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In Ethiopia, unsafe abortions account for approximately 25-50 percent of maternal deaths. Abortion complications are a leading cause of hospitalization for Ethiopian women — costing Ethiopians around $7.4 million (U.S.). Between 2000 and 2004, Ipas Ethiopia worked closely with several regional health bureaus to address these important issues through provider trainings and service improvements.

According to a recent study, “An assessment of postabortion care in three regions in Ethiopia, 2000-2004,” published in the April issue of International Journal of Gynecology and Obstetrics, the interventions were effective in improving postabortion care (PAC) outcomes. More facilities provided PAC services, used manual vacuum aspiration (MVA) — which is recommended by the World Health Organization— rather than sharp curettage, regularly provided postabortion contraception and had one or more providers trained in PAC. The authors, Ipas’s Tamara Fetters, Solomon Tesfaye and Kathryn Anderson Clark, assessed PAC services before and after the training interventions.

“The study was unique in scope and size,” Fetters says. The authors compared pre- and post-intervention data for 119 selected facilities in Addis Ababa, Amhara and Oromia regions. Forty-two facilities received an intensive package of PAC intervention activities designed to scale up and improve the quality of services. The other 77 facilities are used as comparisons in the study.

Below is a snapshot of the article’s findings:

• In 2000, 64 of the 119 facilities provided uterine evacuation services to women with abortion complications. By 2004, 74 facilities provided these services. Nine intervention facilities and one comparison site initiated PAC services — all health centers, not hospitals — increasing access to PAC for hundreds of Ethiopian women each year.
• Participation in the PAC intervention group was closely associated with increased MVA use.
• In 2004, more MVA evacuations were performed by midwives and other midlevel providers in health centers, rather than by gynecologists at the hospital level.
• The study did uncover a deficit in postabortion family planning; perhaps due to lack of donor support for these commodities, which caused supply shortages around the country. “This finding wasn’t surprising — though things have improved since 2004 — but it did allow us to highlight the implications of the shortages at a national level,” Fetters notes.
• Despite commodity shortages, the acceptance of postabortion family planning rose. In the intervention group, the number of facilities routinely providing contraception as part of PAC rose from six in 2000 to 24 in 2004.
  Though there wasn’t dramatic change in the number of facilities providing PAC services, there is noticeable improvement in care, even in facilities that didn’t receive the trainings.
• There was spill over into the non-intervention group, we believe through the exchange and transfer or providers and ongoing work with the regional health bureaus,” Fetters says.   

Continuing the research illustrated in this article, Ipas, in partnership with the Ministry of Health, the Ethiopian Society of Obstetricians and Gynecologists (ESOG), other local partners, and the Guttmacher Institute, has launched a new project, the National Study of the Magnitude and Consequence of Unsafe Abortion in Ethiopia. It includes several main components: facility caseloads, provider reports on service access and quality, cost of abortion to the health system, and estimation of abortion incidence nationally.  This study is one of the few national studies ever conducted to include information on private sector abortion services, as well as public services and one of the only studies that will use multiple methods to calculate and validate abortion-related morbidity, mortality and incidence.

“We’re now looking at the same issues from new angles. We will be able to look at technology, provision of care and facility capacity and make recommendations,” Fetters says.

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For more information, contact media@ipas.org