Abstract
BackgroundWHO has a pivotal role to play as the leading international agency promoting good practices in health and human rights. In 2005, mifepristone and misoprostol were added to WHO’s Model List of Essential Medicines for combined use to terminate unwanted pregnancies. However, these drugs were considered ‘complementary’ and qualified for use when in line with national legislation and where ‘culturally acceptable’.DiscussionThis article argues that these qualifications, while perhaps appropriate at the time, must now be removed. First, compelling medical evidence justifies their reclassification as a ‘core’ essential medicine. Second, continuing to subjugate essential medicines for medical abortion to domestic law and cultural practices is incoherent with today’s human rights standards in which universal access to these medicines is an inextricable part of the right to sexual and reproductive health, which should be supported and realised through domestic legislation.ConclusionThis article shows that removing such limitations will align WHO’s Model List of Essential Medicines with the mounting scientific evidence, human rights standards, and its own more recently developed policy guidance. This measure will send a strong normative message to governments that these medicines should be readily available in a functioning and human-rights-abiding health system.
Highlights
World Health Organization (WHO) has a pivotal role to play as the leading international agency promoting good practices in health and human rights
Maternal mortality claims the lives of 289,000 women annually, while complications during childbirth result in 5.8 million serious injuries every year and deaths due to unsafe abortion remain close to 13% of all maternal deaths [1]
A coherent public health and human rights approach would confer an unfettered endorsement to essential medical abortion medicines, regardless of any possible limitations in domestic law and consonant with WHO’s own mandate to advance the right to health and its policy guidance supporting safe abortion
Summary
Integrating the public health and legal frameworks for sexual & reproductive health Essential medicines for medical abortion Domestic governments can greatly improve the efficient use of health resources by selecting a narrow list of essential medicines, which are defined as ‘those that satisfy the priority healthcare needs of the population’ (p. 15) [13]. Patients seeking safe abortion to end an unwanted pregnancy are often marginalised and can be made vulnerable by restrictive national abortion laws or inaccessible abortion services It is precisely these patients who WHO’s Model List should strive to serve by unequivocally endorsing mifepristone and misoprostol as essential components of every health system. A coherent public health and human rights approach would confer an unfettered endorsement to essential medical abortion medicines, regardless of any possible limitations in domestic law and consonant with WHO’s own mandate to advance the right to health and its policy guidance supporting safe abortion. A human rights approach suggests States are not justified in denying the provision of ‘core’ health services, such as essential medicines for medical abortion, when they do not conform with some restrictive cultural norms. Those cultural practices should be modified in order to advance universal access to sexual and reproductive health
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