Safe abortion: Technical and policy guidance for health systems (World Health Organization, Geneva) 2003. 106 pages. Price: Sw.fr. 30.00/US $ 27.00; in developing countries: Sw.fr. 21. OO ISBN 92-4-159034-3
Safe abortion means providing services for termination of a viable early pregnancy (up to 20 wk) as well as managing other clinical types of abortion such as threatened abortion, inevitable abortion, incomplete abortion and missed abortion. This manual deals with termination of an early viable pregnancy only. Hence the term abortion requires to be defined in the introduction.
The factors need to be considered to formulate the national guidelines based on the countries' experience, health of women seeking the services, availability of supportive services, affordability of services, accessibility of health facilities and expertise of providers, are brought out in various chapters.
Attention need to be focused on women who seek repeated abortions without recourse to contraceptive practices especially in developing countries. Though some of these abortions could be avoided by proper counseling, some women are willing to take the risks of repeated abortions. There is reluctance to practice contraception due to various reasons. Awareness need to be generated in the population belonging to reproductive age group that using contraceptive methods is much less risky than getting abortion done.
The first chapter highlights the background, the reproductive rights and the need for prodiving safe abortion services. It also highlights the need for ready access to early abortion services to reduce maternal mortality and morbidity.
Chapter 2 on various methods that can be used in the procedure of abortion is well described. The use of suction evacuation when available over dilatation and curettage (D&C) is highlighted. Many service providers may not agree with the statement that dilatation and evacuation is the safest and most effective surgical method after 12 wk of pregnancy. The section of Other medical abortion agents' needs to be elaborated describing the methods, various advantages, disadvantages and complications. Some of these methods, such as ethacridine lactate are still the method used extensively in India.
The third and fourth chapters will be very useful for policy makers, service managers and providers. Chapter 3 dealing with upgradation of facilities/starting new facilities for abortion services describes assessing the current status, establishing national norms and standards, ensuring providers skills and performance, monitoring and evaluation and budgeting. Chapter 4 deals with legal and policy considerations. It describes laws, their implementation, creating an enabling policy environment and removing administrative and regulatory barriers. The comprehensive account of all these aspects usually dealt by top level administrators and managers will help in planning to provide appropriate services to all women seeking elective abortion.
The manual is easy to read and understand. The tables provided in each chapter make it easy to appreciate the text. This manual will be useful to the policy makers, health managers and service providers in both developing and developed countries.
Dr Kamala Ganesh
D-I, Gulmohar Park
New Delhi 110049
Copyright Indian Council of Medical Research Jan 2004
Provided by ProQuest Information and Learning Company. All rights Reserved
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