Contents -- Introduction -- Chapter 1: Safe abortion services: the public health challenge -- Summary -- 1. Background -- 2. Induced abortion -- 3. Unsafe abortion -- 4. Safe abortion -- 5. Legal, policy and contextual considerations -- 6. The challenge - making safe services available -- References -- Chapter 2: Clinical care for women undergoing abortion -- Summary -- 1. Pre-abortion care -- 1.1 Patient history -- 1.2 Physical examination -- 1.3 Laboratory testing -- 1.4 Ultrasound scanning -- 1.5 Pre-existing conditions -- 1.6 Reproductive tract infections (RTIs) -- 1.7 Ectopic pregnancy -- 1.8 Rh-isoimmunisation -- 1.9 Cervical cytology -- 1.10 Information and counselling -- 1.10.1 Decision-making counselling -- 1.10.2 Information on abortion procedures -- 1.10.3 Contraceptive information and services -- 2. Methods of abortion -- Summary -- 2.1 Cervical preparation -- 2.2 Pain management -- 2.2.1 Medication for pain -- 2.2.2 Anæsthesia -- 2.3 Surgical abortion -- 2.3.1 Vacuum aspiration -- 2.3.2 Dilatation and curettage -- 2.3.3 Dilatation and evacuation -- 2.3.4 Other surgical procedures of abortion for use in later pregnancy -- 2.3.5 Tissue examination following surgical abortion -- 2.4 Medical methods of abortion -- 2.4.1 Mifepristone and prostaglandin -- 2.4.2 Misoprostol or gemeprost alone -- 2.4.3 Other medical abortion agents -- 2.5 Other issues related to abortion procedures -- 2.5.1 Infection prevention and control -- 2.5.2 Managing abortion complications -- 3. Follow-up -- 3.1 Recovery period -- 3.1.1 Surgical methods of abortion -- 3.1.2 Medical methods of abortion -- 3.2 Contraceptive method provision and STI counselling -- 3.3 Instructions for care after abortion -- References -- Chapter 3: Putting services in place -- Summary -- 1. Assessing the current situation -- 2. Establishing national norms and standards.

2.1 Types of abortion services and where they can be provided -- 2.1.1 Community level -- 2.1.2 Primary-care facility level -- 2.1.3 District hospital (first referral) level -- 2.1.4 Secondary and tertiary referral hospitals -- 2.2 Essential equipment, supplies, medications and facility capabilities -- 2.2.1 Regulatory requirements for drugs and devices -- 2.3 Referral mechanisms -- 2.4 Respect for women's informed decision-making, autonomy, confidentiality and privacy, with attention to the special needs of adolescents -- 2.4.1 Informed and free decision-making -- 2.4.2 Autonomy in decision-making (third party authorization) -- 2.4.3 Confidentiality -- 2.4.4 Privacy -- 2.5 Special provisions for women who have suffered rape -- 3. Ensuring provider skills and performance -- 3.1 Provider skills and training -- 3.1.1 Training programmes -- 3.2 Supervision -- 3.3 Certification and licensing of health professionals and facilities -- 4. Monitoring and evaluation of services -- 4.1 Monitoring -- 4.2 Evaluation -- 5. Financing -- 5.1 Cost to the facility or health system -- 5.2 Making services affordable for women -- References -- Chapter 4: Legal and policy considerations -- Summary -- 1. Women's health and international agreements -- 2. Laws and their implementation -- 3. Understanding legal grounds for abortion -- 3.1 When there is a threat to the woman's life -- 3.2 When there is a threat to the woman's physical or mental health -- 3.3 When pregnancy is the result of rape or incest -- 3.4 When there is fetal impairment -- 3.5 For economic and social reasons -- 3.6 On request -- 3.7 Limits on length of pregnancy -- 3.8 Other limits -- 4. Creating an enabling policy environment -- 4.1 Goals -- 4.2 Constellation of services -- 4.3 Methods of abortion -- 4.4 Range of providers -- 4.5 Service fees -- 4.6 Health system requirements/quality of care.

4.7 Public information -- 5. Removing administrative and regulatory barriers -- References -- Annex 1. Further reading and resources -- Annex 2. International consensus documents in relation to safe abortion -- Annex 3. Instruments and supplies for manual vacuum aspiration (MVA) -- Annex 4. Contraception following abortion.