Around 22 million unsafe abortions are estimated to take place worldwide each year, almost all in low- and middle-income countries. Adolescent girls and those who are poor, unmarried, less educated, and who live in rural contexts are particularly at risk of unsafe abortion. Even though safe, simple, effective primary health-care level interventions exist, many women still do not have access to them, placing their lives unnecessarily at risk.
WHO’s new guideline Health worker roles in providing safe abortion care and post-abortion contraception aims to help break down one critical barrier which limits access to safe abortion care – the lack of trained providers.
It is estimated that the global deficit of skilled health-care professionals will reach 12.9 million by 2035, and the lack of specialised providers is particularly severe in regions where there is a high burden of unsafe abortion. Within countries there are often large disparities of trained safe abortion care providers, with shortages being particularly high in rural areas and the public sector.
There are many barriers to preventing unsafe abortion, and these include issues around policy and regulations as well as social stigma and the unwillingness of some health-care professionals to provide safe abortion and post-abortion care.
Whilst in many settings safe abortion care is limited to specialist doctors, many of the evidence-based interventions for safe abortion and post-abortion care covered in the new WHO guidance, particularly for those in early pregnancy, can be provided on an outpatient basis at the primary-care level – such as medical abortion, which is non-surgical abortion using medications.
WHO’s new guideline helps to address these issues by offering guidance on how different types of tasks can be shifted across or shared appropriately by trained health-care providers. It shows how a greater range of health-care professionals can also be used including for example practitioners, nurses, midwives and auxiliaries.
In a commentary published by The Lancet Global Health the lead author highlights how WHO’s new guideline Health worker roles in providing safe abortion care and post-abortion contraception illustrates that “moving beyond specialists and enabling a wide range of health workers in safe abortion care promotes a rational use of the available health workforce and facilitates equitable and timely access to care”.