Abstract
When conducted in a legal setting and under safe conditions, abortion is an extremely effective and safe procedure. Tragically, almost half of all abortions that take place in the world are conducted under unsafe conditions, mostly in countries where abortion is illegal or highly restricted. These unsafe abortions are a major cause of maternal death and disability. Restricting a woman’s access to abortion does not prevent abortion but simply leads to more unsafe abortions. Barriers to safe abortion are many but include legal barriers, health policy barriers, shortages of trained healthcare workers, and stigma surrounding abortion. This commentary will consider some recent advances to improve access to safe abortion as well as refinements in abortion methods and service delivery in settings where safe abortion is available that further improve the care and wellbeing of women who seek abortion.
Highlights
When conducted in a legal setting and under safe conditions, abortion is an extremely safe procedure associated with few complications
Studies generally indicate that this means of providing medical abortion in the first trimester is associated with high rates of effectiveness and low rates of self-reported complications[13,15], it should be noted that in studies in highly restrictive settings loss to follow up can be significant
Misoprostol was associated with a reduction in the risk of both a complication and incomplete abortion needing re-evacuation (RR 0.3; 95% CI 0.2–0.96)
Summary
When conducted in a legal setting and under safe conditions, abortion is an extremely safe procedure associated with few complications. The availability of medical methods of abortion, which require relatively little training and which may be safely self-managed by women at home (up to 10 weeks’ gestation) with adequate instruction[8], has been a major advance in this respect This has increased women’s access to safe abortion in many parts of the world[5]. Studies generally indicate that this means of providing medical abortion in the first trimester is associated with high rates of effectiveness and low rates of self-reported complications[13,15], it should be noted that in studies in highly restrictive settings loss to follow up can be significant. A large multi-country randomised controlled trial (RCT) conducted by the WHO of over 4,800 women undergoing surgical vacuum aspiration in the first trimester showed that pre-treatment with misoprostol can make this earlier gestation procedure even safer[27]. For women who want to use a LARC method, receiving one at the time of the abortion is associated with higher uptake and fewer subsequent unintended pregnancies than getting one at a later visit[37,40,41]
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