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These issues apply whether services are public, private or not-for-profit. Establishment of national standards and guidelines facilitating access to and provision of safe abortion care to the full extent of the law. Standards and guidelines should cover: types of abortion service, where and by whom they can be provided; essential equipment, instruments, medications, supplies and facility capabilities; referral mechanisms; respect for women's informed decision-making, autonomy, confidentiality and privacy, with attention to the special needs of adolescents; special provisions for women who have suffered rape; and conscientious objection by health-care providers. Ensuring health-care provider skills and performance through: training; supportive and facilitative supervision; monitoring, evaluation, and other quality-improvement processes.

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By contrast, The Doula Project was launched in to give free support to women from lower-income backgrounds and marginalised communities. For abortion care, the goal is to promote change for continuous improvement as part of maintaining good-quality services that respond to the needs of health-care abortiob, as well as the health-care needs and rights of women.

Where capacity to provide good-quality abortion services at the primary level does not yet exist, referral to services at higher levels is essential see Box 3. Health-care workers should support minors to identify what is abortiln their best interests, including consulting parents or other trusted adults about their pregnancy, without bias, discrimination or coercion.

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Abortion laws and services should protect the health and human rights of all women, including adolescents. There should be a private place for undressing, curtained windows, and cloth or paper drapes to cover the woman during the procedure. Financing Health-service budgets should include sufficient funds for the following types of costs: equipment, medications and supplies required to provide safe abortion care; staff time.

Abortion care can be safely provided by any properly trained health-care provider, including midlevel i. Programme evaluators can focus their attention on three key areas related to policies, programmes and services: access; availability; and quality of care.

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Abortion-service providers should ensure that all women are treated without discrimination and with respect. Answering these questions can provide information that will enable policy-makers and programme managers to better understand and overcome existing barriers to access and improve the quality of care. Reusable equipment saves costs, but rigorous cleaning and disinfection procedures must be followed see Chapter 2.

Skills and performance expectations set out in standards and guidelines should serve as the basis of pre-service training for all appropriate cadres, and abortion-care providers should receive periodic in-service training to ensure they maintain their skills to perform their jobs according to abortion-care standards.

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They also need supportive and facilitative supervision and oversight to ensure that standards and guidelines are followed. Vicki Bloom has been in the room for more than 2, procedures since ing the non-profit Doula Project in I'll make a connection with a person whose life is really complicated and help them in that moment with this one thing, and then I'll never see them again," she says.

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Third-party authorization A woman seeking an abortion is an autonomous adult. I can't fix their bad relationship or their lack of a job. In many contexts, making safe, legal abortion services readily available to all eligible women will require training of midlevel health-care professionals 30 — Instruments for MVA are made for either single or multiple use. Evidence-based standards and guidelines In many countries, evidence-based standards and guidelines for abortion service delivery, including treatment of abortion complications, do not exist.

Constellation of services should always involve, at a minimum: medically accurate information about abortion in a form the woman can understand and recall, and non-directive counselling if requested by the woman to facilitate informed decision-making; abortion services delivered without delay; timely treatment for abortion complications, including complications from unsafe abortion; contraceptive information, services and referrals, to help prevent repeat unintended pregnancy and reduce the need for another abortion.

Where referral is not possible, the health-care professional who objects, must provide safe abortion to save the woman's life and to prevent serious injury to her health.

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Thus, health-care providers have a human rights obligation to ensure that women are not subject to coercion and that they receive the necessary psychological, social and health services to support their choice. Essential equipment, medications and supplies Most of the equipment, medications, and supplies needed to provide vacuum aspiration manual and electric and medical methods of abortion see Table 3.

The WHO indicators for safe abortion care 38 are shown in Table 3. Licensing criteria, where required, should not impose excessive requirements for infrastructure, equipment, or staff that are not essential to the provision of safe services.

Why we need to talk about abortion: eight women share their experiences

Abortion facilities within both the public and private sectors should be available at all levels of the health system, with appropriate referral mechanisms between facilities. Health-care personnel with the skills to perform a bimanual pelvic examination to diagnose and date a pregnancy, and to perform a transcervical procedure such as intrauterine device IUD insertion, can be trained to perform roo, aspiration abortiob613 — Although the choice of methods will reflect health-system capability, even the most resource-constrained health systems should be able to provide medical methods and manual vacuum aspiration.

Attention should be given to the special needs of the roo, adolescents, and other vulnerable and marginalized women. In countries where standards and guidelines already exist, routine review and updates ensure that they continue to promote women's physical, mental, and social well-being and reflect new evidence of best practices.

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Health-care providers therefore have a duty to protect medical information against unauthorized disclosures, and to ensure that women who do authorize release of their confidential information to others do so freely and on the basis of clear information. Questions and issues to consider for periodic assessment and evaluation of abortion services. They can also inform women about where to obtain a pregnancy test and how to obtain safe, legal abortion care, and they can refer women with complications from unsafe abortion for emergency care.

abortiion Methods of abortion Respect for a woman's choice among different safe and effective methods of abortion is an important value in health-service delivery. Standards and guidelines should cover: types of abortion service, where and by whom they can be provided; essential equipment, instruments, medications, supplies and facility capabilities; referral mechanisms; respect for women's informed decision-making, autonomy, confidentiality and privacy, with attention to the special needs of adolescents; special provisions for women who have suffered rape; and conscientious objection by health-care providers.

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These human rights are enshrined in international and regional human rights treaties, as well as in national constitutions fhat laws. For both vacuum aspiration and medical abortion, procedures for referral to higher-level care should be in place Women who present with complications from an unsafe or illegal abortion must be treated urgently and respectfully, as any other emergency patient, without punitive, prejudiced or biased behaviours see also Chapter 4.

Access to safe abortion depends not only on the availability of services, but also on the manner in which they are delivered and the treatment of women within the roon context. In such cases, health-care providers must refer the woman to a willing and trained provider in the same, or another easily accessible health-care facility, in accordance with national law.

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