WHO abortion care guideline, what it says about safety and care

The Abortion care guideline replaces and consolidates earlier WHO publications on safe abortion. It was developed under WHO's standard process for guidelines, with systematic reviews of the evidence, a guideline development group of external experts and a graded strength for each recommendation. It covers three areas.

• Law and policy, how laws and regulations affect access to safe care
• Clinical services, including methods by stage of pregnancy, pain management, care before and after abortion, and contraception
• Service delivery, including who can provide care, where, and how telemedicine fits in

The guideline is written for governments, health systems, health workers and organizations that plan services. It is a technical document, not a set of instructions for individuals. National medical societies such as ACOG in the United States, RCOG in the United Kingdom and FIGO internationally publish their own clinical guidance, and in most countries clinicians follow national guidance together with WHO recommendations.

The starting point of the guideline is that abortion is a safe health intervention when it is carried out with a method recommended by WHO, appropriate to the stage of pregnancy, and by a person with the necessary skills. WHO contrasts this with unsafe abortion, carried out without those conditions, which it identifies as a significant and preventable cause of maternal illness and death worldwide.

From that starting point, the guideline treats access to quality abortion care as part of health care, and it looks at what helps or hinders people in reaching safe care in time. Many of its recommendations are about removing delays, because the evidence it reviews shows that the risks of abortion, while low, increase as pregnancy advances.

WHO describes two groups of methods, and both are considered safe when provided in line with the guideline.

Medical abortion

Medical abortion uses medicines, a combination of mifepristone and misoprostol or misoprostol alone, to end a pregnancy in a process similar to a miscarriage. The guideline sets out regimens for different stages of pregnancy. We do not reproduce them here, because the choice of regimen and the follow-up belong to a consultation with a clinician. Our medication abortion guide explains how the process works in general.

Procedural abortion

Procedural abortion uses vacuum aspiration earlier in pregnancy and dilatation and evacuation later in pregnancy. The guideline recommends vacuum aspiration over sharp curettage, an older technique it no longer supports. Our procedural abortion guide describes what happens during the procedure.

Care around the abortion

The guideline also covers pain management, which it recommends offering for both methods, the information people should receive before and after the abortion, and contraception, which it recommends offering to everyone who wants it. It addresses when routine tests are or are not needed. It does not recommend routine ultrasound as a precondition for abortion and leaves its use to clinical judgment. For aftercare, read our abortion aftercare guide.

One of the most discussed parts of the guideline concerns telemedicine. WHO recommends telemedicine as an alternative to in-person interactions with a health worker for medical abortion, in whole or in part. In WHO's framing, telemedicine can cover the consultation, the information given to the patient, and contact after the abortion, provided that the person has access to accurate information, to a health worker and to a facility if needed.

The guideline sees telemedicine as a way to reduce travel, waiting and cost, especially in rural areas and for people with limited mobility. It also notes that telemedicine has to operate within the rules of each health system. Whether telemedicine abortion care is lawful, and under what conditions, is decided by national or state law. Abortion.io lists telehealth services only where they are licensed and where telehealth abortion care is legal. Read our telehealth abortion page.

The guideline also discusses how some steps of early medical abortion can be managed by the person outside a facility, with accurate information and access to a health worker. How this is regulated also depends on the law of each country.

WHO reviews the evidence on which health workers can safely provide different parts of abortion care. It recommends that, in addition to specialist doctors, other trained health workers such as general practitioners, midwives and nurses can provide medical abortion and vacuum aspiration earlier in pregnancy, within their training and national regulations. This approach, often called task sharing, is meant to make care available closer to where people live. Each country decides which professions may provide abortion care under its own law.

The guideline includes recommendations on how laws and regulations affect access to safe abortion. WHO bases these on public health evidence and on human rights standards. Described neutrally, the main recommendations are the following.

• WHO recommends the full decriminalization of abortion, meaning that it is not governed by criminal law for the person who has it, for health workers or for others who provide information or care.
• WHO recommends against laws that restrict abortion to specific grounds, and recommends that abortion be available on the request of the woman, girl or other pregnant person.
• WHO recommends against laws and regulations that prohibit abortion based on gestational age limits.
• WHO recommends against mandatory waiting periods.
• WHO recommends against requiring the authorization of other people or bodies, such as a partner, a parent or a hospital committee.
• WHO recommends that access to and continuity of care be protected where health workers decline to provide abortion on grounds of conscience.

These are recommendations to governments. They do not change the law of any country. Laws differ widely, and in many places they include gestational limits, grounds, waiting periods or consent rules that differ from these recommendations. Abortion.io describes the law that actually applies, with its source and verification date, on every country card and state card. To see what applies where you are, open the world abortion laws map or the map of abortion laws by state.

Our medical pages are based on the WHO Abortion care guideline (2022) and on national medical societies such as ACOG, RCOG, FIGO, CNGOF and HAS in France and DGGG in Germany. We use the guideline to describe methods, safety and the general course of care, and we name it as a source on every method page. We do not give dosages or individual medical advice, and every medical page says that medical decisions are made together with a doctor. Our legal pages describe national and state law as it is, not as any guideline recommends it should be. Read our sources and editorial policy.