Chapter 3. Recommendations and best practice statements across the continuum of abortion care

Service delivery Recommendation 4: Provision of information on abortion care (3.2.1)

3.2.1 Providing information

Abortion-related information for individuals considering or seeking abortion or in the post-abortion period should include:

  • the available options for abortion methods and pain management;
  • information related to free and informed consent;
  • what will occur before, during and after the abortion procedure or process, including any tests and/or pain relief that may be needed and any aspects of the care that could be self-managed if desired, with or without remote support;
  • what the individual is likely to experience during and after the abortion procedure or process, and how long the procedure/process and the recovery are likely to take;
  • when normal activities can be resumed, including sexual intercourse;
  • how to recognize potential side-effects and symptoms of ongoing pregnancy (which may persist temporarily even when abortion has been successful, or which may indicate failure of the abortion), and other medical reasons to return for follow-up care, including complications such as prolonged heavy bleeding or fever; and
  • when, where and how to access follow-up care or additional services that may be desired such as counselling (see section 3.2.2), contraception (see section 3.5.4) and other services (see section 3.2.3).

SERVICE DELIVERY Recommendation 4: Provision of information on abortion care

Type of health worker Recommendation Rationalea
Community health workers (CHWs) Recommend Provision of health promotion interventions by CHWs is generally well accepted and feasible in many contexts where there is a strong CHW programme (moderate-certainty evidence). The potential to expand equitable access to information and quality abortion care by equipping CHWs to provide essential information on abortion is high.
Pharmacy workers Suggest

Condition: In contexts where the pharmacy worker is under the direct supervision of a pharmacist and there is access or referral to appropriate health services.

Insufficient direct evidence was found for the safety, effectiveness and acceptability of this option. However, in many contexts, pharmacy workers are often consulted by women seeking advice on how to deal with delayed menstruation (moderate-certainty evidence). Although the effectiveness of training interventions with pharmacy workers is uncertain, the potential benefits of equipping them to provide essential information outweighs the potential harms of them not providing information or providing incorrect information.
Pharmacists Recommend Pharmacists are qualified to provide information about the medicines they dispense. Evidence was found for the effectiveness of provision of education and counselling on chronic illnesses by pharmacists (low to moderate certainty). In many contexts, pharmacists are often consulted by women seeking advice on how to deal with delayed menstruation (moderate-certainty evidence).
Traditional and complementary medicine professionals

Auxiliary nurses/auxiliary nurse midwives (ANMs)

Nurses

Midwives

Associate/advanced associate clinicians

Generalist medical practitioners

Specialist medical practitioners

Recommend Within their typical scope of practice,b therefore no assessment of the evidence was conducted.
Source: Recommendation from WHO (2015) (23).

Note on updating of the recommendation: This was an existing recommendation for which evidence relating to pharmacy workers was reviewed using GRADE methodology, since that was the only category of health worker that didn’t already have a strong recommendation (“recommend”) for this task. After review, no change was made to the existing weak recommendation (“suggest”). A summary of the evidence is presented in Supplementary material 3, EtD framework on Information provision by pharmacy workers.

a For this and all health worker recommendations, given the limited evidence for many of the health worker–task combinations, the discussions of the expert panel focused on the competency framework in WHO’s 2011 publication, Sexual and reproductive health: core competencies in primary care (121), which provides information on the competencies (including skills and knowledge) required for each task, and also the WHO-INTEGRATE criteria, in particular on the feasibility, equity and acceptability of the intervention and women’s values and preferences.

b For typical scope of work/practice, please refer to Annex 5: Health worker categories and roles.

There is no requirement for location (on-site vs off-site), but privacy and confidentiality should be ensured during the provision of information, with particular attention needed to this requirement in the off-site (out-of-facility) settings, such as pharmacies and community-based sites, where infrastructure and procedures may make this more challenging.

Implementation considerations
  • Different modalities exist for the provision of information on abortion, e.g. remote access via hotlines and telemedicine, and through approaches such as harm reduction and community-based outreach (see section 3.6) as well as in-person interactions with health workers.
  • Information should be accessible and understandable, including formats catering to low-literacy and differently abled populations.

KEY HUMAN RIGHTS CONSIDERATIONS RELEVANT TO THE PROVISION OF INFORMATION

  • Informed consent requires the provision of complete and accurate, evidence-based information.
  • Accurate information on abortion must be available to individuals in a way that respects privacy and confidentiality.
  • The right to refuse such information when offered must be respected.
  • Abortion information should be available to all persons without the consent or authorization of a third party. This includes abortion information being available to adolescents without the consent or authorization of a parent, guardian or other authority.
  • Information must be non-discriminatory and non-biased and presented in a respectful manner. It should not fuel stigma or discrimination.
  • Dissemination of misinformation, withholding of information and censorship should be prohibited.
  • Information should be acceptable to the person receiving it and of high quality; it should be presented in a way that can be understood and it must be accurate and evidence based.

For further information and sources, please refer to Box 1.2 and Web annex A: Key international human rights standards on abortion.