Chapter 3. Recommendations and best practice statements across the continuum of abortion care
Clinical services Recommendation 34: Follow-up care or additional services after abortion (3.5.1)
3.5.1 Follow-up care after abortion
Routine follow-up is not necessary following an uncomplicated surgical or medical abortion, if the individual has adequate information about when to seek care for complications and has received any appropriate supplies or information to meet contraceptive needs. However, an optional follow-up visit 7–14 days after the procedure may be offered to provide contraceptive services, emotional support or management of any medical concerns.
If the woman chooses to attend a follow-up appointment, then use the contact to:
- assess the individual’s recovery and inquire about any signs or symptoms of ongoing pregnancy;
- review any available medical records and referral documents;
- ask about any symptoms experienced since the procedure;
- perform a focused physical examination if needed to assess any complaints; and
- assess the individual’s fertility goals and need for contraceptive services.
- If no contraceptive method was provided or started at the time of the abortion, provide information on contraception and offer contraceptive counselling and provision of contraceptive services, if desired by the woman.
- If a contraceptive method was already started, assess the method used and address any concerns or resupply as needed (122).
CLINICAL SERVICES Recommendation 34: Follow-up care or additional services after abortion
Following uncomplicated surgical abortion or medical abortion: Recommend that there is no medical need for a routine follow-up visit. However, information should be provided about the availability of additional services if they are needed or desired.
- Women, girls and other pregnant persons must be adequately informed about symptoms of ongoing pregnancy (which may or may not indicate failure of the abortion) and other medical reasons to return for follow-up, such as prolonged heavy bleeding, no bleeding at all with medical management of abortion, pain not relieved by medication, or fever.
- The quality of the evidence was low (observational studies and indirect evidence).
Source: Recommendation 9 updated from WHO (2012) (19).
Note on updating of the recommendation: This was an existing recommendation for which an updated literature search was conducted, but GRADE methodology was not applied. The wording of the recommendation was revised to remove the medical abortion regimen that was mentioned (this recommendation now applies to all abortion methods and regimens, see section 3.4) and to use the word “recommend” to make clear this is a strong recommendation.
KEY HUMAN RIGHTS CONSIDERATIONS RELEVANT TO FOLLOW-UP CARE
- Regardless of whether abortion is legal, States are required to ensure access to post-abortion care where it is needed.
- Post-abortion care must be available on a confidential basis, including in situations where abortion is illegal.
- Post-abortion care must be available without the threat of criminal prosecution or punitive measures. States must not require health workers to report persons suspected of undertaking unlawful abortion, or require them to provide any potentially incriminating information during or as a prerequisite to receiving post-abortion care.
For further information and sources, please refer to Box 1.2 and Web annex A: Key international human rights standards on abortion.