Abortion is a safe procedure when carried out in line with evidence-based practices, many of which are reflected in the World Health Organization’s Abortion care guidelines. However, half of abortions that occur around the world are unsafe, meaning the procedure is carried out by a person lacking the necessary skills and/or in an environment that does not conform to minimal medical standards. Life-threatening complications that may result from unsafe abortion include haemorrhage, infection, and injury to the genital tract and internal organs.
“The problem is that many healthcare providers in some high-need countries have not had the opportunity to receive the formal education they need to provide family planning and comprehensive abortion care, but are then put in a situation where they are expected to provide essential care,” said Ulrika Rehnström Loi, technical officer and midwife at WHO. It is crucial 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 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 Abderdeen, Freetown, Sierra Leone on 21 June 2022. © WHO / SRH / Hickmatu Leigh
To address this gap in capacity, the UN’s Special Programme in Human Reproduction (HRP) and the World Health Organization (WHO) worked with midwives, doctors, regional teams and other stakeholders from around the world to develop three volumes of the Family Planning and Abortion Care Toolkit. The 57 competencies define the essential knowledge and skills primary healthcare workers should develop during their education. The family planning and comprehensive abortion care competencies are designed to be suitable for developing learning outcomes (or learning objectives) both for formal education and for lifelong learning in the workplace. It is the actual learning achieved (the outcome) that matters.
Competencies are a benchmark, not just for education but also for performance in the workplace. They help to define standards, and to plan and measure professional development, improving job performance as well as learning.
Subsequently, HRP, in collaboration with the WHO Academy, began developing online courses to help healthcare providers strengthen their competencies in comprehensive abortion care.
“It is important that health care providers, like doctors and midwives, have the necessary knowledge to implement WHO recommendations,” said Antonella Lavelanet, Medical Officer at WHO and HRP. “Publishing recommendations is just the beginning; the next step is ensuring health care providers are equipped to apply the recommendations effectively 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’s Abortion Care Guidelines. It takes six hours and has four modules:
- Pre-abortion assessment
- Medical abortion fundamentals
- Administration of medical abortion and follow-up
- Medical abortion service delivery and health system considerations for abortion care
Participants receive a WHO Academy Award of Completion for finishing each module.
"The training helped me to update my knowledge and skills on medical abortion based on the latest recommendations," said Nani Kaway, a registered nurse in Nepal. "I can use it to provide quality medical abortion services to the client as per our country policy guidelines and the Right to Safe Motherhood and Reproductive Health Act. I can also use this training package during in-service training and preservice education for midwifery students."
The second course has recently been released, called the Integration of a human rights-based approach to comprehensive abortion care, which is on the human rights elements of abortion care.
“This course gives healthcare providers and policymakers practical tools to integrate human rights into abortion care, so services remain accessible, equitable and respectful of all who seek them,” said Ulrika Rehnström, Technical Officer at WHO.
Participants are already reporting on the usefulness of the courses to the context in which they operate. 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 one on postabortion care.
Other resources include a mobile app which walks healthcare workers through the process of assessing patients seeking an abortion. It helps them understand individual cases and patient information, including potential risks, and generates recommendations, checklists and important contextual information. The app can even help schedule follow-ups and referrals. This is complemented by a clinical practice handbook for quality abortion care, which facilitates the practical application of the clinical recommendations from WHO’s Abortion care guidelines. It translates evidence-based recommendations into accessible tools for day-to-day clinical practice.
With learning programmes and digital tools widely accessible, HRP and WHO are helping to close critical knowledge gaps and empower healthcare providers to deliver evidence-based abortion care.