Chapter 1. Introduction

An enabling environment for comprehensive abortion care (1.3)

Figure 1.1: Conceptual framework for abortion care

A person’s environment plays a crucial role in shaping their access to care and influencing their health outcomes. An enabling environment is the foundation of quality, comprehensive abortion care. The three cornerstones of an enabling environment for abortion care are outlined in Box 1.1 and elaborated in the text of this section:

  1. respect for human rights including a supportive framework of law and policy
  2. the availability and accessibility of information, and
  3. a supportive, universally accessible, affordable and well functioning health system.

For clarification, this section of the guideline document does not provide recommendations, rather it details the components and aspects that would comprise an overall enabling environment for quality abortion care, based on WHO best practices, which would provide the ideal context to best facilitate the recommendations in the later sections of this chapter and in Chapter 3. While this enabling environment represents an ideal context, complete implementation of the components of this enabling environment is not necessarily a precondition to implementation and application of the recommendations contained in this guideline.

Box 1.1: Core components of an enabling environment for abortion care

Respect for human rights including a supportive framework of law and policy

  • Countries ratify international and regional human rights treaties and conventions addressing health, including sexual and reproductive health (SRH).
  • Laws and policies promote SRH for all, and are consistent with sexual and reproductive health and rights.
  • There are appropriate administrative, political and judicial arrangements to facilitate quality abortion care, including accessible, transparent and effective mechanisms providing remedies. These include:
    • accessible mechanisms for women to challenge denial of abortion in a timely manner, and
    • appropriate monitoring mechanisms for failure to facilitate quality care, including regular review and reform of law and policy to recognize and remove barriers to quality abortion care.
  • Policies minimize the rate of unintended pregnancy by providing quality contraceptive information and services, including a full range of contraceptive methods (emergency, short-acting and long-acting methods).
  • All people and communities receive the health services they need, without suffering financial hardship and without any discrimination.

Availability and accessibility of information

  • Evidence-based comprehensive sexuality education (CSE) is provided for all individuals and made available in multiple and accessible forms and languages.
  • Accurate, non-biased and evidence-based SRH information, including on abortion and contraceptive methods, is widely available in multiple and accessible forms and languages.

Supportive, universally accessible, affordable and well functioning health system

  • Universal health coverage (UHC) ensures that all individuals can receive the care they need without financial hardship (see section 1.4.1).
  • The health system is adequately resourced, meaning that resources including essential medicines, supplies, equipment, workforce and financial allocations are available, accessible, acceptable, affordable and of good quality.
  • Equitable access to quality-assured essential medicines and health products is ensured.
  • Leadership and clinical standards promote evidence-based SRH services.
  • The organization of the health system ensures respect for SRH and human rights, including non-discrimination and equality, and for autonomy in decision-making.
  • The workforce is robust and receives competency-based training and is skilled in the provision of evidence-based SRH counselling and service delivery.
  • In addition to technical training, SRH services are provided by persons who are trained in the content and meaning of the law and trained and empowered to interpret and apply law and policy in rights-compliant ways.
  • Confidentiality and privacy of care are ensured, and there are efforts to counteract abortion stigma.
  • There is access to safe and timely comprehensive abortion care and women do not have to resort to unsafe abortion.
  • Health financing policies should avoid making access to SRH services conditional on direct payment from patients at the point of service.
  • Care is always provided respectfully and with compassion.
  • Communities are engaged and supportive.