ABSTRACT:
Safe abortion care is a critical component of sexual and reproductive health, yet national clinical guidelines often lag behind evolving evidence and global standards. This perspective article reflects on the structured, participatory process undertaken to align South Africa’s national clinical abortion guideline with the latest guidance from WHO and FIGO. Beginning in 2024, the South African National Department of Health convened four roundtable discussions involving representatives from the Department, WHO, clinical providers, academics, legal experts, and SRHR civil-society organisations. This process aimed to 1) assess the alignment of South Africa’s abortion law and policy with WHO recommendations; 2) identify policy barriers that limit access to abortion services; and 3) draft an updated guideline to address these barriers and improve access to abortion services. We conducted a comparative policy analysis of the 2019 South African National Clinical Guideline for Implementation of the Choice on Termination of Pregnancy Act, the 2022 WHO Abortion Care Guideline and 2023 WHO Clinical Practice Handbook for Quality Abortion Care, alongside a review of the national law and regulations. Each content area was systematically assessed for alignment or divergence. Areas of divergence were explored in five thematic roundtable discussions with subject-matter experts, covering operational, legal, and other issues. We employed framework analysis to synthesise stakeholders’ perspectives and identify barriers to access. These findings shaped a set of policy recommendations and guided the drafting of an updated national clinical abortion guideline. The drafted guideline was iteratively reviewed and revised by stakeholders. This collaborative process was crucial to produce a guideline that is both consistent with global best practice and responsive to South Africa’s operational realities and reproductive health landscape.