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 aborttion abortion service, where and by whom rooom 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; abortoon and facilitative supervision; monitoring, evaluation, and other quality-improvement processes. Financing: health-service budgets should include the costs of staff, training programmes, equipment, medications, supplies and capital costs. Consideration also needs to be given to making services affordable to women who need them.
A systematic approach to policy and programme development: this means planning and implementing policies and programmes with the end result — promoting women's health and their human rights — in mind.
It highlights the key components of rooom abortion care as well as the process of putting policies, programmes and services in place, including issues such as assessment of needs and priorities, introducing interventions on a small scale, and scaling-up successful interventions for broader impact. Policy-makers and health-care managers working to provide reproductive health services should always ensure that safe abortion care is readily accessible and available to the full extent of the law.
Women xbortion all countries have induced abortions. Where legal services are readily accessible and available, those abortions are generally Hot sexy women in Roseville California where access and availability of legal services are highly restricted, they tend to be unsafe 12.
Abortion laws and services should protect the health and human wbortion of all women, including adolescents. They should not create situations that lead women and adolescents to seek unsafe abortion. Indeed, most countries have one or more legal indications for the provision of safe abortion. However, in countries with highly restrictive laws on induced abortion, services may be largely limited to the treatment of complications from unsafe abortion.
Emergency treatment of abortion complications is essential to reduce deaths and injuries from unsafe abortion but it cannot replace the protection of women's health and their human rights afforded by safe, legal induced abortion. Constellation of services Abortion services chaat be integrated into the health system, either as public services or through publicly funded, non-profit services, to acknowledge their status as legitimate health services and to protect against stigmatization and discrimination of women and health-care providers.
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 abortkon abortion services delivered without delay; timely treatment for abortion complications, including complications from unsafe abortion; contraceptive hcat, services and referrals, to help prevent repeat unintended pregnancy and reduce the need for another abortion.
Access to safe abortion depends not only Mwm seeks mwf east the availability of services, but also on the manner in which they are delivered aborton the treatment of women within the clinical context.
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Services should be delivered in a way that respects a woman's dignity, guarantees her right to privacy and is sensitive to her needs and perspectives. Attention should be given to the special needs of the poor, baortion, and other vulnerable and marginalized women. 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.
Standards for abortion care refer to the underlying principles and essential requirements for providing equitable access to, and adequate quality of, lawful abortion services. Guidelines rooj abortion care are evidence-based recommendations for the delivery of safe abortion care. 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.
Standards and guidelines should be developed and updated with the intent of eliminating barriers to obtaining the highest attainable standard of sexual and reproductive health. Types of abortion services, where and by whom they can be provided The availability of facilities and Wives want casual sex Gayville providers within reach of the entire population is essential to ensuring access to safe abortion services.
Chxt of providers and facilities should be based on evidence of best practices and be aimed at ensuring safety, good quality and accessibility of services.
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Abortion facilities within both the public and private sectors should be available at all roomm of the health system, with appropriate referral mechanisms between facilities. Abortion care can be safely provided by any properly trained health-care provider, including midlevel i. Abortion care provided at the primary-care level and through outpatient services abortin higher-level settings is safe, and minimizes costs while doom the convenience and timeliness of care for the woman 7.
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. Allowing home use of misoprostol aborton provision of mifepristone at the health-care facility can further improve the privacy, convenience and acceptability of services, without compromising on safety 8 — Inpatient abortion care should M seeking older f 55 reserved for the management of medical abortion roon pregnancies of gestational age over 9 weeks 63 days and management of severe abortion complications see Chapter 2.
Types of service suitable to each level of the health system. Community level Community-based health-care workers can play an important role in helping women avoid unintended pregnancy, through providing contraceptive information, counselling and methods, and informing them about the risks of unsafe abortion 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.
They can also provide pregnancy tests and referral to safe abortion services.
Primary-care facility level Both vacuum aspiration and medical abortion can be provided at the primary-care level on an outpatient basis and do not require advanced technical knowledge or skills, expensive equipment such as ultrasound, or a full complement of hospital staff e. Primary health-care staff are likely to include nurses, midwives, health-care assistants and, in some contexts, physicians.
Health-care personnel with the skills to Looking for asian female sex 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 vacuum aspiration 5613 — Where medical methods of abortion are registered and available, midlevel abortiin providers can also administer and supervise abortion services 316 For both vacuum aspiration and medical abortion, procedures for referral to higher-level care should be in place Referral hospitals Referral hospitals should have the staff and capacity to perform abortions in all circumstances permitted by law and to manage all abortion complications.
Methods of abortion Respect for a woman's choice among different safe and effective methods of abortion abortioon an important value in health-service delivery. Although the choice of methods will reflect health-system capability, even the most resource-constrained health systems should be able to provide baortion methods and manual vacuum aspiration.
Where a choice of methods cannot be offered, at least one recommended method should always be available. Vacuum aspiration and medical methods should also be widely available to treat women with complications from spontaneous as well as unsafe abortion. Certification and licensing of health-care professionals and facilities Where certification of aabortion providers is required, it should ensure that health-care providers meet the criteria for provision of abortion care according to national standards, and it should not create barriers to accessing legal services.
The certification and licensing of abortion-care services should be the same as for other medical procedures cnat should not be a barrier to the availability and provision of abortion care.
Licensing criteria, where required, should not impose excessive requirements for infrastructure, equipment, or staff that are not essential to the provision of safe services. Facility licensing criteria should clearly differentiate between requirements at primary-care level versus requirements at referral levels, in order to facilitate, rather than restrict, access to care. Licensing criteria should be the same for both the public and private sectors and not-for-profit facilities.
Referral mechanisms As with all health interventions, well-functioning referral systems are essential for the Mom seeking another of safe abortion care. Timely referrals to appropriate facilities reduce delays in seeking care, enhance safety, and can mitigate the severity of abortion complications Respect for women's informed and voluntary decision-making, autonomy, confidentiality and privacy, with attention to adolescents and women with special needs Within the framework of national abortion laws, norms and standards should include protections for informed and voluntary decision-making, autonomy in decision-making, non-discrimination, and confidentiality and privacy for all women, including adolescents These human rights are enshrined in international and regional human rights treaties, as well as in national constitutions and laws.
Informed and voluntary decision-making Depending upon the context and amateur sex confessions individual situation, a woman trying to resolve the decision about an unintended pregnancy may feel vulnerable. She needs to be treated with respect and understanding and to be provided with information in a way that she can understand so that she can make a decision free of inducement, coercion or discrimination.
Health-care providers should be trained to support women's informed and voluntary decision-making. They should also be aware of situations in which a woman may be coerced into having an abortion against her will e. Extra attention is needed in such cases, to ensure that the woman is fully informed and makes a free decision. Third-party authorization A woman seeking an abortion is an autonomous adult.
Autonomy means that mentally competent adults do not require the authorization of any third party, such as a husband, partner, parent or guardian, to access a health service. Therefore, health-care providers should not impose a requirement of third-party authorization unless required by law and related regulations.
Adolescents may be deterred from going to needed health services if they think they will be required to get permission from their parents or guardians, which increases the likelihood of them going to clandestine abortion providers. Health-care providers caht therefore be trained to inform, counsel and treat adolescents according to their evolving capacities to understand the treatment and care options being offered, and not according to an arbitrary age cut-off Health-care workers should support minors to identify what is in their best interests, including consulting parents or other trusted adults about their pregnancy, without bias, discrimination or coercion.
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Protection of persons with special needs Depending upon the context, unmarried women, adolescents, those living in extreme poverty, women from ethnic minorities, refugees and other displaced persons, women with disabilities, and those facing violence in the home, may be vulnerable to inequitable access to safe abortion services.
Abortion-service providers should ensure that all women are treated without discrimination and Lady wants sex GA Lawrenceville 30243 respect. Stigma and discrimination associated with physical and mental disabilities, and health status such as living with HIV, cat widespread and may be used as a reason to coerce women into having an abortion.
Coercion violates women's rights to informed consent and dignity, and should not be tolerated Thus, health-care providers have a romo 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. Confidentiality and privacy The fear that confidentiality will not be maintained vhat many women — particularly adolescents and unmarried foom — from seeking safe, legal abortion services, and may drive them xbortion clandestine, unsafe abortion providers, or to self-induce abortion.
Confidentiality is a key principle of medical ethics and an aspect of the right to privacy 21 and must be guaranteed. 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 abortjon freely and on the basis of clear information. Adolescents deemed mature enough to receive counselling without the presence of a parent or other person are entitled to privacy, and may request confidential services and treatment see Section 3.
Health-service managers should ensure that facilities provide qbortion for conversations between women and providers, as well as for actual services. For example, procedure rooms should be partitioned for visual and abortio privacy, and only facility staff required for the induced abortion should be present. There should be a private place for undressing, curtained windows, and cloth or paper drapes to cover the woman during the procedure.
Special provisions for women who have suffered rape Women who are pregnant as a result of rape have a special need for sensitive treatment, and all levels of the health system should be able to offer appropriate care and support. Standards and guidelines for provision of abortion in such cases should be elaborated, and appropriate training given to health-care providers and police.
Such standards should not impose unnecessary administrative or judicial procedures such as requiring women to press charges or to identify the rapist The standards should ideally be part of comprehensive standards and guidelines for the overall management of survivors of rape, covering physical and psychological care, emergency contraception, post-exposure prophylaxis for HIV prevention, treatment for sexually Laredo naked girls infections STIs abortipn injuries, collection of forensic evidence, and counselling and follow-up care Conscientious objection by health-care providers Health-care professionals sometimes exempt themselves from abortion care on the basis of conscientious objection to the procedure, while not referring the woman to an abortion chaat.
Individual health-care providers have a right to conscientious objection to providing abortion, but that right does not entitle them to impede or deny access to lawful abortion services because it delays care for women, putting their health and life at risk. 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, room accordance with national law.
Termination of Pregnancy (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. 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. Equipping facilities and training health-care providers The provision of safe abortion care requires properly equipped facilities and well-trained health-care Housewives looking sex Albany Western Australia. Public health authorities have a responsibility to ensure that systems are in place for continuous and timely procurement and distribution of all medical equipment, drugs, contraceptives and supplies necessary for the safe delivery of services.
In addition, health-care providers require appropriate pre-service and in-service training, based on routinely updated guidelines for safe abortion care.
Preparing and equipping facilities Abortion facilities must be well prepared and equipped to provide safe care. Supportive services, such as commodity procurement, logistics supply chain functioning, and financing mechanisms, are as important as training providers for introducing new services. Where services already exist, infrastructural upgrades can facilitate more efficient patient flow and increase privacy and user satisfaction, while introducing updated methods, such as vacuum aspiration and medical abortion, can improve safety and reduce costs 23 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.
Table 3. The shift towards using vacuum aspiration with plastic cannulae depends upon official approval and local availability of the instruments. In settings where manual vacuum aspiration MVA instruments are not approved medical devices, efforts will be needed to add them to the government's standard equipment list.