Abortion as “Basic Health Care” – WHO 2025 Guidelines and Their Implications

On August 24, the World Health Organization published the second edition of its Abortion Care Guideline, which unequivocally defines abortion as an integral and inseparable part of basic health care (pp. 12–20). The aim of these Guidelines is to present a comprehensive set of WHO recommendations and best practices on abortion care. As the authors point out, although regulatory and political contexts and service delivery systems differ between countries, this document aims to “support evidence-based decision-making” to ensure “quality abortion care.” These Guidelines update and replace earlier WHO publications, including Safe abortion: technical and policy guidance for health systems (second edition, 2012), Health worker roles in providing safe abortion care and post-abortion contraception (2015, previously known as the “task sharing” Guidelines), Medical management of abortion (2018), and the first edition of the Abortion Care Guideline (2022).

Abortion is “uncomplicated” and “safe”

The second edition of the Abortion Care Guideline imposes on states an obligation to ensure full, unrestricted access to abortion services, introducing a series of recommendations that, in practice, amount to a radical reorganization of national health systems and the removal of all legal and procedural barriers. The WHO document defines abortion as a medical procedure whose safety depends not only on the competence of personnel but also on ensuring systemic support as well as patient education, and monitoring the quality of services. It says bluntly: ” Abortion is a safe and non-complex health-care intervention that can be effectively managed using medication or a surgical procedure in a variety of settings. Complications are rare with both medical and surgical abortion, when abortions are safe – meaning that they are carried out using a method recommended by WHO, appropriate to the gestational age, and by someone with the necessary skills (introduction, section XX).”

The very choice of words is significant. The WHO does not call abortion a risky procedure, does not mention the possibility of complications, but portrays it as a medical intervention no different from a routine outpatient procedure. The strategy lies in this one sentence: since something is simple and safe, there is no basis for restricting access to it. The problem, however, is that the medical reality is different. Even if the WHO limits itself to statistical approaches to risk, in fact every abortion has consequences for a woman’s health: physical and psychological. Hemorrhages, uterine perforations, infectious complications, and in the longer term fertility problems or post-abortion syndrome are not isolated cases, but real stories of women who go through an ordeal as a result of this “simple procedure.” 

Elimination of all limitations

The WHO not only unequivocally advocates that abortion be available as part of basic health care, but also recommends that states eliminate restrictions on access (pp. 20–78). As indicated in the report:

• Abortion is to be performed “on request,” without the need to provide medical or even social reasons.
• It is recommended that cooling-off periods for decisions, which until now have served as a natural mechanism for reflection, be abolished or radically shortened.
• All administrative and procedural requirements arising from criminal law or other regulations should be removed according to the WHO.

As a result, states are legally encouraged to change their laws if those laws have until now protected unborn life, and the WHO presents this as merely a health issue rather than a fundamental legal change constituting a departure from protecting the lives of the weakest and smallest. 

At the same time, the WHO document incorrectly (falsely?) states that: “ A number of common approaches to law and policy on abortion (…) are inconsistent with international human rights legal instruments, and can have negative effects on the exercise of human rights.” The WHO appears to be reinterpreting treaties and other international obligations anew and in its own way. In fact, from the existing treaties it is clear that abortion is not a human right. Inter alia, in 1994, at the International Conference on Population and Development, United Nations Member States agreed that abortion is a matter to be decided exclusively within the framework of national policy and legislation (A/CONF.171/13, para. 8.25). Despite this longstanding consensus, repeatedly affirmed by UN Member States, including in the 2030 Agenda (A/RES/70/1, SDG 5.6), UN agencies have been systematically promoting abortion for the past twenty-five years, and, for some time now, also gender ideology.

More on this topic:

• UNICEF plans to negatively impact children’s welfare
• The UN and abortion: how concessions turn into permanent international pressure

Abortion without a doctor

The new Guidelines also describe in detail the use of pharmacological agents – mifepristone (a synthetic steroid that is a progesterone receptor antagonist and blocks the action of the hormone necessary to maintain pregnancy, thereby causing a miscarriage) and misoprostol (inhibits the action of the hormone progesterone, which leads to detachment of the embryo from the uterine lining and, as a result, abortion) – both in medical facilities and in the self-administration of medications under remote supervision model (pp. 54–70, 122–130).

Moreover, the WHO promotes a “task-sharing model” that allows abortions to be performed by nurses, midwives, and other health-care workers who are not physicians. This solution aims to improve access to “services”, especially in regions with limited availability of physicians (pp. 56–60).

However, such a model means lowering the requirements for abortion providers. The doctor, who until now has been the guarantor of safety and quality, is being reduced to a supervisory role, which undermines the standards of medical care. Such an approach may lead to an increased risk of medical errors and a violation of a woman’s right to complete and accurate information. Additionally, self-administering medications outside medical facilities, even when remotely supervised, limits direct medical care, which poses serious health and legal risks. For this reason, the WHO’s recommendations once again prompt serious concern about whether ideological considerations have taken precedence over health considerations within the World Health Organization, which also explains the United States’ withdrawal from this UN agency.

Read also:

• UNICEF: Attack on the World’s Children(a report by C-FAM)
• Will there be a debate in Poland about leaving the WHO?Ordo Iuris presents a special report

Abortion without parental consent or the partner’s knowledge 

The World Health Organization remains consistent in its Guidelines. Recognizing abortion as an ordinary, uncomplicated, and safe medical procedure inevitably leads to the conclusion that a legal guardian’s consent should be unnecessary. Especially if we deny the unborn child personhood. Therefore, later in the document, WHO experts recommend amending national regulations so that:

• minors have access to abortion without requiring the consent of parents or guardians, and adult women without the need to inform the child’s father,
• these procedures are available in a non-discriminatory manner, also in places where a humanitarian crisis occurs,
• all countries ensure full access regardless of legal status and social circumstances.

The authors of the document “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. Remark: While parental or partner involvement in abortion decision-making can support and assist women, girls or other pregnant persons, this must be based on the values and preferences of the person availing of abortion and not imposed by third-party authorization requirements.” (page 43) And they further say: “ Third-party authorization requirements are incompatible with international human rights law, which provides that States may not restrict women’s access to health services on the ground that they do not have the authorization of husbands, partners, parents or health authorities, because they are unmarried, or because they are women.” (page 43)

Although the argument about what the international human rights system says on abortion is completely misguided and has been repeatedly corrected, so it is not worth referring to it again, it is worth drawing attention to another consequence of adopting the regulations recommended by the WHO. Such an approach de facto shifts part of parental authority from parents to the state and to “international standards,” thus in practice undermining the protection of the family and of parental rights. In Poland, this would undermine even the constitutional guarantees afforded to parents to raise their children in accordance with their own beliefs, which are also reflected in the Charter of Fundamental Rights of the European Union. It is also worth emphasizing that the lack of a requirement for parental consent when making the decision to kill an unborn child leaves a young person without adequate protection and support, exposing them not only to serious health consequences (physical and psychological) but also to social ones. This position is all the more surprising, given that, as a rule, a person who has not yet reached adulthood cannot even drive a car or buy tobacco or alcohol, whereas—according to WHO experts—they should be able to have an abortion. 

Telemedicine and self-administration of medications 

The Guidelines place particular emphasis on telemedicine (the authors of the document themselves define this term as “ a mode of health service delivery where providers and clients, or providers and consultants, are separated by distance. The interaction may take place in real time (synchronously), using telephone or video link, or asynchronously using a store-and-forward method, when a query is submitted and an answer is provided later (e.g. by email, text or voice/audio message)” – p. 97) and the model of self-administration of medications at home (pp. 95–118). Female patients should have the option to undergo a medication abortion under the remote supervision of medical staff. The WHO document states: “ Even for procedures that take place at a health-care facility, some elements of the care (e.g. pre-abortion information and counselling, cervical priming or post-abortion follow-up care) can take place in other locations. ”

This model minimizes the role of traditional, in-person medical care. There is no doubt that this way of presenting the problem not only lowers the standard of women’s health care, but also directly endangers them. By proposing such a model, the WHO effectively removes from the sphere of responsibility of physicians and medical institutions the most important element—actual oversight of the conduct of the procedure. Instead, responsibility is effectively shifted onto the woman herself, who, in a home setting, deprived of adequate diagnostic care and access to immediate intervention, is left to fend for herself. This is not only a drastic reduction in health care standards but also a serious problem from the standpoint of legal liability for potential complications.

Decriminalization of abortion and restriction of conscientious objection

The WHO calls for the full decriminalization of abortion (p. 24), which means removing any legal sanctions against people performing abortions, and at the same time, the WHO guidelines limit healthcare workers’ right to conscientious objection only to situations in which an alternative is guaranteed that ensures the abortion is carried out. As a result, an obligation is placed on the state to organize procedures in such a way that conscientious objection cannot effectively block access to abortion (pp. 60–62). The WHO guidelines “recommend that access to and continuity of comprehensive abortion care be protected against barriers created by conscientious objection.” This accompanied with the following remarks: “Health services should be organized in such a way as to ensure the exercise of conscientious objection does not prevent people from accessing available abortion services. Where conscientious objection is permitted, international human rights law requires States to take steps to ensure that it does not operate as a barrier to access to abortion care. The mere existence of regulation of conscientious objection is not sufficient. In practice, this means that if States permit conscientious objection, they must regulate it in a way that is effective in ensuring that abortion is available and accessible in practice.” (page 61) 

But in practice, such an approach, which erroneously reinterprets international law, deprives conscientious objection of its real substance. For if a doctor or a nurse has no practical ability to refuse to participate in an abortion procedure, or must contribute to that abortion by proposing an alternative that will ensure that the abortion takes place, then the right to conscientious objection is reduced to pure fiction. Conscientious objection becomes a mere declaration that has no practical effect. Moreover, the WHO document suggests that conscientious objection in itself constitutes a “barrier” to accessing services, which should be overcome. The result of implementing such guidelines would be the creation of a system in which doctors and nurses are compelled, directly or indirectly, to participate in procedures they consider deeply immoral and contrary to medical ethics. This, in turn, would lead to the marginalization, in the medical professions, of believers and of those who follow the principle of protecting life from conception. In a broader perspective, this is also a serious violation of human rights, this time not of patients but of the medical professionals themselves, whose freedom of conscience is treated by the WHO as an obstacle to be removed. It is worth noting that, unlike abortion, freedom of conscience is a well-established human right, enshrined in international legal instruments such as the Charter of Fundamental Rights of the European Union (Article 10) and the International Covenant on Civil and Political Rights (Article 18).

See also:

• The right of nurses and midwives to act in accordance with their conscience – Ordo Iuris brochure (in Polish)

Summary and potential consequences

The new WHO guidelines from August 24 reveal the full extent of the organization’s ideological shift. The World Health Organization not only openly promotes abortion, even though there is no consensus among member states on this issue, but also ignores the position of a large group of countries that consistently oppose the decriminalization of abortion. 

Moreover, the international organization whose primary goal should be the protection of public health is, in fact, promoting lower health care standards. Guidelines permitting the use of telemedicine in abortion procedures lead to a situation in which a woman may be left alone at home with abortion pills, without genuine support from a physician and without adequate medical safeguards. Such a model, instead of protecting women’s health, exposes them to additional risk of complications that, under conditions of isolation, can have tragic consequences.

The greatest paradox, however, remains that the WHO itself is sawing off the very branch on which it has been building its narrative for years. For decades, the argument made by proponents of expanding access to abortion was that “illegal abortion” is dangerous and threatens women’s health. Meanwhile, the WHO now presents abortion as a simple medical procedure, one that can be performed even at home, with minimal support from medical personnel. Such an approach seriously weakens the long-standing argument of abortion advocates about the alleged threat to women’s lives in countries where abortion is officially illegal and, if it is performed at all, it is done at home, with only telephone supervision by a doctor. This blatant inconsistency indicates that the WHO is not guided by medical facts and the desire to protect women’s health, but is instead pursuing a specific ideological agenda. 

In summary, the new WHO guidelines not only lower the standard of women’s health care, but also strike at the very foundation of international law, namely, respect for the diversity of positions held by states and the protection of fundamental human rights, and above all, the right to life. An organization that should be a guarantor of objective medical knowledge is becoming an instrument of ideology, promoting policies that contradict both medical ethics and elementary logic.

Julia Książek – analyst at the Ordo Iuris Center for International Law.

See also:

• Abortion Access Is Not a Human Right—and Here’s Why

Source of cover photo: Pexels