Abortion is a safe procedure when performed in line with evidence-based practices, many of which are reflected in the World Health Organization’s abortion care guidelines. However, half of the abortions performed worldwide are unsafe, meaning the procedure is performed by a person lacking the necessary skills and/or in an environment that does not meet minimum medical standards. Life-threatening complications that can result from an unsafe abortion can include bleeding, infection, and injury to the genital tract and internal organs.
“The problem is that many health care providers in some high-need countries have not had the opportunity to receive the formal education needed to provide family planning and comprehensive abortion care, but are then put into a situation where they are expected to provide the necessary care,” said Ulrika Renström Loi, technical officer and midwife at WHO. It is important that health workers providing safe abortion care have the skills to use recommended methods, manage pain and complications, and provide accurate information and counselling. They must also ensure that care is respectful, confidential, rights-based, and linked to post-abortion and contraceptive services.
A nurse inputs data during a post-abortion care appointment with a patient at the Marie Stopes International Clinic in Aberdeen, Freetown, Sierra Leone, on June 21, 2020.2. © WHO / SRH / Hikmathu Leh
To address this gap in capacity, the United Nations Special Program in Human Reproduction (HRP) and the World Health Organization (WHO) worked with midwives, doctors, regional teams and other stakeholders around the world to develop a three-volume family planning and abortion care toolkit. 57 competencies define the essential knowledge and skills that primary health workers should develop during their education. Family planning and comprehensive abortion care competencies are designed to be suitable for developing learning outcomes (or learning objectives) for both formal education and lifelong learning in the workplace. It is the actual learning (outcome) achieved that matters.
Competencies are a criterion not only for education but also for performance in the workplace. They help in defining standards, and planning and measuring professional development, improving job performance as well as learning.
Subsequently, HRP, in collaboration with the WHO Academy, began to develop online courses to help healthcare providers strengthen their competencies in comprehensive abortion care.
“It is important that health care providers such as doctors and midwives have the necessary knowledge to implement WHO recommendations,” said Antonella Lavallante, medical officer for WHO and HRP. “Publishing the recommendations is just the beginning; the next step is to ensure that health care providers are equipped to effectively implement the recommendations in their daily practice.”
The first course launched, called Medical Abortion, is a self-paced, comprehensive abortion care (CAC) learning program that focuses on how to provide medical abortion services. The course content is based on WHO abortion care guidelines. It takes six hours and consists of four modules:
- pre-abortion assessment
- Basics of Medical Abortion
- Administration and follow-up of medical abortion
- Medical abortion service delivery and health system considerations for abortion care
Participants receive a WHO Academy Award for completing each module.
“The training helped me update my knowledge and skills on therapeutic abortion based on the latest recommendations,” said Nani Kawe, a registered nurse in Nepal. “I can use it to provide quality medical abortion services to the client as per our country’s policy guidelines and the Right to Safe Maternal and Reproductive Health Act. I can also use this training package during in-service training and pre-service education for midwifery students.”
A second course has recently been released, called Integrating a Human Rights-Based Approach to Comprehensive Abortion Care, which is on the human rights elements of abortion care.
Ulrika Renström, Technical Officer at WHO, said, “This course gives health care providers and policy makers practical tools to integrate human rights into abortion care, so that services remain accessible, equitable and respectful for all who seek them.”
Participants are already reporting on the usefulness of the courses in the context in which they work. WHO and HRP are now working on two additional courses to be added to this comprehensive abortion care learning package; One on surgical abortion and the other on post-abortion care.
Other resources include a mobile app that walks health workers through the process of assessing patients seeking an abortion. This helps them understand individual cases and patient information, including potential risks, and generate recommendations, checklists and important relevant information. The app can also help schedule follow-ups and referrals. It is complemented by a clinical practice handbook for quality abortion care, which facilitates the practical application of clinical recommendations from the WHO abortion care guidelines. It translates evidence-based recommendations into accessible tools for day-to-day clinical practice.
With wide access to learning programs and digital tools, HRP and WHO are helping to close critical knowledge gaps and empower healthcare providers to provide evidence-based abortion care.