Chapter Seven – Comprehensive Abortion Care



*VU[LU[Z
05;96+VTLUPUTPKKSLVYSH[LZLJVUK[YPTLZ[LY
ZOV\SKILYLMLYYLK[VHOVZWP[HS^P[OZ\YNPJHS
MHJPSP[PLZMVY[YLH[TLU[

4LKPJHSTL[OVKZMVYPUK\JLK
HIVY[PVU\W[V ^LLRZZPUJL347
4PMLWYPZ[VULHUK4PZVWYVZ[VS
TNTPMLWYPZ[VULVYHSS`MVSSV^LKHM[LY
OYZI`›NTPZVWYVZ[VS]HNPUHSS`
VYZ\ISPUN\HSS`
4PZVWYVZ[VSHSVUL
JHUPUK\JLHIVY[PVUPULHYS`WYLNUHUJ`
I\[YLWLH[LKKVZLZHYLULLKLKZ\JOHZ
›NTPZVWYVZ[VS]HNPUHSS`VYZ\ISPU
N\HSS`YLWLH[LKL]LY`OV\YZ\W[V[OYLL
KVZLZ4PZVWYVZ[VSHSVULOV^L]LYPZSLZZ
LMMLJ[P]L[OHUTPMLWYPZ[VULHUKTPZVWYVZ
[VSJVTIPULKHUKNLULYHSS`JH\ZLZZPKL

LMMLJ[Z

7VZ[HIVY[PVU*HYL7(*
)V[O]HJ\\THZWPYH[PVUHUKTPZVWYVZ[VSHYL
ZHMLLMMLJ[P]LHUKHJJLW[HISLTL[OVKZMVY

*OHW[LY!*VTWYLOLUZP]L(IVY[PVU*HYL

L]HJ\H[PVUVM[OL\[LY\ZMVYWVZ[HIVY[PVUJHYL
4PZVWYVZ[VSYLK\JLZ[OLJVZ[VM7(*ZLY]PJLZ
HZP[KVLZUV[YLX\PYL[OLPTTLKPH[LH]HPSHIPSP[`
VMZ[LYPSPaLKLX\PWTLU[VWLYH[PUN[OLH[YLZVY
ZRPSSLKWLYZVUULS4PZVWYVZ[VSMVY[OL[YLH[TLU[
VMPUJVTWSL[LHIVY[PVUPZHUPTWVY[HU[VW[PVUPU
O\THUP[HYPHUZL[[PUNZ^OLYLP[PZKPMÄJ\S[[VTHPU
[HPU4=(LX\PWTLU[HUKHWWYVWYPH[LS`[YHPULK
WYV]PKLYZHUK^OLYLYLMLYYHSMVYZ\YNPJHS\[LYPUL
L]HJ\H[PVUTH`ILKLSH`LK

+PSH[H[PVUHUKJ\YL[[HNL+

*
(SZVRUV^UHZ¸ZOHYWJ\YL[[HNL¹^P[O
TL[HSPUZ[Y\TLU[Z+
*PZUVSVUNLYYLJ
VTTLUKLKL_JLW[PUJHZLZ^OLYL]HJ\\T
HZWPYH[PVUVYTLKPJHSTL[OVKZHYLUV[
H]HPSHISL>OLYL+
*PZJ\YYLU[S`WYHJ
[PZLKHSSWVZZPISLLMMVY[ZZOV\SKILTHKL
[VYLWSHJLP[^P[O]HJ\\THZWPYH[PVUVY
TLKPJHSTL[OVKZ[VPTWYV]L[OLZHML[`HUK
X\HSP[`VMJHYL

;OL\ZLVMTPZVWYVZ[VSMVYVIZ[L[YPJPUKPJH[PVUZ
PZYHWPKS`L]VS]PUN9/WYVNYHTTLTHUNLYZ
HUKZLY]PJLWYV]PKLYZZOV\SKZ[H`HIYLHZ[VM[OL
L]VS]PUNJSPUPJHSHUK[LJOUPJHSSP[LYH[\YL:LL
-\Y[OLY9LHKPUN
;OL\ZLVMTPMLWYPZ[VULHUKVYTPZVWYVZ[VSMVY
ZHMLHIVY[PVUHUKWVZ[HIVY[PVUJHYLYLX\PYLZ[OL

IHJR\WVM]HJ\\THZWPYH[PVUZLY]PJLZLP[OLY

4PZVWYVZ[VSMVYPUJVTWSL[L
HIVY[PVU\W[V^LLRZ
ZPUJL347
TPJYVNYHTTPZVWYVZ[VSVYHSS`VUL
KVZLPZLMMLJ[P]LHUKZHML
5VW\ISPZOLKZ[\KPLZOH]LPU]LZ[PNH[LK
[OL\ZLVMTPZVWYVZ[VS[V[YLH[^VTLU^P[O
ZLW[PJHIVY[PVU



VUZP[LVY[OYV\NOYLMLYYHSPUJHZLVMMHPSLKVY
PUJVTWSL[LL]HJ\H[PVUVM\[LYPULWYVK\J[Z


7YL]LU[PVUVM[L[HU\Z
>VTLU^OVOH]LOHK\UZHMLHIVY[PVUZ^P[OUVU
Z[LYPSLPUZ[Y\TLU[ZHYLH[YPZRVM[L[HU\Z7YV]PKL

VYYLMLY[OLWH[PLU[MVY[L[HU\ZWYVWO`SH_PZPM[OPZPZ
RUV^UVYZ\ZWLJ[LKWHY[PJ\SHYS`PUJVTT\UP[PLZ
^OLYL[L[HU\ZHM[LYHIVY[PVUOHZILLUYLWVY[LK
(IVVZ[LYPUQLJ[PVUVM[L[HU\Z[V_VPK;;ZOV\SK
ILNP]LU[V^VTLU^OVOH]LILLUWYL]PV\ZS`
]HJJPUH[LK;L[HU\ZPTT\UVNSVI\SPU;0.HUK
;;ZOV\SKILHKTPUPZ[LYLK[V^VTLU^OVOH]L
UV[ILLUWYL]PV\ZS`PTT\UPaLKVY^OVZLSHZ[
KVZL^HZTVYL[OHUÄ]L`LHYZHNV0M[OLYLPZHU`
\UJLY[HPU[`YLNHYKPUN[OLWH[PLU[»Z]HJJPUH[PVU
OPZ[VY`IV[O;0.HUK;;ZOV\SKILHKTPUPZ[LYLK
0M]HJJPULHUKPTT\UVNSVI\SPUHYLNP]LUH[[OL
ZHTL[PTL\ZLZLWHYH[LULLKSLZHUKZ`YPUNLZ
HUKKPMMLYLU[ZP[LZVMHKTPUPZ[YH[PVU7H[PLU[Z
ZOV\SKILHK]PZLK[VJVTWSL[L[OL]HJJPUH[PVU
ZJOLK\SLZLJVUK;;KVZLH[MV\YTVU[OZ[OPYK
;;KVZLH[ZP_TVU[OZ[VVUL`LHY


4HUHNPUNJVTWSPJH[PVUZ

>OPSLYHYLJVTWSPJH[PVUZHYLWVZZPISL^P[O\[LYPUL
L]HJ\H[PVUWYVJLK\YLZHUK[OL`T\Z[ILKLHS[
^P[OI`X\HSPÄLKWYV]PKLYZPTTLKPH[LS`:LYPV\Z
JVTWSPJH[PVUZHYL]LY`YHYLI\[P[PZPTWVY[HU[
[VMVSSV^\WHSSWH[PLU[ZHZ[OLYLPZHZTHSSYPZR
VMPUMLJ[PVUVYOHLTVYYOHNL,UZ\YL[OH[^VTLU
OH]LVUNVPUNHJJLZZ[VLTLYNLUJ`JHYLK\YPUN
[OLPY[YLH[TLU[0M[OL^VTHUYLX\PYLZ[YLH[TLU[
IL`VUK[OLJHWHIPSP[`VM[OLMHJPSP[`^OLYLZOLPZ
ZLLUZ[HIPSPaLOLYJVUKP[PVUILMVYLZOLPZ[YHUZ
MLYYLK[VHOPNOLYSL]LSYLMLYYHSZLY]PJL


 7VZ[WYVJLK\YLJV\UZLSSPUN
HUKMVSSV^\W
>VTLUZOV\SKILNP]LUPUZ[Y\J[PVUZVUOV^
[V[HRLJHYLVM[OLTZLS]LZHM[LY[OLWYVJLK\YL
:LY]PJLWYV]PKLYZZOV\SKL_WSHPUZPNUZVMH



;HISL!.LZ[H[PVU;PTPUNHUKDOLYLHIVY[PVUPZUV[
HNHPUZ[[OLSH^Z\JOHIVY[PVUZOV\SKILZHML0U
HSSJHZLZ^VTLUZOV\SKOH]LHJJLZZ[VX\HSP[`
ZLY]PJLZMVY[OLTHUHNLTLU[VMJVTWSPJH[PVUZ
HYPZPUNMYVTHIVY[PVU¹
7YVNYHTTLVM(J[PVUVM[OL0*7+WHYHNYHWO
*HPYV 
;OLYLZWLJ[WYV[LJ[PVUHUKM\SÄSTLU[VMO\THU



YPNO[ZYLSH[LK[VHIVY[PVUPUJS\KL!
‹ [HRPUNWVZP[P]LZ[LWZ[VYLK\JLTH[LYUHS
TVY[HSP[`^OPJOJHUILJH\ZLKI`\UZHML
HIVY[PVU"
‹ LUZ\YPUN[OH[:[H[LZNP]LPUMVYTH[PVU[VOLSW
^VTLUWYL]LU[\UPU[LUKLKWYLNUHUJPLZ"
‹ THRPUNZHMLHIVY[PVUZLY]PJLZH]HPSHISLPU
JPYJ\TZ[HUJLZ^OLYLHIVY[PVUPZSLNHS"

‹ YLTV]PUNW\UP[P]LWYV]PZPVUZMVY^VTLU
^OV\UKLYNVHIVY[PVUILJH\ZLJYPTPUHS
PaPUNHIVY[PVUTH`SLHK^VTLU[VZLLR
\UZHMLWYVJLK\YLZ^P[OZ\IZLX\LU[YPZRZ[V
[OLPYSPMLHUKOLHS[O
;OLMVSSV^PUNHYLJPYJ\TZ[HUJLZPU^OPJOO\THU
YPNO[ZHI\ZLZVJJ\Y!
‹ -VYJPUNH^VTHU[VJHYY`HU\U^HU[LKVY
\U]PHISLWYLNUHUJ`[V[LYTPZJVUZPKLYLK
KLNYHKPUNHUKJH\ZLZTLU[HSZ\MMLYPUN
LZWLJPHSS`PUJHZLZVMYHWLVYPUJLZ[
‹ +LU`PUNTLKPJHS[YLH[TLU[[VH^VTHUZ\M
MLYPUNMYVTJVTWSPJH[PVUZVM\UZHMLHIVY
[PVU\USLZZZOLWYV]PKLZPUMVYTH[PVUVU[OL
WLYZVU^OVWLYMVYTLK[OL\UZHMLHIVY[PVU
JVUZ[P[\[LZJY\LSHUKKLNYHKPUN[YLH[TLU[
‹ 3H^Z[OH[YLX\PYLZLY]PJLWYV]PKLYZ[V
YLWVY[^VTLU^OVOH]LOHKHUHIVY[PVUVY
ULLKLK[YLH[TLU[MVY\UZHMLHIVY[PVU]PVSH[L
^VTLU»ZYPNO[[VWYP]HJ`

‹ 3HJRVMJVUÄKLU[PHSP[`PU[OLOLHS[OZ`Z[LT
VYYLX\PYLTLU[ZMVY[OPYKWHY[`JVUZLU[[V
[OLWYVJLK\YLTH`KL[LY^VTLUVYNPYSZ
MYVTZLLRPUNOLHS[OZLY]PJLZ
‹ -VYJPUN^VTLUVML[OUPJTPUVYP[PLZVY^P[O
KPZHIPSP[PLZ[V\UKLYNVHIVY[PVUZPZKPZJYPTP
UH[VY`
‹ -VYJLKWYLNUHUJ`PZHO\THUYPNO[Z]PVSH
[PVUHUKPUZVTLZP[\H[PVUZH^HYJYPTL



‹ KPZJ\ZZVW[PVUZ^P[O`V\YJSPLU[LNPM`V\
HYL\UHISL[VWYV]PKLJLY[HPUTL[OVKZVM
HIVY[PVU`V\JHUJV\UZLSOLY^OLYLZOL
JHUVI[HPUZLY]PJLZ"
‹ L_WSVYLSPURHNLZ^P[OHUKYLMLYYHSZ[VSVJHS
VYNHUPaH[PVUZ[OH[TPNO[ILHISL[VOLSW
`V\YJSPLU[M\Y[OLY"
‹ ^OPSLYLZWLJ[PUN[OLJVUÄKLU[PHSP[`VM`V\Y

JSPLU[PKLU[PM`^P[OJVSSLHN\LZHUKV[OLY9/
WYV]PKLYZOV^[VH]VPKHUKTHUHNLZ\JO
ZP[\H[PVUZPU[OLM\[\YL"
‹ YHPZL[OLZLJVUJLYUZPUOLHS[OJVVYKPUH[PVU
TLL[PUNZ"
‹ [HSR[V`V\YZ\WLY]PZVY

*OHSSLUNLZHUKVWWVY[\UP[PLZ
9/WYVNYHTTLTHUHNLYZHUKZLY]PJLWYV]PKLYZ
TH`MHJLKPMÄJ\S[KLJPZPVUZVYKPSLTTHZYLNHYK
PUNHIVY[PVU;OL`TH`ÄUK[OH[[OLPYHIPSP[`[V
WYV]PKLJVTWYLOLUZP]LHIVY[PVUJHYLPZYL
Z[YPJ[LKI`UH[PVUHSSLNPZSH[PVUZVJPHSVYJ\S[\YHS
UVYTZVYTLKPJHSTPZJVUJLW[PVUZ
-VYL_HTWSLL]LU^OLYLP[PZSLNHSS`WLYTP[[LK
ZHMLHIVY[PVUTH`UV[ILLHZPS`HJJLZZPISL"[OLYL
TH`ILHKKP[PVUHSYLX\PYLTLU[ZYLNHYKPUNJVU
ZLU[HUKJV\UZLSSPUNHUKJV\U[YPLZVM[LUPTWVZL
HSPTP[VU[OLWLYPVKK\YPUN^OPJOHIVY[PVUTH`
ILWLYMVYTLK6[OLYJOHSSLUNLZTH`PUJS\KL

Q\KNTLU[HSVYKPZJV\YHNPUNH[[P[\KLZVMOLHS[O
JHYLWYV]PKLYZPUZ\MÄJPLU[ZLY]PJLJHWHJP[`[V
TLL[[OLKLTHUKVY\UL]LUS`KPZ[YPI\[LKVY
WVVYX\HSP[`ZLY]PJLZ(SZV^VTLU[OLTZLS]LZ
TH`IL\UH^HYLVM[OLH]HPSHIPSP[`VMHIVY[PVU
ZLY]PJLZVY[OLPYYPNO[[VHJJLZZ[OLT^P[OPU[OL
SLNHSMYHTL^VYR



4VUP[VYPUN

*VU[PU\V\ZS`TVUP[VYHUKL]HS\H[LZHMLHIVY
[PVUHUK7(*ZLY]PJLZ(ZZLZZ[OLSL]LSVM\ZL
VM[OLZLZLY]PJLZHUKYL]PL^JSPLU[Z»YLJVYKZ
[OLH]HPSHIPSP[`HUKWYVWLY\ZLVMLX\PWTLU[HUK
Z\WWSPLZHUKZWLJPÄJPUKPJH[VYZVM[OLX\HSP[`VM
(ZHU9/WYVNYHTTLTHUHNLYVYZLY]PJLWYV
JHYL0KLU[PM`JOHUNLZVYWYVISLTZ[OH[VJJ\Y
]PKLY`V\HYLSPRLS`[VÄUK`V\YZLSMMHJPUNZ\JO

WYV]PKLMLLKIHJR[VZ[HMMHUKPU[LY]LUL[VJVY
JOHSSLUNLZ@V\T\Z[ILH^HYLVM`V\YHNLUJ`
YLJ[HU`WYVISLTZPKLU[PÄLK
VYNHUPaH[PVUWVZP[PVUVU[OLZLPZZ\LZHUKPUJS\KL 
P[HZWHY[VM`V\YHUHS`ZPZVM[OLZP[\H[PVUHUK
-VYTVYLPUMVYTH[PVUVUTVUP[VYPUNZLL*OHW[LY
WVZZPISLUL_[Z[LWZ
!(ZZLZZTLU[4VUP[VYPUNHUK,]HS\H[PVU
;YHPUHUKLX\PWHSS9/ZLY]PJLWYV]PKLYZ[V
WYV]PKL*(*PUMVYTH[PVUHUKZLY]PJLZVYYLMLY[V
ZHMLHUKSLNHSHIVY[PVUZLY]PJLZ^P[OPU[OLMYHTL
^VYRVM[OLSH^0[PZLZZLU[PHS[OH[9/VMÄJLYZ
WYVNYHTTLTHUHNLYZHUKZLY]PJLWYV]PKLYZ
\UKLYZ[HUKJSLHYS`^OH[PZHSSV^LK\UKLY[OLSH^
PU[OLJV\U[Y`^OLYL[OL`HYL^VYRPUN,MMVY[ZI`
WVSPJ`THRLYZT\Z[HKKYLZZHKTPUPZ[YH[P]LHUK
YLN\SH[VY`IHYYPLYZ[VZHMLHIVY[PVUHUKWVZ[H
IVY[PVUJHYL
>OLUMHJLK^P[OHKPMÄJ\S[ZP[\H[PVU`V\YÄYZ[
WYPVYP[`T\Z[IL[OLILZ[PU[LYLZ[VM`V\YJSPLU[
MVJ\ZPUNVUOLYOPZZHML[`HUKOLHS[O0[PZHSZV
PTWVY[HU[[VJVUZPKLY`V\YV^UZHML[`HUK[OL
ZHML[`VM`V\YJVSSLHN\LZ;OLU`V\TH`^PZO
[V!



-\Y[OLYYLHKPUN
,ZZLU[PHSYLHKPUN
:HMLHIVY[PVU![LJOUPJHSHUKWVSPJ`N\PKHUJL
MVYOLHS[OZ`Z[LTZ>/6.LUL]HO[[W!
^^^^OVPU[YLWYVK\J[P]LOLHS[OW\ISPJH[PVUZ
ZHMLFHIVY[PVUZHMLFHIVY[PVUWKM
4HUHNPUNJVTWSPJH[PVUZPUWYLNUHUJ`HUKJOPSK
IPY[O!HN\PKLMVYTPK^P]LZHUKKVJ[VYZ>/6
.LUL]HO[[W!^^^^OVPU[YLWYVK\J[P]L
OLHS[OPTWHJPUKL_O[TS
(KKP[PVUHSYLHKPUN
/LYYPJR1L[HS>VTHUJLU[LYLKWVZ[HIVY[PVU
JHYL[YHPULY»ZHUKYLMLYLUJLTHU\HSZ0WHZ

*OHW[LY!*VTWYLOLUZP]L(IVY[PVU*HYL



;HISL!0UKPJH[VYZ[V4VUP[VY(]HPSHIPSP[`HUK,MMLJ[P]LULZZVM:HML(IVY[PVUHUK7(*
:LY]PJLZ
5HTL





+LÄUP[PVU

-VYT\SH

;`WL

5\TLYH[VYHUK
+LUVTPUH[VY

7YVJLZZ
V\[JVTLVY
PTWHJ[

+H[H:V\YJL

9LTHYRZ

(IVY[PVU
ZLY]PJLZ
WLYMVYTLK
^P[O
HWWYVWYPH[L
[LJOUVSVN`

7YVWVY[PVUVM
HIVY[PVUZLY]PJ
LZWLYMVYTLK
^P[OHWWYVWYP
H[L[LJOUVSVN`
]HJ\\THZWPYH
[PVUVYTLKPJHS
TL[OVKZ

5\TILYVM
HIVY[PVUZLY]PJ
LZWLYMVYTLK
^P[OHWWYVWYPH[L
[LJOUVSVN`[V[HS
U\TILYVMHIVY
[PVUZ_

6\[JVTL

-HJPSP[`YLJVYKZ

¸(IVY[PVUZLY
]PJLZ¹PUJS\KL
[YLH[TLU[VM
HIVY[PVUJVTWSP
JH[PVUZYLZ\S[
PUNMYVTIV[O
ZWVU[HULV\ZVY
PUK\JLK\UZHML
HIVY[PVUHZ^LSS
HZWYV]PZPVUVM
PUK\JLKHIVY
[PVUWYVJLK\YLZ

>VTLUHJ
JLZZPUNHIVY
[PVUZLY]PJLZ
^OVYLJLP]L
JVU[YHJLW[PVU
WYPVY[VKPZ
JOHYNLMYVT
[OLMHJPSP[`

7YVWVY[PVUVM
^VTLUYLJLP]
PUNHIVY[PVU
ZLY]PJLZ^OV
YLJLP]LJVU[YH
JLW[PVUWYPVY[V
KPZJOHYNLMYVT
[OLMHJPSP[`

5\TILYVM
^VTLU^OV
YLJLP]LK
JVU[YHJLW[P]L
ZLY]PJLZWYPVY
[VKPZJOHYNL
MYVT[OLMHJPS
P[`U\TILYVM
^VTLU^OV
^LYL[YLH[LKMVY
HIVY[PVU_

6\[JVTL

-HJPSP[`YLJVYKZ

9LJVTTLUKH
[PVU!([SLHZ[
VMHSS
^VTLUYLJLP]
PUNHIVY[PVU
ZLY]PJLZ^PSSYL
JLP]LHJVU[YH
JLW[P]LVM[OLPY
JOVPJLILMVYL
KPZJOHYNLMYVT
[OLMHJPSP[`

,_[LU[[V
^OPJOPUK\JLK
HIVY[PVUZHYL
ILPUNWYV]PKLK

7YVWVY[PVUVM
^VTLU^OV
YLJLP]LHIVY[PVU
ZLY]PJLZ[OH[
YLJLP]LPUK\JLK
WYVJLK\YLZ

5\TILYVM
^VTLUYLJLP]
PUNPUK\JLK
HIVY[PVUWYVJL
K\YLZH[MHJPS
P[`PUHNP]LU
WLYPVKU\TILY
VMHSS^VTLU
YLJLP]PUNHIVY
[PVUZLY]PJLZ
PUMHJPSP[`PU
[OLZHTL[PTL
WLYPVK_

6\[JVTL

/LHS[OZLY]PJL
YLJVYKZ·
I\[WV[LU[PHS
WYVISLTZ^P[O
\UKLYYLWVY[PUN
PLVTPZZPVU
VMJHZLZUV[
HKTP[[LK[V
MHJPSP[PLZHUK
TPZJSHZZPÄJH
[PVU

6]LY[PTLH
ZOPM[[V^HYKH
OPNOLYWYVWVY
[PVUVM^VTLU
YLJLP]PUN
PUK\JLKHIVY
[PVUHZHWHY[
VMHSSHIVY[PVU
ZLY]PJLZPU
MHJPSP[`
9LJVTTLUKH
[PVU!HWWYVHJO
PUN



*OHWLS/PSS5*O[[W!^^^PWHZVYN7\I
SPJH[PVUZ>VTHUJLU[LYLKFWVZ[HIVY[PVUFJHYLF
;YHPULYZFTHU\HSHZW_
/`THU(L[HS>VTHUJLU[LYLKHIVY[PVUJHYL
[YHPULY»ZTHU\HS0WHZ*OHWLS/PSS5*
O[[W!^^^PWHZVYN7\ISPJH[PVUZ>VTHUJLU
[LYLKFHIVY[PVUFJHYLF;YHPULYZFTHU\HSHZW_
4PZVWYVZ[VSPU6IZ[L[YPJZHUK.`ULJVSVN`^^^
TPZVWYVZ[VSVYN
-YLX\LU[S`HZRLKJSPUPJHSX\LZ[PVUZHIV\[TLKP
JHSHIVY[PVU>VYSK/LHS[O6YNHUPaH[PVU
O[[W!^^^^OVPU[YLWYVK\J[P]LOLHS[OW\ISPJH
[PVUZLU