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| Richard Lord |
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In Ethiopia, one in seven women dies from pregnancy-related causes, and unsafe abortion is a major contributor to maternal deaths. Since the country’s abortion law reform in 2005, efforts have been made to improve and expand abortion care services around the country. The Safe Abortion Care (SAC) monitoring framework has tracked positive change in the Tigray region of Ethiopia in just the past two years: women’s access to care has improved and fewer women suffer complications from unsafe abortion.
The SAC model assesses whether health facilities provide three elements of care critical to reducing deaths and injuries from unsafe abortion:
- Treatment of abortion-related complications
- Safe abortion for all legal indications
- Postabortion contraception to prevent unwanted pregnancy
According to recent Ipas evaluation of the SAC model in Tigray, which has a population of more than four million, abortion care improved greatly from 2007 to 2009. In March 2007, most of the 50 facilities in the region were not providing safely induced abortion services. Two years later, after adopting the SAC approach, 38 facilities were providing safe abortion care.
Availability of care wasn’t the only improvement. Abortion care services were decentralized so that women can now obtain care in health centers closer to their homes, rather than just in large hospitals. Abortion complications decreased and safe induced abortions increased during the two-year period. In fact, at the onset of the evaluation, only 7.3 percent of abortions were considered safe. After two years, nearly 60 percent are considered safe. In addition, contraceptive acceptance also improved. Now more than 80 percent of women who receive abortion services in Tigray leave 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 March 2007, only 30 percent of uterine evacuations were performed using recommended methods—primarily manual vacuum aspiration. Two years later, the proportion of evacuations using recommended methods increased to 86 percent.
The improvements were achieved through clinical provider training, equipping and supporting the service-delivery structure, supervisory and monitoring visits, and the introduction of the SAC model for tracking facility performance.
“This two-year collaborative effort to monitor the progress of abortion-care services has vividly demonstrated improvements in availability and use of safe services, and thus strongly suggests related decreases in deaths and disability from unsafe abortion. Use of the SAC approach has helped us focus on the evidence-based interventions most critical to end the needless death and disability from unsafe abortion,” said Dr. Gebreab Bernabas, head of the Tigray Health Bureau.
For more information, contact media@ipas.org