Safe Abortion: Technical and Policy Guidance for Health Systems

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In October 2000,at the United Nations Millennium Summit,all countries agreed on the global imperative to reduce poverty and inequities.The need to improve maternal health was identified as one of the key Millennium Development Goals,with a target of reducing levels of maternal mortality by three-quarters between 1990 and 2015.
The causes of maternal deaths are multiple.Women die because complications during labour and delivery go unrecognised or are inadequately managed.They die from diseases such as malaria,that are aggravated by pregnancy.They die because of complications arising early in pregnancy,sometimes even before they are aware of being pregnant,such as ectopic pregnancy.And they die because they seek to end unwanted pregnancies but lack access to appropriate services. Achieving the Millennium Development Goal of improved maternal health and reducing maternal mortality requires actions on all these fronts.
Despite dramatically increased use of contraception over the past three decades,an estimated 40-50 million abortions occur annually,nearly half of them in circumstances that are unsafe.Globally,approximately 13% of all maternal deaths are due to complications of unsafe abortion.In addition to some 70,000 women who die each year,tens of thousands suffer long-term health consequences including infertility.Even where family planning is widely accessible,pregnancies occur due to contraceptive failure,difficulties with use,non use or as a result of incest or rape.Pregnancy may pose a threat to the woman’s life or to her physical and mental health.In recognition of such circumstances,nearly all countries in the world have passed laws that permit termination of pregnancy under specified conditions.In some settings,abortion is legal only to save the woman’s life; in others,abortion is allowed upon request by the woman.Health systems need to respond accordingly.
The role of the World Health Organization is to develop norms and standards and provide advice to Member States in order to strengthen the capacity of health systems.For over three decades WHO has assisted governments, international agencies and non-governmental organizations to plan and deliver maternal health services,including managing complications of unsafe abortion and providing high-quality family planning services.
At the Special Session of the United Nations General Assembly in June 1999,Governments agreed that “in circumstances where abortion is not against the law,health systems should train and equip health-service providers and should take other measures to ensure that such abortion is safe and accessible.Additional measures should be taken to safeguard women’s health.”
This document provides guidance to turn this agreement into reality.

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