Remarks:

• Observational studies indicate that vacuum aspiration is associated with fewer complications than D&C; however, randomized controlled trials were underpowered to detect a difference in complication rates.
• No evidence supports the use of sharp curette checks following vacuum aspiration.
• The quality of the evidence based on randomized controlled trials is low to moderate.

Implementation considerations

• For all providers, skills needed for D&E provision are greater than for a vacuum aspiration done in earlier pregnancy and training needs are higher.
• D&E includes the use of vacuum aspiration and therefore skills and knowledge of vacuum aspiration are relevant for this task.
• Health workers providing abortion or caring for women undergoing abortion at gestational ages ≥ 12 weeks may have additional needs for professional and mentoring support.

KEY HUMAN RIGHTS CONSIDERATIONS RELEVANT TO SURGICAL ABORTION

• Health-care facilities, commodities and services must be available, accessible, acceptable and of good quality. This means they must be evidence-based and scientifically and medically appropriate and up to date.
• AT < 14 WEEKS OF GESTATION: As dilatation and sharp curettage (D&C) causes pain and suffering to women and is not recommended for use, its use is incompatible with numerous human rights including the right to health.
• AT ≥ 14 WEEKS OF GESTATION: States must ensure adequate access to essential medicines in an affordable and non-discriminatory manner.