Annexes

Annex 11: Details about guideline dissemination and updating

Dissemination

The full guideline will be published digitally (both an interactive web-based version and a PDF document available online for download) and in print. The recommendations from this guideline will also feature in the annually updated compendium of recommendations approved by the WHO Guidelines Review Committee (GRC), which will be produced by the WHO Department of Sexual and Reproductive Health and Research (SRH) across all thematic areas. The digital versions of the guideline will be available via the WHO website.[1] The links to the digital versions will be disseminated through nongovernmental organization (NGO) partners, the websites of professional associations, and social media platforms. Supplementary materials including the corresponding GRADE Evidence-to-Decision (EtD) frameworks for each of the recommendations are also available online. Print versions of the guideline will be distributed to WHO regional and country offices, NGO partners and professional associations.

Translation of the guideline into Spanish (in collaboration with the Pan American Health Organization [PAHO]), French and Portuguese is planned. Translations into other United Nations languages will be developed as needed. Third-party translations into additional languages will be encouraged, provided they comply with WHO guidance on such translations.

The guideline will be launched through dissemination meetings in each WHO region, and specific knowledge transfer and adaptation activities and implementation research will take place in select countries based on need and expressed interest to move ahead with implementation of the recommendations. Additional products will support the launch of the guideline to allow for regional colleagues to disseminate the key information widely. Such products include:

  • a PowerPoint presentation that summarizes the key messages and new elements to the guideline;
  • a PowerPoint presentation on the evidence behind selected recommendations;
  • social media tiles.

WHO regional offices and a number of interested agencies and NGO partners are expected to be active partners in the regional, national and local dissemination and adaptation of this guideline and in developing derivative informational materials.

Updating

This guideline will be presented online in an interactive web-based format soon after publication of the standard format version, which will be available for download. The web-based format will allow the guideline to be a “living guideline”, facilitating review of new research evidence to ensure that it can be brought to the GDG for review and then updated as appropriate in the guideline on an ongoing basis. This consolidated guideline currently combines and updates recommendations from three former WHO guidelines on abortion care,[2] and future updates will also cover new related topics, as needed.

The rapidly evolving nature of the interventions and approaches for quality abortion care, especially those for self-management of abortion, calls for a continuous review of the literature. The WHO Guideline Steering Group (see Annex 1) is in the process of developing a database system that will allow for continuous search and review of the evidence. This in turn will help with future updates of the recommendations and will inform any areas that may potentially require a new recommendation. There are many areas for which no evidence was found or which are only supported by low-certainty evidence (see Chapter 4, section 4.3), and in these cases new recommendations or a change in the published recommendation, respectively, may be warranted. Any concern about the validity of an existing recommendation can be communicated promptly to the Prevention of Unsafe Abortion (PUA) Unit at WHO’s Department of Sexual and Reproductive Health and Research (email: [email protected]), after which the PUA Unit will seek approval from the WHO GRC to undergo the process for a “rapid guidance”, and plans will be made to update the recommendation as needed. All technical products developed during the process of developing this guideline – including full reports of systematic reviews, corresponding search strategies and dates of searches – will be archived for future reference and use. Where there are concerns about the validity of a recommendation based on new evidence, the systematic review addressing the primary question will be updated. To update the review, the search strategy used for the initial review will be re-applied. Any new questions identified following the original scoping exercise for the guideline will undergo a similar process of evidence retrieval, synthesis and application of the GRADE approach in accordance with the standards in the WHO handbook for guideline development.[3] For further information on the “living guidelines” process, refer to recent publications by Vergara-Merino et al. (2020)[4] and Vogel et al. (2019).[5]

Footnotes

  1. Available here.
  2. Safe abortion: technical and policy guidance for health systems, second edition. Geneva: World Health Organization; 2012 (https://www.who.int/publications/i/item/9789241548434).
    Health worker roles in providing safe abortion care and post-abortion contraception. Geneva: World Health Organization; 2015 (https://www.who.int/reproductivehealth/publications/unsafe_abortion/abortion-task-shifting/en/).
    Medical management of abortion. Geneva: World Health Organization; 2018 (https://www.who.int/reproductivehealth/publications/medical-management-abortion/en/).
  3. WHO handbook for guideline development, second edition. Geneva: World Health Organization; 2014 (https://apps.who.int/iris/handle/10665/145714).
  4. Vergara-Merino L, Verdejo C, Carrasco C, Vargas-Peirano M. Living systematic review: new inputs and challenges. Medwave. 2020;20(11). doi:10.5867/medwave.2020.11.8092.
  5. Vogel J, Dowswell T, Lewin S, Bonet M, Hampson L, Kellie F, et al. Developing and applying a “living guidelines” approach to WHO recommendations on maternal and perinatal health. BMJ global health. 2019;4(4). doi:10.1136/bmjgh-2019-001683.