Remarks

• The combination regimen (Recommendation 29a) is more effective than use of misoprostol alone.
• Evidence suggests that the vaginal route is the most effective. Consideration for patient and provider preference suggests the inclusion of all routes.
• Pregnancy tissue should be treated in the same way as other biological material unless the individual expresses a desire for it to be managed otherwise. * Misoprostol can be repeated at the noted interval as needed to achieve success of the abortion process. Providers should use caution and clinical judgement to decide the maximum number of doses of misoprostol in pregnant individuals with prior uterine incision. Uterine rupture is a rare complication; clinical judgement and health system preparedness for emergency management of uterine rupture must be considered with later gestational age. ǂ The dose of misoprostol should be reduced for induced abortion beyond 24 weeks due to limited data. Clinical judgement should be used to determine the appropriate dosage, recognizing the greater sensitivity of the uterus to prostaglandins.

Implementation consideration

• 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 MEDICAL ABORTION

• Everyone has a right to privacy and confidentiality in sexual and reproductive health (SRH) care.
• Abortion regulation should be human rights and evidence based.
• States must ensure adequate access to essential medicines in an affordable and nondiscriminatory manner.
• Everyone has the right to scientific progress and right to health, which requires the availability and accessibility, acceptability, and quality of medical abortion. This means that States should ensure access to abortion medicines, and that evidence-based standards and guidelines for the provision and delivery of SRH services, are (i) in place and (ii) routinely updated to incorporate medical advancements. For further information and sources, please refer to Box 1.2 and Web annex A: Key international human rights standards on abortion.