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

• While MVA is more commonly used and more likely in primary care settings, the skills required for EVA are similar, thus the recommendations above apply to the provision of either form of vacuum aspiration.
• MVA is used earlier in pregnancy and in the absence of access to a stable source of electricity.
• Dilatation and sharp curettage (D&C) should be replaced with MVA.

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.