dr arvind mathur- regional situation of preventing unsafe abortion in sear

8/11/2019 Dr Arvind Mathur- Regional Situation of Preventing Unsafe Abortion in SEAR

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Situation of preventing unsafeabortion in SEAR

Mapping of clinical services

Dr Arvind Mathur

WHO-SEARO

Intercountry Orientation

Workshop on Clinical

Practice Handbook for SafeAbortion


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Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion

Unsafe abortion

22 million abortions unsafe abortionsyearly, resulting in:

47,000 deaths (13% of pregnancy-related deaths)

5 million disabilities 20% of total mortality & disability

burden due to pregnancy & childbirth

98% occur in developing countries


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Estimated Number of Unsafe Abortions,

Globally and by major region-2003 and 2008


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Regional Estimates of Mortality due to

unsafe abortion


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Preventing Unsafe Abortion in SEAR


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Preventing Unsafe Abortion in SEAR


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Grounds on which abortion is permitted in

SEAR countries


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Mapp ing o f Cl in ical

Services
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Policy or Legal Restrictions for Abortion/MR/PACRestrictions WHO India Bdesh

Gestational limits apply

Authorization of medical

professional(s) required. Please

indicate number of professionals who

need to authorize abortion provision

Parental or judicial consent required

for minors

Husbands consent required for

married women

By certified providers only

Authorized in licensed facilities only

Compulsory counselling or waiting

periods

Prohibition of sex-selective abortion

Any other (please specify)


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Place of provision of Abortion/MR/PACSetting/ facility WHO India Bdesh

Primary Health Centre

Secondary health center

including community leveland district level facilities

Any private facility

Only private facilities that are

registered as abortion care

facilities

Pharmacies

Other, please specify


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Health Care ProviderHealth care personnel providing

abortion services

WHO (As per law

applicable)

India Bdesh

Specialist Ob/gyn

General practitioner

Only those general practitionerswho are trained in abortion

provision

Midlevel providers (Midwives,

Nurses, clinical officers,

physician assistants, FamilyWelfare Visitors, and others)

trained in basic clinical

procedures

Any other personnel, specify


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Methods of Abortion: SurgicalWHO

Recommendation

(2012)

India Bangladesh

Up to 10weeks

Surgical Abortion

12 weeks or

less

13-14 weeks

>14 weeks

15- 20 weeks


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Methods of Abortion: MedicalWHO India BDesh

Up to 7 weeks

(49 days)

8-9 weeks

(50-63 days)

10-12 weeks

64-84 days

1318 weeks


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Ultrasound

WHO

Recommends

India Bangladesh

Mandatory

USG to

confirm

pregnancy

Mandatory

USG to

confirm

completion

of abortion


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InvestigationsTests mandatory by guidelines WHO

Recommends

India Bangladesh

Not mandatory unless signs of

pregnancy not present and

provider unsure of woman being

pregnant

Urine for pregnancy

confirmation

Urine for sugar

Rh Status

Hb status


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Investigations

WHO India BDesh

HIV testing/counselling

STI screening

Cervical cancer

screening (performed

during pelvic exam)

Ultrasound

Any other , specify


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Guiding principles-establishing and

strengthening abortion services

Safe abortion services should be readily available and

affordable to all women and adolescents, to the full

extent of the law.

National standards and guidelines for safe abortion

care should be evidence based and periodically

updated, and should provide the necessary guidance toachieve equitable access to high-quality care.

New policy and programme interventions should be

based on evidence-based best practices.

Training of abortion providers must ensure that theyhave the competencies to provide high-quality care in

accordance with national standards and guidelines.


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Guiding principles-establishing and

strengthening abortion services

Ensuring high-quality in-service deliveryrequires ongoing supervision, quality

assurance, monitoring and evaluation

Financing of abortion services should be

organized taking into account costs to thehealth system as well as the need to ensure

equitable financial access for all women; and

Successful scaling-up requires systematic

planning, management, guidance and support

for the process


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Quality Service by choice!

Thank you

dr arvind mathur- regional situation of preventing unsafe abortion in sear

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