Pregnancy – WMA – The World Medical Association

Adopted by the 24^th World Medical Assembly, Oslo, Norway, August 1970
and revised by the 35^th World Medical Assembly, Venice, Italy, October 1983,
the 57^th WMA General Assembly, Pilanesberg, South Africa, October 2006,
and the 69^th WMA General Assembly, Reykjavik, Iceland, October 2018

Preamble

Medically-indicated termination of pregnancy refers only to interruption of pregnancy due to health reasons, in accordance with principles of evidence-based medicine and good clinical practice. This Declaration does not include or imply any views on termination of pregnancy carried out for any reason other than medical indication.
Termination of pregnancy is a medical matter between the patient and the physician. Attitudes toward termination of pregnancy are a matter of individual conviction and conscience that should be respected.
A circumstance where the patient may be harmed by carrying the pregnancy to term presents a conflict between the life of the foetus and the health of the pregnant woman. Diverse responses to resolve this dilemma reflect the diverse cultural, legal, traditional, and regional standards of medical care throughout the world.

Recommendations

Physicians should be aware of local termination of pregnancy laws, regulations and reporting requirements. National laws, norms, standards, and clinical practice related to termination of pregnancy should promote and protect women’s health, dignity and their human rights, voluntary informed consent, and autonomy in decision-making, confidentiality and privacy. National medical associations should advocate that national health policy upholds these principles.
Where the law allows medically-indicated termination of pregnancy to be performed, the procedure should be performed by a competent physician and only in extreme cases by another qualified health care worker, in accordance with evidence-based medicine principles and good medical practice in an approved facility that meets required medical standards.
The convictions of both the physician and the patient should be respected.
Patients must be supported appropriately and provided with necessary medical and psychological treatment along with appropriate counselling if desired.
Physicians have a right to conscientious objection to performing an abortion; therefore, they may withdraw while ensuring the continuity of medical care by a qualified colleague. In all cases, physician must perform those procedures necessary to save the woman’s life and to prevent serious injury to her health.
Physicians must work with relevant institutions and authorities to ensure that no woman is harmed because medically-indicated termination of pregnancy services are unavailable.

Adopted by the 53^rd WMA General Assembly, Washington, DC, USA, October 2002,
revised by the 64^th WMA General Assembly, Fortaleza, Brazil, October 2013
and by the 72^nd WMA General Assembly (online), London, United Kingdom, October 2021

PREAMBLE

Since the start of the global HIV epidemic, women and girls in many regions have been disproportionately affected by HIV. Young women (aged 15-24), and adolescent girls (aged 10-19) in particular, account for a disproportionate number of new HIV infections.

Gender inequality contributes to the spread of HIV. It can increase infection rates and reduce the ability of women and girls to cope with the illness. Often, they have less information about HIV and fewer resources to take preventive measures. Sexual violence, a widespread violation of women’s rights, exacerbates the risk of HIV transmission.

Many women and girls living with HIV struggle with stigma and exclusion, aggravated by their lack of rights. Women widowed by AIDS or living with HIV may face property disputes with in-laws, complicated by limited access to justice to uphold their rights. Regardless of whether they themselves are living with HIV, women generally assume a disproportionate burden of care for others who are sick from or dying of AIDS, along with the orphans left behind. This, in turn, can reduce prospects for education and employment. It can also significantly reduce prevention of mother-to-child transmission (PMTCT) efforts and strategies.

Access to healthcare, including both preventative and therapeutic strategies, is a fundamental human right. This imposes an obligation on government to ensure that these human rights are fully respected and protected. Gender inequalities must be addressed and eradicated. This should impact every aspect of healthcare.

The promotion and protection of the reproductive rights of women are critical to the ultimate success of confronting and resolving the HIV/AIDS pandemic.

RECOMMENDATIONS

The WMA requests all national member associations to encourage their governments to undertake and promote the following actions:

Develop empowerment programs for women of all ages to ensure that women are better supported and free from discrimination. Such programs should include universal and free access to reproductive health education and life skills training,
Develop programme to provide HIV testing and post-exposure prophylaxis in the form of antiretrovirals to all survivors of assault.
Governments must provide universal access to antiviral therapy and treatment to all HIV infected women, protecting their health, and in the case of pregnant women, preventing mother to child transmission.
Provide universal HIV testing of all pregnant women, with patient notification of the right of refusal, as a routine component of perinatal care, and such testing should be accompanied by privacy protection, basic counseling and awareness of appropriate treatment, if necessary.
Patient notification should be consistent with the principles of informed consent. Universal and free access to antiretroviral therapy must also be provided to all HIV-positive pregnant women in order to prevent mother to child transmission of HIV.