Woman-centered Comprehensive Abortion Care (CAC) includes high-quality counselling and post-abortion contraception as essential components of care. The methods being used to provide abortions need to be as per current standards. Recommended methods include – manual vacuum aspiration (MVA), electric vacuum aspiration (EVA), medical methods of abortion (MMA) and Dilation and Evacuation (D&E).
Obsolete and unsafe methods such as Dilation and Curettage (D&C) need to be phased out completely. It is not enough to only ensure the provision of abortion services but equally important to ensure that all critical components of care are being provided and the right to privacy and confidentiality is being maintained. Obtaining the voluntary consent of the woman at all stages needs to be a non-negotiable component of CAC.
The primary challenge remains with the implementation of these guidelines. Acute provider shortage and inadequate infrastructure limit the ability of public health facilities to ensure delivery of comprehensive abortion care (CAC).
The Government of India has developed the ‘Training and Service Delivery Guidelines for Comprehensive Abortion Care’ in 2010.
There are several barriers to the provision of comprehensive abortion care (CAC). Provider shortage is perhaps one of the most significant obstacles. All over the world, including in South Asian countries like Nepal, there has been a considerable and evidence-based shift to include an expanded pool of skilled providers – midwives, nurses and paramedics – in the delivery of abortion services. This has happened in two ways.
For some methods of abortion provision, particularly during the first trimester, there has been ‘task shifting.’ Task shifting involves moving, where appropriate, the delivery of a service, e.g. medical abortion, to a less specialised health worker. For more advanced stages of abortion where surgical methods of abortion are being used ‘task sharing’ is being introduced to ‘optimise’ health workers’ skills to provide some elements of care to support the specialists.