Remark

• Vacuum aspiration can be used during a D&E (i.e. for the purpose of amniotomy or tissue removal at the end of the D&E).

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. For further information and sources, please refer to Box 1.2 and Web annex A: Key international human rights standards on abortion.