Beyond safety: the 2022 WHO abortion guidelines and the future of abortion safety measurement

Correspondence to Dr Caitlin Gerdts; cgerdts@ ibis repr oduc tive health. org © Author(s) (or their employer(s)) 2022. Reuse permitted under CC BYNC. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION In March 2022, the World Health Organization (WHO) released updated guidelines consolidating the current evidence and best practices for quality abortion care. Undergirded by a framework of human rights standards and in recognition of the centrality of an enabling environment, the new set of recommendations span law, policy, clinical services, and mechanisms for service delivery. For the first time, WHO abortion service delivery recommendations include the selfmanagement of medical abortion (Recommendation #50) and fully recommend trained community health workers, pharmacy workers, and pharmacists as providers for the medical management of abortion up to 12weeks gestation (Recommendation #28). These shifts in WHO abortion care guidelines are the result of decades of work by grassroots activists and researchers. Their innovative efforts to ensure access to evidencebased abortion care—regardless of legal setting— laid the groundwork for widespread experiential knowledge and scientific evidence regarding the safety and effectiveness of selfmanaged medical abortion. Informed by this body of work, the recommendations for selfmanagement of medical abortion in the new WHO guidelines have the potential to transform abortion access if international bodies, governments, and health systems expand the availability of abortion pills and access to trained support. The guidelines also have important implications for the way we conceptualise and measure abortion safety.