Background: In March 2022, the WHO released updated guidelines consolidating the current evidence and best practices for provision of quality abortion care, which, for the first time, include self-management of medical abortion as a fully recommended model of abortion care.

Methods: The new guidelines have the potential to transform abortion access if international bodies, governments and health systems expand the availability of medication abortion pills and trained support. The guidelines also have important implications for the way we conceptualise and measure abortion safety. Abortion safety has historically been conceptualised from a purely biomedical (clinical and public health) perspective and relied on clinical process measures (method, provider and setting) for classification. This operationalisation required that the abortion involves a recommended method delivered by an appropriately trained provider, in an appropriate facility, to be considered ‘safe’.

Results: Over time, however, as knowledge, availability, and use of abortion medications (misoprostol with or without mifepristone) increased outside of clinic settings, the process measures (method, provider, setting) that defined the abortion safety paradigm no longer correlated as directly with biomedical risk.

Conclusions: This commentary discusses limitations of the current approach to the measurement of abortion safety, highlights the required reclassification of self-managed abortion as ‘safe’, and calls for a new paradigm to emerge for the measurement and understanding of global abortion experiences that is centred in a rights-based conceptualisation of quality care for all abortion experiences.