Recommendations General considerations • The recommendations include tasks related to safe abortion care (including post-abortion contraception) and the management of complications of abortion (also known as post-abortion care in some settings and provided as part of emergency obstetric care). • Recommendations about who can provide care have been made only for clinical interventions that have been recommended as safe and effective according to current WHO technical guidance i.e. Safe abortion: technical and policy guidance for health systems (3). The recommendations in this guideline should be implemented in accordance with the technical standards and human rights principles as laid down in that document. • The recommendations are not targeted specifically to low-resource or low-income settings; they are intended for all settings where abortion-related care is provided. • The recommendations are intended to be implemented within the context of functioning mechanisms for referral, monitoring and supervision, as well as access to the necessary equipment and commodities. • The recommendations provide a range of options of types of health workers who can perform the specific task safely and effectively. The options are intended to be inclusive and do not imply either a preference for or an exclusion of any particular type of provider. The specific choice of health workers depends upon the needs and conditions of the local context. It is also important to note that the following assumption underlies all the options that have been recommended in this guideline: • It is assumed that any health worker discussed in this guideline has the basic training required of that type of health worker. In addition, the recommendations all assume that health workers will receive the training or information specific to the task, prior to implementation of the recommendation option. It is important to interpret all of the recommendations that follow in the context of these general considerations and assumptions.
Recommendation categories Four types of recommendations are made: Recommended The benefits of implementing this option outweigh the possible harms. This option can be implemented including at scale. For certain health worker–task combinations, the GDG decided that the option was within the typical scope of practice of the health worker. No assessment of evidence was made in such cases and this has been noted in the justification. Recommended in specific circumstances The benefits of implementing this option outweigh the possible harms in specific circumstances. The specific circumstances are outlined for each recommendation. This option can be implemented under these specific circumstances. Recommended in the context of rigorous research There are important uncertainties about this option (related to benefits, harms, acceptability and feasibility) and appropriate, well designed and rigorous research is needed to address these uncertainties. Recommended against This form of task shifting should not be implemented. For certain health worker–task combinations, the GDG decided that the option was outside the typical scope of practice of the health worker. No assessment of evidence was made in such cases and this has been noted in the justification. The explanation and justification for each recommendation is provided and the certainty of the evidence has been indicated where appropriate as follows: • High certainty: Further research is very unlikely to change our confidence in the estimate of effect. • Moderate certainty: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. • Low certainty: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. • Very low certainty: We are very uncertain about the estimate. Confidence assessments of qualitative research evidence are referred to in the following terms: • High confidence: It is highly likely that the review finding is a reasonable representation of the phenomenon of interest. • Moderate confidence: It is likely that the review finding is a reasonable representation of the phenomenon of interest. • Low confidence: It is possible that the review finding is a reasonable representation of the phenomenon of interest. • Very low confidence: It is not clear whether the review finding is a reasonable representation of the phenomenon of interest