Child and Adolescent Health and Development RHR RHR Guidance of WHO on safe abortion FIAPAC, Moscow October 28, 2005 G. Lazdane Regional Adviser RHR WHO Regional office for Europe

Child and Adolescent Health and Development RHR RHR The WHO global reproductive health strategy adopted by WHO's 191 Member States during World Health Assembly in May 2004

Child and Adolescent Health and Development RHR RHR Core aspects of the WHO Global Reproductive Health Strategy Family planning Family planning Maternal and perinatal health Maternal and perinatal health Sexually transmitted infections (including HIV and cervical cancer) and reproductive tract infections Sexually transmitted infections (including HIV and cervical cancer) and reproductive tract infections Unsafe abortion Unsafe abortion Sexual health Sexual health

Child and Adolescent Health and Development RHR RHR Global WHO Reproductive Health Strategy Annually in the world: 19 million unsafe abortions 40% in the age group less than 24 years Due to unsafe abortion ~ women die t.i. 13% of all death cases due to pregnancy

Child and Adolescent Health and Development RHR RHR Resolution of 58 th WHA (2005) URGES Member States: 1. to commit resources and to accelerate national action towards universal access and coverage with maternal, newborn and child health interventions, through reproductive health care 2. … to establish monitoring mechanisms for measuring progress towards the achievement of agreed goals, particularly the target on universal access to reproductive health care by …

Child and Adolescent Health and Development RHR RHR

Child and Adolescent Health and Development RHR RHR WHO Priorities of SRH for in EUROPE Maternal and perinatal mortality and morbidity Prevention of unwanted pregnancy and ensuring safe abortion Improving SRHR of young people, also through the provision of YFHS, emphasising the needs of vulnerable and underserved groups Promoting the role of the health sector in addressing gender based violence Planning of the family in the new Europe

Chapter 1: Safe abortion services: the public health challenge Chapter 2: Clinical care for women undergoing abortion Chapter 3: Putting services in place Chapter 4: Legal and policy considerations Structure of the guidance

Child and Adolescent Health and Development RHR RHR Methods of abortion

Child and Adolescent Health and Development RHR RHR Up to 9 completed weeks since LMP 200 mg mifepristone followed hours by: 1.0mg vaginal gemeprost or 800  g vaginal misoprostol or 400  g oral misoprostol up to 7 completed weeks After 12 completed week since LMP 200 mg mifepristone followed after hours by: 1 mg vaginal gemeprost (repeated every 3 hours up to maximum of 4 doses) or 400  g misoprostol every 3 hours up to 5 doses or 800  g vaginal misoprostol followed by 400  g oral misoprostol every 3 hours up to a maximum of 4 doses Medical methods of abortion Mifepristone plus prostaglandin regimens

Child and Adolescent Health and Development RHR RHR WHO Safe abortion guidance (2003) Available in English, Russian, French, Polish, Portuguese, Spanish ( safe_abortion/safe_abortion.html) Implementation: o Workshop – in combination with Strategic approach o IPPF EN + Ipas + WHO EURO o Strategic Approach of improvement of services – MDA (RUS, UKR, LVA, LIT) o Development of National guidelines

The issue is co- published with the IPPF European Network

Child and Adolescent Health and Development RHR RHR European protocols for RH services for PLWHA (2006) WHO Regional Office for Europe Contraception Termination of pregnancy МАR RTI

Child and Adolescent Health and Development RHR RHR Future development of policies and programmes Future development of policies and programmes EUROPEAN Strategy for Child and Adolescent Health and Development – RC 2005 A framework for implementing the WHO global RH strategy (in development) STI Global strategy (in development – WHA 2006) EUROPEAN Strategy for Improving Maternal and Perinatal Health (in development – RC 2006) Assistance to the countries in development their national strategies and policies

WHO guideline in FP/STI 3 rd ed. Medical Eligibility Criteria for Contraceptive Use (2004) – Russian translation (2005) 2 nd ed. Selected Practices Recommendations for Contraceptive Use (2005) - Russian translation (in print) STI/RTI: a guide for essential practices ( 2005)– Russian translation (in print)