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Unsafe abortion occurs when a pregnancy terminated by persons lacking necessary skills

Unsafe abortion occurs when a pregnancy terminated by persons lacking necessary skills

Kolkata, Aug 10 (UNI) The World Health Organization (WHO) defines unsafe abortion

occurs when a pregnancy is terminated either by persons lacking the necessary skills

or in an environment that does not conform to minimal medical standards, or both.

This definition embodies concepts first outlined in a 1992 WHO Technical Consultation.

Although widely used, it is inconsistently interpreted. In this editorial we discuss its

correct interpretation and operationalization.

WHO’s definition of unsafe abortion was conceptualized within the framework of

emerging guidelines on the management of the complications of induced abortion

and was intended to be interpreted within that context.

This linkage to technical guidelines is crucial for its correct interpretation. Nothing in

the definition predetermines who should be considered a “safe” abortion provider or

what the appropriate skills or standards for performing abortions should be. Such things

are not static; they evolve in line with evidence-based WHO recommendations.

For example, WHO guidelines now recommend mifepristone and misoprostol – or

misoprostol alone if mifepristone is not available – and vacuum aspiration in lieu of the

sharp curettage used formerly. They now consider induced abortions provided at the

primary care level or by non-physician health-care providers as safe. The guidelines

on task shifting that are being developed are expected to clarify who can safely provide

an abortion under current standards.

To ensure that “unsafe abortion” is correctly interpreted, we recommend always

providing an explanatory note along with the definition, as follows: “The persons,

skills and medical standards considered safe in the provision of abortion are different

for medical and surgical abortion and also depend on the duration of the pregnancy.

What is considered ‘safe’ should be interpreted in line with current WHO technical

and policy guidance.”

Although unsafe abortions are, by definition, risky, safety cannot be dichotomized

because risk runs along a continuum. Risk is lowest if an evidence-based method is

used to terminate an early pregnancy in a health facility; it is highest if a dangerous

method, such as the use of caustic substances orally or vaginally or the insertion

of sticks into the uterus, is employed clandestinely to terminate an advanced

pregnancy.

There is a spectrum of risk between these two extremes. Along that spectrum,

for example, lie cases of self-administration of misoprostol or the use of outdated

procedures, such as sharp curettage, by skilled health-care providers.

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