In the course of developing this guideline, during the meetings of the Evidence and Recommendation Review Groups (ERRGs) and the Guideline Development Group (GDG), several evidence gaps and areas for further research were identified.

Law and policy

• Impact of abortion laws and policies on people with disabilities and people with diminished capacity who seek abortion
• Impact of abortion laws and policies on groups in vulnerable situations and groups with marginalized identities, specifically adolescents and transgender individuals
• Impacts, effects and rights-related implications of procedural barriers to abortion in various contexts
• Impacts, effects and rights-related implications of making abortion available on the request of the woman, girl or other pregnant person, with no additional restrictions
• Impacts, effects, and rights-related implications of the decriminalization of self-management of abortion and of assistance with self-management of abortion

Clinical services

• Efficacy, safety and acceptability of the letrozole plus misoprostol combination regimen across gestational ages and compared with the mifepristone plus misoprostol combination regimen
• Effectiveness of using misoprostol alone (i.e. typical/real use outside of study conditions, optimal number of repeat doses)
• Efficacy, safety and acceptability of the use of misoprostol alone across gestational ages
• Effectiveness, safety and acceptability of outpatient medical abortion at gestational ages ≥ 12 weeks
• Safety, effectiveness and acceptability of anti-epileptics and anxiolytics for pain management for medical abortion at gestational ages ≥ 14 weeks
• Management of cervical priming prior to dilatation and evacuation (D&E) at gestational ages ≥ 18 weeks in settings where osmotic dilators are not available
• Optimal antibiotic regimens for post-abortion infection prophylaxis
• Effective methods for diagnosis and treatment of non-symptomatic ectopic pregnancy
• Safety and effectiveness of screening and antibiotic treatment for pelvic inflammatory disease before surgical abortion versus provision of pre- or perioperative prophylactic antibiotics without screening or risk assessment for pelvic inflammatory infection
• Effectiveness of telemedicine for medical abortion at gestational ages < 6 weeks
• Efficacy, safety and acceptability of all abortion methods and related clinical interventions across gestational ages in transgender, nonbinary and intersex individuals seeking abortion care
• Development and adaptation of validated materials to provide individuals engaging in self-management of abortion with the information they need to make informed decisions about the risks/benefits of and the alternatives to the use of different medical abortion regimens
• Development of effective and user-friendly information for abortion seekers, e.g. leaflets and web pages or information for use in the context of hotlines and telemedicine services
• Development and validation of quality training materials for use in training of providers on a range of abortion care services (e.g. to train pharmacists, pharmacy workers and community health workers to effectively provide – or support self-management of – all tasks involved in medical abortion at gestational ages < 12 weeks)
• Safety, convenience and acceptability of re-using manual vacuum aspiration (MVA) equipment

Service delivery

• Safety, effectiveness and feasibility of expansion of health worker roles for certain abortion care tasks in low- and middle-income settings (e.g. surgical abortion at gestational ages ≥ 12 weeks, vacuum aspiration for incomplete abortion)
• Feasibility of pharmacists administering injectable contraception in low- and middle-resource settings (implementation research)
• Impact of social marketing and social franchising approaches in abortion care assessed through evaluation research
• The most appropriate prescribing and dispensing authorities for abortion medicines, including comparison of self-sourced abortion medicines versus medicines prescribed and/or dispensed by trained health workers
• Mechanisms for ensuring individuals who manage medical abortion on their own have access to medicines for pain management and to contraceptive methods
• Acceptability of and satisfaction with a range of service-delivery approaches for quality abortion care for transgender, nonbinary and intersex individuals

Universal health coverage (UHC), health financing and commodities

• Impact of the WHO Model Lists of Essential Medicines changes to the mifepristone plus misoprostol combination regimen assessed through evaluation research

Indicators for use in monitoring and evaluation (M&E) of care

• Development and validation of indicators that include social and economic disability in addition to physical disability when calculating years living with abortion-related disability (in line with the growing focus on global burden of disease and disability estimation)
• Development and validation of standardized data-verification methods, so that abortion-related data can be presented with a verification score (as part of efforts to address the underreporting of abortion-related data as a result of abortion-related stigma)
• Development and increased use of qualitative methods for M&E of quality abortion care to assess barriers to progress and enablers for strengthening health system performance