surgical Abortion
12 weeks or
less
13-14 weeks
>14 weeks
15- 20 weeks
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion

Methods of Abortion: Medical
WHO India BDesh
Up to 7 weeks
(49 days)
8-9 weeks
(50-63 days)
10-12 weeks
64-84 days
13 18 weeks

Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion

Ultrasound
WHO
Recommends
India Bangladesh
Mandatory
USG to
confirm
pregnancy
Mandatory
USG to
confirm
completion
of abortion

Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion

Investigations
Tests mandatory by guidelines WHO
Recommends
India Bangladesh
Not mandatory unless signs of
pregnancy not present and
provider unsure of woman being
pregnant
Urine for pregnancy
confirmation
Urine for sugar
Rh Status
Hb status
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion

Investigations
WHO India BDesh
HIV testing/counselling
STI screening
Cervical cancer
screening (performed
during pelvic exam)
Ultrasound
Any other , specify
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion

Guiding principles-establishing and
strengthening abortion services
Safe abortion services should be readily available and
affordable to all women and adolescents, to the full
extent of the law.
National standards and guidelines for safe abortion
care should be evidence based and periodically
updated, and should provide the necessary guidance to
achieve equitable access to high-quality care.
New policy and programme interventions should be
based on evidence-based best practices.
Training of abortion providers must ensure that they
have the competencies to provide high-quality care in
accordance with national standards and guidelines.
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion

Guiding principles-establishing and
strengthening abortion services
Ensuring high-quality in-service delivery
requires ongoing supervision, quality
assurance, monitoring and evaluation
Financing of abortion services should be
organized taking into account costs to the
health system as well as the need to ensure
equitable financial access for all women; and
Successful scaling-up requires systematic
planning, management, guidance and support
for the process
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion

Quality Service by choice!
Thank you