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March 29, 2007
In Ethiopia, access to essential health services has been expanding considerably, thanks in part to a recent intervention and relatively new laws valuing women’s health and rights.
In Ethiopia, access to essential health services has been expanding considerably, thanks in part to a recent intervention and relatively new laws valuing women’s health and rights.
Photo courtesy of Pep Bonet, Panos Pictures.

In Ethiopia, where one in seven women dies of causes related to pregnancy or childbirth, Ipas Ethiopia has created partnerships with the Ethiopian government to improve women’s health by increasing access to comprehensive postabortion care (PAC). Key in these efforts has been a six-year collaboration between Ipas Ethiopia and regional health bureaus (RHBs) involving an intervention to expand and improve the quality of PAC services. The PAC-services intervention, which included intensive training workshops, was carried out at selected health-care facilities in three of the country’s 11 states — Addis Ababa, Amhara and Oromia — home to a majority of nation’s 74 million citizens.

To evaluate the impact of the intervention, Ipas researcher Solomon Tesfaye, MD, MPH, and colleagues collected and analyzed data on several health-services indicators from the 42 intervention facilities, along with 77 comparison sites, at two time points — in 2000, before the intervention, and again in 2004, after the intensive intervention. The data were obtained in interviews conducted with the head of gynecology services at each participating facility; 100 percent of the 119 facilities that participated at baseline participated in the follow-up interview.

The researchers’ findings are reported in a recently published Ipas monograph, Expanding our reach: an evaluation of the availability and quality of postabortion care services in three regions in Ethiopia between 2000 and 2004.¹

By virtually all measures, the intervention was remarkably effective at increasing the availability and comprehensiveness of the PAC services offered. For example, services for uterine evacuation — one of the most frequently performed procedures in the world, and an essential clinical element of PAC — was offered by 33 intervention facilities (79%) in 2004, compared with only 24 (57%) pre-intervention. In addition, the proportion of intervention facilities with manual vacuum aspiration (MVA) instruments — a very safe and effective technology used to treat incomplete abortion and other conditions warranting uterine evacuation — increased substantially (from 26% to 79%), as did the proportion of facilities actually performing MVA (17% to 67%).

Some of the other outcomes showing impressive gains from start to follow-up include the availability of clinicians with at least the minimum skill level necessary to provide high-quality PAC, the regular provision of contraceptive services as part of comprehensive PAC services offered on-site and the proportion of uterine-evacuation procedures performed by using MVA (instead of sharp curettage, a surgical method that poses a considerably higher health risk to the woman).

In addition, for all these outcomes, the differences in the pre- versus postintervention measurements between the facilities that had taken part in the intervention and those that had not were statistically significant, indicating the success of the intervention.

Two of the study’s findings have particularly important implications for the health of women living in rural communities. First, over the course of the study period, PAC services were initiated at 10 local health centers (where rural women are most likely to seek care), but no hospital facilities. Second, the clinicians who underwent training in uterine-evacuation procedures during the four-year period were primarily midwives, and such mid-level providers are often the only types of health-care providers seen by women in or near their communities.

Although the intervention proved highly successful, the authors note that many facilities experienced shortages of essential medications and instruments; continued not to offer pain management to most women undergoing PAC procedures; lacked certain types of modern contraceptive methods, which are necessary to prevent future unwanted pregnancies (and in the case of condoms, to protect against HIV infection); or had no form of emergency transportation for patients in serious or critical condition.

The findings of this large evaluation have been released at an important time for the women of Ethiopia. In the past few years, the Ethiopian Parliament resolved to improve the health of millions of its citizens by http://www.ipas.org/english/press_room/2005/releases/06072005.asp">revising the country’s penal code — in particular, by liberalizing provisions that had long denied women their sexual and reproductive rights, including access to safe, legal abortion care. Today, as http://www.ipas.org/english/press_room/2006/releases/08012006.asp">efforts to implement these new laws are fully under way, the success of Ipas–RHBs’ intervention ensures that countless women will finally have essential health-care services available to them in their communities — including potentially life-saving postabortion care.

Reference

1. Tesfaye, Solomon, Tamara Fetters, Kathryn Andersen Clark and Heathe Luz McNaughton. Expanding our reach: An evaluation of the availability and quality of postabortion care services in three regions in Ethiopia between 2000 and 2004. Chapel Hill, NC, Ipas.

For more information, contact:
Kirsten Sherk
Senior Associate, Media Relations
e-mail: sherkk@ipas.org
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