Women may experience amenorrhoea for reasons other than pregnancy, however, and some women who are pregnant may not report having missed a period. the first day of bleeding and whether the menstruation was normal, as well as about her menstrual history, including the regularity of her cycles. The woman should be asked about the first day of her last menstrual period (LMP), i.e. Most women begin to suspect that they are pregnant when their expected menstrual period does not occur. Staff should also be competent to offer counselling to help the woman consider her options if needed (see Section 2.1.8). Health-care centres that are not staffed and equipped to provide induced abortion must be able to refer women promptly to the nearest services with minimal delay.
Every health-service-delivery point should have staff who are trained and competent to take the woman's medical history and perform a bimanual pelvic and an abdominal examination to accurately assess pregnancy and its duration. Determination of the length of pregnancy is a critical factor in selecting the most appropriate abortion method, and determines the content of the information and counselling to be given to women prior to abortion. The risks associated with induced abortion, though small when abortion is properly performed, increase with the duration of pregnancy ( 1, 2). The first steps in providing abortion care are to establish that the woman is indeed pregnant and, if so, to estimate the duration of the pregnancy and confirm that the pregnancy is intrauterine.