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| Health facility in Ethiopia |
| © Richard Lord |
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The demand for abortion in Ethiopia, a predominantly poor and rural country, is rooted in dramatic unmet need for contraception and high levels of unintended pregnancy. But recent data illustrate positive change and a focus on safe and comprehensive abortion care.
In 2008, more than 380,000 induced abortions occurred in Ethiopia, some within the formal health system and many outside of it. Of those abortions, more than 50,000 women sought care for complications from unsafe abortion. Since the country’s abortion law reform in 2005, efforts have been made to improve and expand abortion care services around the country.
Such efforts have paid off. Findings from a two-year project in the Tigray region of Ethiopia, published in the International Journal of Gynecology and Obstetrics, show marked improvements in abortion care from 2007 to 2009. In a fairly simple way, the Safe Abortion Care (SAC) monitoring approach captured the improvements in Ministry of Health services, including an increase in the numbers of facilities offering safe abortion care; a shift from treatment of abortion complications to provision of safe abortion; decentralization of services to health centers; and improvements in postabortion contraceptive uptake.
The SAC model was developed to monitor preventive and curative means to reduce unsafe abortions. Based on the Emergency Obstetric Care (EmOC) model, the SAC approach assumes that if safe abortion services are available, used, and of sufficient quality, abortion-related mortality should decline.
In the SAC model, sufficient availability of services is calculated on the need for five facilities offering safe abortion care per 500,000 people. With a population of over 4 million, the Tigray region required 44 facilities. In March 2007, just 17 public sector sites were providing care, but by the project’s end, 38 facilities did so.
Availability of care wasn’t the only improvement. Abortion care services were decentralized so that women can obtain care in health centers closer to their homes, rather than just in large hospitals. Furthermore, at the outset of the project, just 7 percent of the roughly 2,300 abortion-related services were for safe abortion---the remaining were for treatment of miscarriage and for complications of unsafe abortions performed elsewhere---but by the project’s end, nearly 60 percent of almost 4,500 procedures were for induced abortion. In addition, contraceptive acceptance improved—78 percent of women who received abortion services in Tigray public hospitals and health centers in 2009 left the facility with a contraceptive method—up from just above 30 percent in 2007.
Quality of care also improved in Tigray in a short time. In 2007, only 30 percent of roughly 2,000 uterine evacuations were performed using recommended methods. Two years later, the proportion of evacuations using recommended methods increased to 85 percent of nearly 4,300 procedures.
The model’s simplicity allowed providers and facilities to focus on the essential elements needed for adequate access to and quality of safe abortion care, note the study’s authors. “The improvements in Tigray, both in the percentage of all abortion cases and in absolute numbers of women served, represent a rapid transition from a focus on treatment of abortion complications to provision of safe abortion since legal reform,” says Karen Otsea, lead author.
For more information, contact media@ipas.org