Chapter 2. Abortion regulation including relevant recommendations
Recommendations relating to regulation of abortion (2.2)
Three recommendations relating specifically to the regulation of abortion are presented in this section (Recommendations 1–3) and four additional recommendations, also relating to law and policy and abortion, are presented in Chapter 3, section 3.3: Pre-abortion (Recommendations 6,7,21 and 22). These seven recommendations were formulated by the expert panels formed for the development of this guideline, including expert human rights advisers (all contributors are listed in Annex 1 and the roles of the contributing groups are described in Annex 4). The evidence was first systematically reviewed for each prioritized topic and question, and the level of certainty of that evidence was assessed (i.e. based on the quality of the evidence, including the types and sizes of studies conducted and their various limitations).
The direction (in favour or against) and strength of each recommendation was determined by the panel of experts based on the six substantive criteria of the WHO-INTEGRATE framework as applied to each intervention for the specified population – balance of health benefits and harms; human rights and sociocultural acceptability; health equity, non-discrimination and equality; societal implications; financial and economic considerations; feasibility and health system considerations – while also taking into account the meta-criterion: quality of evidence (118).
Recommendations in favour of an intervention are qualified as either strong or weak (with the conditions of use specified for the latter), with the third alternative being a recommendation against the intervention. To clearly indicate the strength and direction of each recommendation, the following wording is used:
- Recommend – a strong recommendation in favour of the intervention
- Suggest – a weak recommendation in favour of the intervention (requiring additional wording to qualify the recommendation, specifying the conditions of use)
- Recommend against – a strong recommendation against the intervention/in favour of the comparison.
For each topic covered, both in this chapter and also in Chapter 3, first brief background information is presented, then the recommendation itself, followed next by a list of remarks (if any) from the expert panel that reviewed the evidence in detail, explaining the conditions and context relevant to the recommendation, and then the rationale, or summary of the evidence base and decision-making process for the recommendation, and finally a box listing any key human rights considerations relevant to the recommendation or broader topic. It should be noted that the 2012 Safe abortion guidance provided a composite recommendation related to law and policy; in this guideline, this has been developed this into seven separate recommendations using GRADE methodology, but they are not considered to be “new” (i.e. Recommendations 1,2,3,6,7,21,22). The methods are described in full in Annex 4, including the differences in the methods applied for the seven recommendations relating to law and policy issues compared with the other types of recommendations. A summary table linking the topics covered, the research questions, the systematic reviews conducted and the recommendation numbers is provided in Annex 7. The full Evidence-to-Decision (EtD) frameworks are provided online as supplementary material and hyperlinked cross-references to these are supplied with the rationale for new and updated recommendation presented.
- The expert panels included the Evidence and Recommendations Review Groups (ERRGs) for each of the three domains (Law and policy, Clinical services and Service delivery) and later the Guideline Development Group (GDG), and each phase and each meeting of these groups also involved at least one human rights adviser. For further details on the roles of these groups and the full methodology for the guideline development process, see Annex 4: Methods. ↩
- Supplementary material 1: EtD frameworks for law and policy topics, available here. ↩