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Quality of care and abortion: beyond safety

Governments, advocates, providers, policymakers and other stakeholders who want to fully support women’s rights to access abortion across the globe must address quality of care, in addition to efforts to change abortion laws, train providers and expand service provision. Documenting and working to improve the quality of abortion care is necessary in order to improve service delivery and health outcomes, expand access to safe abortion especially in legally restricted settings, and to ensure the human right to the highest attainable standard of health, as outlined by the WHO.1 Quality of healthcare services is the degree to which services produce desired health outcomes and rely on best available evidence.2 Domains of quality as defined by the WHO3 and the Institute of Medicine (IOM)2 ask whether healthcare is effective, efficient, accessible, acceptable/patient-centred, equitable and safe.

The safety of abortion is well established in settings where abortion is legal,4 despite claims to the contrary from those who seek to restrict access to abortion. A safe abortion is understood to mean a medical (medication), aspiration, or surgical abortion that conforms to WHO guidelines.5 Well-managed self-use of medical abortion is on the spectrum of safe abortion. In settings with high-quality clinical data and access to legal abortion such as the United States, first-trimester abortions carry an extremely low risk …