Glossary of Terms

Sexual and reproductive health is a state of physical, emotional, mental, and social wellbeing in relation to all aspects of sexuality and reproduction, not merely the absence of disease, dysfunction, or infirmity.

Achievement of sexual and reproductive health relies on the realisation of sexual and reproductive rights, which are based on the human rights of all individuals to:

• have their bodily integrity, privacy, and personal autonomy respected;
• freely define their own sexuality, including sexual orientation and gender identity and expression;
• decide whether and when to be sexually active;
• choose their sexual partners;
• have safe and pleasurable sexual experiences;
• decide whether, when, and whom to marry;
• decide whether, when, and by what means to have a child or children, and how many children to have;
• have access over their lifetimes to the information, resources, services, and support necessary to achieve all the above, free from discrimination, coercion, exploitation, and violence.

Sexual and reproductive health and rights (SRHR)¹ are essential for sustainable development because of their links to gender equality and women's wellbeing, their impact on maternal, newborn, child, and adolescent health, and their roles in shaping future economic development and environmental sustainability.

Sexual and reproductive justice exists when all people have the power and resources to make healthy decisions about their bodies, sexuality and reproduction^[1] Rooted in the internationally-accepted human rights framework created by the United Nations, Sexual and Reproductive Justice combines Sexual & reproductive rights, and social justice. SRJ is about analysing and dismantling power dynamics. It is about enabling access of the most marginalized to SRH, and addressing intersecting oppressions impacting SRH.

• Community-based care: Services delivered by a broadly defined community health workforce, according to their training and capacity, encompassing a range of health workers, lay and professional, formal and informal, paid and unpaid, as well as facility-based personnel who support and supervise them and provide outreach services and campaigns (1).
• Comprehensive abortion care (CAC): Provision of information, abortion management (including induced abortion and care related to pregnancy loss), and post-abortion care.
• Concluding observations: Following submission of a State report and a constructive dialogue with the State party to the particular convention, treaty monitoring bodies issue concluding observations to the reporting State, which are compiled in an annual report and sent to the United Nations General Assembly (2).
• Conscious sedation: The use of a combination of medicines – a sedative to relax and an anaesthetic to block pain – to induce a depressed level of consciousness during a medical procedure.
• Conscientious objection or conscientious refusal: The practice of health-care professionals refusing to provide abortion care on the basis of personal conscience or religious belief.
• Decriminalization: Removing abortion from all penal/criminal laws, not applying other criminal offences (e.g. murder, manslaughter) to abortion, and ensuring there are no criminal penalties for having, assisting with, providing information about, or providing abortion, for all relevant actors.
• Dilatation and evacuation (D&E): D&E is used after 12–14 weeks of pregnancy. It is the safest and most effective surgical technique for later abortion, where skilled, experienced practitioners are available. D&E requires preparation of the cervix using osmotic dilators and/or pharmacological agents, and evacuating the uterus primarily with forceps, using vacuum aspiration (refer to entry in this list) to remove any remaining blood or tissue.
• Gestational age (duration of pregnancy): The number of days or weeks since the first day of the woman's last normal menstrual period (LMP) in women with regular cycles (see Table 1). For women with irregular cycles or when LMP is unknown, gestational age is the size of the uterus, estimated in weeks, based on clinical examination or ultrasound, that corresponds to a pregnant uterus of the same gestational age dated by LMP.

  Table 1. Equivalent gestational ages in weeks and days during early pregnancy

  Weeks of gestation	Days of gestation	Weeks of gestation	Days of gestation
  0	0–6	8	56–62
  1	7–13	9	63–69
  2	14–20	10	70–76
  3	21–27	11	77–83
  4	28–34	12	84–90
  5	35–41	13	91–97
  6	42–48	14	98–104
  7	49–55

  Note: Day 0 is the first day of the last menstrual period (LMP), and is also the first day of Week 0 of gestation (not Week 1).
  Source: Adapted from 2012 Safe abortion guidance (2) based on International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10), 2004 (3).

• Health: A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (4).
• Health system: A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health (5).
• Health workers: All people engaged in actions whose primary intent is to enhance health. While, strictly speaking, this includes unpaid carers (e.g. parents caring for sick children, and self-carers), the data available on health worker numbers are generally limited to people engaged in paid activities (6; Chapter 1: Health workers).
• Human rights standards: The meaning and scope of human rights as provided for in international human rights treaties and as interpreted and applied by the human rights bodies tasked with this work, which can include international, regional and national courts, and human rights committees (2).
• Incomplete abortion: Clinical presence of an open cervical os and bleeding, whereby all products of conception have not been expelled from the uterus, or the expelled products are not consistent with the estimated duration of pregnancy. Common symptoms include vaginal bleeding and abdominal pain. Uncomplicated incomplete abortion can result after an induced or spontaneous abortion (i.e. miscarriage).
• International human rights treaty (also sometimes called a covenant or a convention): An international legal instrument adopted by the international community of States, normally at the United Nations General Assembly. Each treaty sets out a range of human rights and corresponding obligations which are legally binding on States that have ratified the treaty (2) (Annex 2 includes a list of relevant treaties).
• Intrauterine fetal demise (IUFD; fetal death): The intrauterine death of a fetus at any point in time during the pregnancy (7).
• Mandatory waiting period: A requirement imposed by law or policy, or in practice, to wait a specified amount of time between requesting and receiving abortion care.
• Medical methods of abortion (medical abortion): Use of pharmacological agents to terminate a pregnancy (2).
• Mental health: A state of well-being in which every individual realizes their own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to their community (8).
• Miscarriage: Spontaneous loss of a pregnancy before the fetus is usually viable outside the uterus. The clinical signs of miscarriage are vaginal bleeding, usually with abdominal pain and cramping. If the pregnancy has been expelled, the miscarriage is termed "complete" or "incomplete" depending on whether or not tissues are retained in the uterus (9).
• Missed abortion: Arrest of pregnancy development where the embryo/fetus/embryonic tissue or empty gestational sac remains in the uterus and the cervical os is closed. Symptoms may include pain and/or bleeding, or there may be no symptoms at all (10).
• Osmotic dilators: Short, thin rods made of seaweed (laminaria) or synthetic material. After placement in the cervical os, the dilators absorb moisture and expand, gradually dilating the cervix (2).
• Policy: A law, regulation, procedure, administrative action, incentive or voluntary practice of governments and other institutions (11).
• Post-abortion care: Provision of services after an abortion, such as contraceptive services and linkage to other needed services in the community or beyond. It can also include management of complications after an abortion.
• Primary health care (PHC): A whole-of-society approach to health that aims at ensuring the highest possible level of health and well-being and their equitable distribution by focusing on people's needs and preferences as early as possible along the continuum from health promotion and disease prevention to treatment, rehabilitation and palliative care, and as close as feasible to people's everyday environment (12).
• Quality of care (QOC): QOC encompasses six areas or dimensions of quality that are required in relation to health care:
  • effective, delivering health care that is adherent to an evidence base and results in improved health outcomes for individuals and communities, based on need;
  • efficient, delivering health care in a manner which optimizes resource use and avoids waste;
  • accessible, delivering health care that is timely, geographically reachable, and provided in a setting where skills and resources are appropriate to medical need;
  • acceptable/patient-centred, delivering health care that takes into account the preferences and aspirations of individual service users and the cultures of their communities;
  • equitable, delivering health care that does not vary in quality because of personal characteristics such as gender, race, ethnicity, geographical location or socioeconomic status;
  • safe, delivering health care that minimizes risks and harm to service users (13; p. 9).
• Regulation of abortion: All formalized laws, policies and other instruments (e.g. facility-level protocol) that regulate pregnancy and abortion.
• Self-care: The ability of individuals, families and communities to promote health, prevent disease, maintain health, and cope with illness and disability with or without the support of a health worker. The scope of self-care thus includes health promotion, disease prevention and control, self-medication, providing care to dependent people, seeking hospital/specialist/primary care if necessary, and rehabilitation, including palliative care. It includes a range of self-care practices and approaches (14).
• Self-management of abortion: Self-management of the entire process of medical abortion or one or more of its component steps, such as self-assessment of eligibility for medical abortion, self-administration of medicines without the direct supervision of a health worker, and self-assessment of the success of the abortion process.
• Social enterprise: Defined as a business that has specific social objectives that serve its primary purpose. Social enterprises seek to maximize profits while maximizing benefits to society and the environment. Their profits are principally used to fund social programmes (15).
• Social franchising: Defined as a system of contractual relationships usually run by a nongovernmental organization which uses the structure of a commercial franchise to achieve social goals. The overarching difference between social and commercial franchising is that social franchising seeks to fulfil a social benefit whereas commercial franchising is driven by profit (16, 17).
• Social marketing: Broadly defined as the application of marketing techniques to social problems. Aims to persuade or motivate people to adopt specific courses of action or behaviour which are generally accepted as being beneficial. It is the design, implementation and control of programmes seeking to increase acceptability of a social idea or practice in a target group(s). It cannot create the behaviour, it can only help to gain acceptance and a willingness to adopt the behaviour. Its strategy is predominately preventive (18).
• Surgical methods of abortion (surgical abortion): Use of transcervical procedures for terminating pregnancy, including vacuum aspiration, and dilatation and evacuation (D&E). (See definitions in this list) (2).
• Telemedicine (or Telehealth): A mode of health service delivery where providers and clients, or providers and consultants, are separated by distance (19). That interaction may take place in real time (synchronously), e.g. by telephone or video link. But it may also take place asynchronously (store-and-forward), when a query is submitted and an answer provided later, e.g. by email or text/voice/audio message.
  • Client-to-provider telemedicine: Provision of health services at a distance; delivery of health services where clients/patients and health workers are separated by distance (e.g. consultations between remote client/patient and health worker; clients/patients transmit medical data [images, notes, videos] to health worker) (20).
• Third-party authorization: A requirement imposed by law or policy, or in practice, that a party other than the woman, girl or other pregnant person (typically a parent, guardian, spouse, partner, health worker, health authority or judicial authority) must authorize an abortion where other applicable legal requirements for lawful abortion have been met.
• Treaty monitoring body: Each of the international human rights treaties (see above) is monitored by a designated treaty monitoring body (see Annex 2). The treaty monitoring bodies are committees composed of independent experts. Their main function is to monitor the States' compliance with the treaty in question, including through the examination of State reports (2).
• Universal health coverage (UHC): Ensuring that all people have access to needed promotive, preventive, curative, rehabilitative, and palliative health services, of sufficient quality to be effective, while also ensuring that the use of these services does not expose any users to financial hardship (12).
• Vacuum aspiration (electrical or manual; EVA or MVA): Vacuum aspiration involves evacuation of the contents of the uterus through a plastic or metal cannula, attached to a vacuum source. Electric vacuum aspiration (EVA) employs an electric vacuum pump. With manual vacuum aspiration (MVA), the vacuum is created using a hand-held, hand-activated, plastic 60 ml aspirator (also called a syringe). MVA aspirators accommodate 4–12 mm cannulae. Suction tubing for EVA can be used with cannulae up to 16 mm in diameter, permitting VA to be used up to 15–16 weeks of pregnancy or for post-abortion care cases presenting with dilated cervix where a higher number of cannulae is required for effective vacuum.