FIGO supports ADPF 1207 in Brazil aimed at expanding abortion care by health workers other than doctors

On 3 February 2025, the Brazilian Supreme Court received a petition – known as ADPF 1207 – to remove the restriction of the provision of legal abortion care by doctors. If approved, this measure may expand access to safe abortion while other initiatives to reform the penal code are not taken.

Around 73 million induced abortions take place worldwide each year.1 Unfortunately, despite scientific advances that have made treatment for induced abortion one of the simplest and safest healthcare interventions to exist, almost half (45.9%) of abortions performed globally are considered unsafe.2 This is mainly due to arbitrary restrictions on access to quality care, whether through restrictive abortion laws or regulations that restrict the roles of healthcare workers on providing abortion.

To date, there is a robust amount of evidence (from both high- and lower-middle-income countries) and recommendations from the World Health Organization (WHO) assuring the feasibility and safety of task shifting and task sharing for safe abortion care, particularly before 12 weeks of pregnancy.3-8 All health care workers whose main function relates to delivering preventive, promotive or curative health services – that is physicians, nurses and midwives, laboratory technicians, public health professionals, community health workers, pharmacists and all other support workers whose primary intent is to enhance health – can be involved, if adequately trained, in one or all of the subtasks related to abortion care, including medication abortion.9

Women themselves can self-manage their induced medication abortion process provided that they have access to accurate information, quality-assured medicines including for pain management, the support of trained health workers and access to a healthcare facility and to referral services if they need or desire it.10

FIGO position on issue 

Countries with restrictive laws regarding induced abortion tend to be slower to reform legislation – and often changes are not made in line with the WHO recommendations on the total decriminalisation of abortion.10 Despite this, FIGO welcomes any and all measures taken to expand access to quality abortion care, including:

  • Expanding the provision of abortion care by adequately trained health care workers, not only by doctors. 
  • Providing abortion at the primary care level and on an outpatient basis.
  • Strengthening health systems to ensure they are supportive of self-managed medication abortion.

Such measures have the potential to reduce maternal morbidity and mortality related to unsafe abortion, especially in countries with currently limited access to safe abortion care.

References

  1. Bearak J, Popinchalk A, Ganatra B, Moller A-B, Tunçalp Ö, Beavin C et al. Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990–2019. Lancet Glob Health. 2020 Sep; 8(9):e1152-e1161. doi: 10.1016/S2214-109X(20)30315-6. 
  2. Ganatra B, Gerdts C, Rossier C, et al. Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model. Lancet 2017; 390: 2372–81. 
  3. Tamang A, Puri M, Lama K, Shrestha P. Pharmacy workers in Nepal can provide the correct information about using mifepristone and misoprostol to women seeking medication to induce abortion. Reprod Health Matters. 2014; 22(supp44): 104–15. 
  4. Chor J, Young D, Quinn MT, Gilliam M. A novel lay health worker training to help women engage in postabortion contraception and well-woman care. Health Promot Pract. 2020;21(2):172-4. 
  5. Glenton C, Sorhaindo A, Ganatra B, Lewin S. Implementation considerations when expanding health worker roles to include safe abortion care: a five-country case study synthesis. BMC Public Health 2017;17. doi:10.1186/s12889-017-4764-z. 
  6. Kapp N, Dijkerman S, Getachew A, Eckersberger E, Pearson E, Abubeker FA, Birara M. Can mid-level providers manage medical abortion after 12 weeks' gestation as safely and effectively as physicians? A non-inferiority, randomized controlled trial in Addis Ababa, Ethiopia. Int J Gynaecol Obstet. 2024 Jun;165(3):1268-1276. doi: 10.1002/ijgo.15392. 
  7. Barnard S, Kim C, Park MH, Ngo TD. Doctors or mid-level providers for abortion. Cochrane Database Syst Rev. 2015 Jul 27;2015(7):CD011242. doi: 10.1002/14651858.CD011242.pub2. 
  8. Jejeebhoy SJ, Kalyanwala S, Mundle S, Tank J, Zavier AJ, Kumar R, et al. Feasibility of expanding the medication abortion provider base in India to include ayurvedic physicians and nurses. Int Perspect Sex Reprod Health. 2012;38(3):133-42. doi:10.1363/3813312.  
  9. World Health Organization. Health worker roles in providing safe abortion care and post abortion contraception. Geneva: WHO, 2015. ISBN 978 92 4 154926 4.  
  10. World Health Organization. Abortion care guideline. Geneva: WHO, 2022. Licence: CC BY-NC-SA 3.0 IGO. 

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