First Trimester Abortion Guidelines and Protocols

Providing high quality, client-centred services IPPF strives to ensure access to safe, legal abortion services worldwide. In line with this vision, these guidelines and protocols are intended to support service providers to offer high quality, client-centred abortion and abortion-related services. The document is grounded in the values and principles laid down in IPPF’s Charter on Sexual and Reproductive Rights; the clinical procedures are based on the Quality of Care Framework developed and implemented across all aspects of service provision throughout IPPF.

The document integrates protocols, guidelines and standards in a broad framework to ensure that no aspect of care is overlooked when providing comprehensive abortion care in the first trimester of pregnancy.

The intended audience is staff involved in abortion services – whether as direct providers of abortion care or as counsellors or educators – who might be interested in some of the medical aspects that this document addresses.

Our aim is to present the underlying principles and desired outcomes in a format that is as practical as possible. This reflects the World Health Organization statement: “Guidelines are systematically developed evidence-based statements which assist providers […] to make informed decisions about appropriate health interventions. Guidelines are formal advisory statements which should be robust enough to meet the unique circumstances and constraints of the specific situation to which they are being applied.

The basic nature and intent of guidelines have also been expressed under other formats variously labeled as protocols, best practice, algorithms, consensus statements, expert committee recommendations, and integrated care pathways […].” (World Health Organization: Guidelines for WHO Guidelines: see Bibliography on page 32.) More comprehensive training tools on early abortion are available from TEACH at – developed for use in the USA, they are very detailed, and offer useful additional information.

In addition to clinical protocols, a clinic providing abortion care should have a counselling protocol (including counselling on options when facing an unwanted pregnancy, on pre- and post-abortion care and on contraception), clear guidelines for patient flow, a written protocol for waiving or reducing the costs of the procedure for women in need, and a client satisfaction survey tool.

Finally, all possible steps must be taken to ensure or improve service quality.


This education resource is intended to be a supportive tool and does not dictate an exclusive course of management. It contains recognized methods and techniques of medical care that represent currently appropriate clinical practice. Variations in the needs of individual patients and in the resources available may justify alternative approaches to those contained in this resource. IPPF and its staff are not responsible for adverse clinical outcomes that might occur in the delivery of abortion services in which it is not expressly and directly involved in as the primary caregiver.