8/11/2019 Dr Arvind Mathur- Regional Situation of Preventing Unsafe Abortion in SEAR
1/19
Situation of preventing unsafeabortion in SEAR
Mapping of clinical services
Dr Arvind Mathur
WHO-SEARO
Intercountry Orientation
Workshop on Clinical
Practice Handbook for SafeAbortion
8/11/2019 Dr Arvind Mathur- Regional Situation of Preventing Unsafe Abortion in SEAR
2/19
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion
Unsafe abortion
22 million abortions unsafe abortionsyearly, resulting in:
47,000 deaths (13% of pregnancy-related deaths)
5 million disabilities 20% of total mortality & disability
burden due to pregnancy & childbirth
98% occur in developing countries
8/11/2019 Dr Arvind Mathur- Regional Situation of Preventing Unsafe Abortion in SEAR
3/19
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion
Estimated Number of Unsafe Abortions,
Globally and by major region-2003 and 2008
8/11/2019 Dr Arvind Mathur- Regional Situation of Preventing Unsafe Abortion in SEAR
4/19
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion
Regional Estimates of Mortality due to
unsafe abortion
8/11/2019 Dr Arvind Mathur- Regional Situation of Preventing Unsafe Abortion in SEAR
5/19
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion
Preventing Unsafe Abortion in SEAR
8/11/2019 Dr Arvind Mathur- Regional Situation of Preventing Unsafe Abortion in SEAR
6/19
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion
Preventing Unsafe Abortion in SEAR
8/11/2019 Dr Arvind Mathur- Regional Situation of Preventing Unsafe Abortion in SEAR
7/19
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion
Grounds on which abortion is permitted in
SEAR countries
8/11/2019 Dr Arvind Mathur- Regional Situation of Preventing Unsafe Abortion in SEAR
8/19
Mapp ing o f Cl in ical
Services
http://localhost/var/www/apps/conversion/tmp/scratch_2/Mapping%20Clinical%20Practices%20in%20SEAR/Abortion%20provision_Final_21august2014.dochttp://localhost/var/www/apps/conversion/tmp/scratch_2/Mapping%20Clinical%20Practices%20in%20SEAR/Abortion%20provision_Final_21august2014.dochttp://localhost/var/www/apps/conversion/tmp/scratch_2/Mapping%20Clinical%20Practices%20in%20SEAR/Abortion%20provision_Final_21august2014.dochttp://localhost/var/www/apps/conversion/tmp/scratch_2/Mapping%20Clinical%20Practices%20in%20SEAR/Abortion%20provision_Final_21august2014.doc8/11/2019 Dr Arvind Mathur- Regional Situation of Preventing Unsafe Abortion in SEAR
9/19
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion
Policy or Legal Restrictions for Abortion/MR/PACRestrictions WHO India Bdesh
Gestational limits apply
Authorization of medical
professional(s) required. Please
indicate number of professionals who
need to authorize abortion provision
Parental or judicial consent required
for minors
Husbands consent required for
married women
By certified providers only
Authorized in licensed facilities only
Compulsory counselling or waiting
periods
Prohibition of sex-selective abortion
Any other (please specify)
8/11/2019 Dr Arvind Mathur- Regional Situation of Preventing Unsafe Abortion in SEAR
10/19
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion
Place of provision of Abortion/MR/PACSetting/ facility WHO India Bdesh
Primary Health Centre
Secondary health center
including community leveland district level facilities
Any private facility
Only private facilities that are
registered as abortion care
facilities
Pharmacies
Other, please specify
8/11/2019 Dr Arvind Mathur- Regional Situation of Preventing Unsafe Abortion in SEAR
11/19
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion
Health Care ProviderHealth care personnel providing
abortion services
WHO (As per law
applicable)
India Bdesh
Specialist Ob/gyn
General practitioner
Only those general practitionerswho are trained in abortion
provision
Midlevel providers (Midwives,
Nurses, clinical officers,
physician assistants, FamilyWelfare Visitors, and others)
trained in basic clinical
procedures
Any other personnel, specify
8/11/2019 Dr Arvind Mathur- Regional Situation of Preventing Unsafe Abortion in SEAR
12/19
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion
Methods of Abortion: SurgicalWHO
Recommendation
(2012)
India Bangladesh
Up to 10weeks
Surgical Abortion
12 weeks or
less
13-14 weeks
>14 weeks
15- 20 weeks
8/11/2019 Dr Arvind Mathur- Regional Situation of Preventing Unsafe Abortion in SEAR
13/19
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion
Methods of Abortion: MedicalWHO India BDesh
Up to 7 weeks
(49 days)
8-9 weeks
(50-63 days)
10-12 weeks
64-84 days
1318 weeks
8/11/2019 Dr Arvind Mathur- Regional Situation of Preventing Unsafe Abortion in SEAR
14/19
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion
Ultrasound
WHO
Recommends
India Bangladesh
Mandatory
USG to
confirm
pregnancy
Mandatory
USG to
confirm
completion
of abortion
8/11/2019 Dr Arvind Mathur- Regional Situation of Preventing Unsafe Abortion in SEAR
15/19
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion
InvestigationsTests mandatory by guidelines WHO
Recommends
India Bangladesh
Not mandatory unless signs of
pregnancy not present and
provider unsure of woman being
pregnant
Urine for pregnancy
confirmation
Urine for sugar
Rh Status
Hb status
8/11/2019 Dr Arvind Mathur- Regional Situation of Preventing Unsafe Abortion in SEAR
16/19
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion
Investigations
WHO India BDesh
HIV testing/counselling
STI screening
Cervical cancer
screening (performed
during pelvic exam)
Ultrasound
Any other , specify
8/11/2019 Dr Arvind Mathur- Regional Situation of Preventing Unsafe Abortion in SEAR
17/19
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion
Guiding principles-establishing and
strengthening abortion services
Safe abortion services should be readily available and
affordable to all women and adolescents, to the full
extent of the law.
National standards and guidelines for safe abortion
care should be evidence based and periodically
updated, and should provide the necessary guidance toachieve equitable access to high-quality care.
New policy and programme interventions should be
based on evidence-based best practices.
Training of abortion providers must ensure that theyhave the competencies to provide high-quality care in
accordance with national standards and guidelines.
8/11/2019 Dr Arvind Mathur- Regional Situation of Preventing Unsafe Abortion in SEAR
18/19
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion
Guiding principles-establishing and
strengthening abortion services
Ensuring high-quality in-service deliveryrequires ongoing supervision, quality
assurance, monitoring and evaluation
Financing of abortion services should be
organized taking into account costs to thehealth system as well as the need to ensure
equitable financial access for all women; and
Successful scaling-up requires systematic
planning, management, guidance and support
for the process
8/11/2019 Dr Arvind Mathur- Regional Situation of Preventing Unsafe Abortion in SEAR
19/19
Intercountry Orientation Workshop on Clinical Practice Handbook for Safe Abortion
Quality Service by choice!
Thank you