Bela Ganatra


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    Update on unsafe abortion Despite technological advances, unsafe abortion
    continues as a public health problem and
    important cause of maternal mortality globally. As
    per WHO’s recent estimates, currently, about 22
    million unsafe abortions occur every year—98%
    of them in the developing world. The global rate
    is 14 unsafe abortions per 1,000 women 15-44
    years, but there are wide disparities across

    geographic regions, with Eastern and Middle
    Africa having the highest rate of unsafe abortion
    at 36 unsafe abortions per 1,000 women aged
    15-45. Adolescents and poor women also bear a
    disproportionate burden.
    Sexuality education, access to affordable,
    effective contraception and to lifesaving care to
    treat complications can all help to reduce the
    unintended pregnancies or the morbidity and
    mortality from unsafe abortion, but access to
    safe, legal abortion care remains central to
    dealing with the problem. Barriers include health
    system, finances, regulations, and policies,
    stigma and the ways existing laws and regulations
    are interpreted and implemented.
    Effective interventions do exist and progress
    has been made in recent years, as is evidenced
    by a decrease in case-fatality rates from unsafe
    abortion. The Safe Abortion: Technical and
    Policy guidance for health Systems (WHO, 2012)
    presents the public health and human rights
    based evidence to address the issue.

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    Non-physician providers’ roles in access to safe abortion care: an overview of evidence

    Bela Ganatra WHO, Geneva, Switzerland -

    Unsafe abortion continues to constitute a major mortality and morbidity burden especially in the developing world (21.6 million unsafe abortions; 13% of maternal deaths). Access to safe abortion is limited by numerous barriers but one of the most critical is the lack of trained providers. Many countries limit abortion service provision to specialist doctors. However, most developing country regions suffer from a critical short supply of OBGYNs , generalist doctors and even midwives. Areas with a critical shortage of health service providers also have the highest burden of unsafe abortion-related deaths. Expanding the provider base to include a range of other health workers is a recognized strategy to expand access to health services and scale up implementation of interventions of public health significance including for safe abortion care. Medical abortion as an effective and recommended technology has made it even more relevant to expand health workers' roles in provision of safe abortion care and to look at self-assessment as ways of reducing the need for health worker time and resources. There is a growing body of research evidence on the issue. Additionally, in several countries use of some cadres of non-physician providers is already part of practice (though often not of policy). The Department of Reproductive Health and Research at the WHO is currently reviewing and synthesizing evidence related to task shifting and task sharing in the provision of safe abortion and postabortion care with the aim of developing specific recommendations on the issue. The evidence base includes comparative studies, qualitative data and country case studies to synthesize programmatic experience form countries where non-physician providers have already been providing such care. The presentation will give a broad overview of the evidence on this topic and the process of the guidelines development.