The following are excerpts from the 21-page report of this conference:
With the aim to unify the efforts to promote and advocate for sexual and reproductive rights and universal access to comprehensive reproductive health care, professionals and SCOs members with expertise on safe abortion and family planning from 12 countries from Eastern Europe and Central Asia (EECA) created The Regional Reproductive Health and Rights Coalition (RRHRC). The Coalition was launched during the First Regional Conference “Bringing the WHO Recommendations on Safe Abortion and Family Planning Closer to Women in Countries of Eastern Europe and Central Asia” organized on 16 November 2018, in Chisinau, Moldova.
The mission of the Coalition is to promote, respect and advance Sexual and Reproductive Rights, universal access to comprehensive SRH services, including to safe abortion, to align them to WHO recommendations, focusing on the needs of women and men in Countries of Eastern Europe and Central Asia. RRHRC activities are coordinated by the Regional Training Center (Reproductive Health Training Center from Moldova) and financially supported by the Safe Abortion Action Fund (SAAF).
Coalition activities included a series of training of trainers in safe abortion in all participating countries and creation of national professional teams, updates to university curricula – inclusion of safe abortion training modules, support for participation of colleagues from member countries in regional and international SRH and safe abortion conferences and meetings, numerous information articles, news, manuals translated into Russian and distributed via Workplace. In the first three years, the main efforts of the Coalition were focused on improving access to and quality of safe abortion services in the region through the alignment of national safe abortion guidelines and protocols with the most recent WHO recommendations. Experiences and lessons learned by EECA countries in the process of updating and implementing national safe abortion guidelines and protocols were presented and discussed during the 2nd edition of the Regional Conference “Bringing WHO recommendations on safe abortion and family planning closer to women in countries of Eastern Europe and Central Asia” organised by RRHRC on December 16-17, 2021.
The 3rd Regional Conference theme was: “Self-care in reproductive health: family planning and safe abortion according to WHO recommendations in Eastern Europe and Central Asia” on 15-16 May 2025. in Chisinau, Moldova. Participants of the 3rd edition of RRHRC Regional Conference were politicians, service providers, activists, NGO leaders from 11 Eastern Europe and Central Asia (EEAC) countries, international and national experts in the area of safe abortion and family planning, as well as representatives of WHO, IPPF, UNFPA, DKT International, ESC, Gynuity Health Projects and other international organizations. The conference took place in a hybrid format: with physical presence for participants in Moldova and online, through the Zoom platform.
The conference was organized with the support of the Safe Abortion Action Fund (SAAF).
At the start of the Conference Dr. Caron Kim (WHO) and Dr. Rodica Comendant
(Director of RHTC) presented the latest WHO activities and recommendations on quality comprehensive abortion care, including on self-care in safe abortion and post-abortion family planning. It was stressed that WHO has included comprehensive abortion care in the list of essential health services, considering abortion a safe, effective and non-complex health care intervention. Also, WHO recommends that abortion should not be regulated differently to other forms of health care activities, such as regulated under criminal law: women and girls risk their lives and health resorting to unsafe abortion in countries in which pregnancy termination services are unavailable and/or legally restricted.
Law and policy WHO recommendations:
- WHO recommend the full decriminalization of abortion.
- WHO recommend against laws and other regulations that restrict abortion by grounds.
- WHO recommend that abortion be available on the request of the woman, girl or other pregnant person.
- WHO recommend against laws and other regulations that prohibit abortion based on gestational age limits.
- WHO recommend against mandatory waiting periods for abortion.
- WHO recommend that abortion be available on the request of the woman, girl or other pregnant person without the authorization of any other individual, body or institution.
- WHO recommend that access to and continuity of comprehensive abortion care be protected against barriers created by conscientious objection.
- WHO recommend against regulation on who can provide and manage abortion that is inconsistent with WHO guidance.
Clinical service recommendations address methods of abortion and related clinical care: provision of information, counselling and pain management: methods and regimens for abortion and provision of post-abortion care, including all methods of contraception.
Service delivery recommendations include those relating to settings where abortion procedures can be performed and to which categories of health workers can provide the relevant clinical services. WHO consider all methods of vacuum aspiration (MVA, EVA) for induced abortion at gestational ages < 14 weeks as simple and safe medical procedures: vacuum aspiration can be performed in a primary care facility and on an outpatient basis by a wide range of providers, including traditional and complementary medicine professionals, nurses, midwifes, associate/advanced associate clinicians and generalist and specialists medical practitioners.
WHO maintain the recommendation that dilatation and sharp curettage (D&C) should be replaced with vacuum aspiration. According to WHO, additionally to those mentioned above, a wider range of providers can safely offer medical abortion at gestational ages < 12 weeks: community health workers, pharmacists, auxiliary nurses/ANMs.
In the 2022 WHO Abortion care guideline were included two new important service delivery recommendations: one regarding telemedicine and one – on models of service delivery. Guideline states that there is no single recommended approach to providing abortion services. The choice of specific health worker(s) (from among the recommended options) or management by the individual them-self, and the location of service provision (from among the recommended options) will depend on the values and preferences of the woman, girl or other pregnant person, available resources, and the national and local context.
The 2022 WHO Abortion care guideline recommend the option of telemedicine as an alternative to in-person interactions with the health worker to deliver medical abortion services in whole or in part.
Aligning national policy documents to WHO recommendations on self-management.
As initial steps before implementation, several countries and territories, members of RRHR Coalition (Armenia, Azerbaijan, Georgia, Moldova, Kazakhstan, Kirgizstan, Ukraine, Uzbekistan and Transnistria region of Moldova) conducted formative research and/or pilot studies on appropriateness, feasibility and acceptability of Medical Abortion via telemedicine or self-care. These activities were conducted under the guidance of RTH (RHTC, Chisinau, Moldova) with technical and financial support of SAAF and Gynuity Health Projects.
The main aims of formative research on MA via telemedicine or self-care were: to evaluate awareness and preparedness of population and providers to accept implementation of MA via telemedicine and self-care, identify possible legal, regulatory and service conditions and barriers and develop appropriate strategies for introducing telemedicine abortion services…. Formative research, conducted in Kazakhstan, Kirgizstan and Armenia revealed a very high level of awareness among women about medical abortion – more that 90% and between 60 and 72% of women stated that they will be able to cope with the process of medical abortion on their own.
A very high proportion of women, potential users of services (between 78 and 100%) declared that they are ready for implementation of MA via telemedicine, and more than two thirds believe that this approach can be implemented in their countries. Vast majority of providers also support implementation of MA through telemedicine (94%) and declared that it is possible to implement this approach (84%).
It is worth mentioning that result of studies on MA through telemedicine conducted in several EECA countries (Moldova, Georgia, Ukraine, Uzbekistan and Azerbaijan) were published in prestigious medical journals. Dissemination and discussion of results of these studies at country level and experiences obtained by providers while conducting them, helped local experts, policymakers and ministries of health to revise national abortion guidelines and include MA via telemedicine in national abortion standards/protocols in Moldova, Kazakhstan, Kirghizstan and Ukraine.
Formative research on telemedicine in Azerbaijan (Gulnara Rzayeva (Scientific Research Institute of Obstetrics and Gynecology, Azerbaijan)) investigated also policy maker’s views on next steps necessary to accomplish to implement telemedicine. Most policy makers mentioned changes in legislation, inclusion of MA through telemedicine in national guidelines on safe abortion, training of service providers and information campaign for service providers and women.
Low success rate of MA due to the use of uncertified, low-quality drugs is a frequent problem of quality of abortion services in a number of EECA countries, disqualifying this method among both women and providers. Petra Procter (Concept Foundation) stressed the importance of quality drugs for women’s health, including abortion. Quality assured drugs are considered products approved and listed by a stringent regulatory authority (SRA), prequalified and listed by WHO Prequalification of Medicines Programme, or WHO Listed Authority listed at maturity level 4 for medicines. Quality testing that was done by Concept Foundation in 11 low-middle income countries, including Moldova and Kyrgyzstan, demonstrated ongoing quality issues with non-quality assured misoprostol and mifepristone.
In the vast majority of EECA countries, abortion on request is permitted up to 12 weeks of pregnancy and access to abortion services was improved by allowing pregnancy terminations in outpatient settings and in private clinics, by cancellation of mandatory referrals and examinations unrelated to abortion safety, and simplified procedures to obtain abortion in the second trimester.
Unfortunately, due to increasing influence of anti-choice movements and organisations, in several countries of EECA region many legal and other unnecessary barriers were recently imposed to restrict access to abortion, e.g. in Georgia.
For country delegates, this meeting was an excellent opportunity to meet colleagues, experts from different countries and representatives of partner organisations to hear about the successes and achievements, as well challenges in ensuring good access safe abortion, and a platform to discuss different innovative solutions and interventions that are being promoted in the region and worldwide to improve the quality of abortion services and to respect reproductive and sexual rights of women and families. Also, many participants appreciated the opportunity to talk about people with special needs who might not have possibility to access these services on equality base. Participants promised to share all these ideas and experiences with ministries of health, academic institutions and professionals in their own countries to be used and implemented for the benefit of women and local communities.
Necessity to strengthen regional cooperation and the networking in the field of abortion was also emphasized. It was considered important to ensure a fruitful and effective cooperation not only during periodical conferences, but as a sustainable and continuous process using RRHRC on-line Platform.
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