Ipas model provides national snapshot of changes since law reform in Ethiopia

Friday, June 21, 2013

Ipas model provides national snapshot of changes since law reform in Ethiopia


Following abortion law reform in 2005 and subsequent service expansion and improvements, Ethiopia remains committed to reducing complications from unsafe abortion. A recent study, “Meeting the need for safe abortion care in Ethiopia: Results of a national assessment in 2008,” provides the first national snapshot of service quality and availability in a dynamic abortion care environment.


Prior to the 2005 legal reforms enacted by Ethiopia’s parliament, pregnancy terminations were permitted only to avoid ‘grave or imminent danger’ to the pregnant woman. In an effort to reform laws related to women’s and children’s issues, parliament made sweeping legal changes—including to the abortion law. Legal changes led to abortion service delivery guidelines in 2006 to increase the potential for safe and legal abortion care by expanding the indications for when a woman can obtain an abortion, as well as by expanding the types of health-care workers and facilities that could potentially provide this service.


Monitoring safe abortion and emergency treatment services is especially important following the revision of the abortion law and efforts to scale up safe abortion care. In 2008, only a quarter of all abortions in Ethiopia occurred in safe and legal settings. This study, says Tamara Fetters, one of the authors, is the first to assess the current availability, distribution, utilization and quality of abortion services on a national level using the Ipas Safe Abortion Care (SAC) model.


Researchers collected and analyzed data from 335 health facilities, which were representative of all the country’s public and private health facilities. More than 300 health providers were interviewed and data was collected on more than 8,000 women presenting with abortion complications or seeking induced abortion, as well as from facility logbooks.


Overall, the study found positive developments, coupled with many national challenges. A high proportion, 87 percent of all abortion care, was performed with appropriate technology, namely manual vacuum aspiration (MVA), at the time of the study. Seventy-five percent of women who received abortion care left the facility with a contraceptive method. Yet the number of women who accepted a contraceptive method was much higher, 89 percent, in primary care facilities than in hospitals where only 31 percent of women received a contraceptive method following abortion care.


More than 90 percent of facilities in the country were providing basic abortion care as determined by the SAC indicators, except for the provision of first-trimester induced abortions, which are available in only 67 percent of hospitals. The researchers note that while not every SAC indicator has been met, scaling up safe abortion services in Ethiopian health facilities only began two years prior to this 2008 assessment.


The percentage of all cases that are induced abortion care, the use of appropriate technologies, and the provision of postabortion contraception were markedly higher among private facilities than in public facilities. For women able to access private services, these results are reassuring, says Fetters, but they underscore the need for improvements in public facilities that serve large numbers of poor and rural women. Also important to note, medical abortion was introduced in 2009 in an effort to improve abortion service delivery and accessibility for women. Now, medical abortion is chosen by roughly half the women who seek early termination of pregnancy in public facilities.


The picture of women’s reproductive health in Ethiopia, though improved, is still one fraught with challenges. Although modern contraceptive use in Ethiopia has increased from 6 percent to 27 percent among married Ethiopian women over the past decade, 25 percent of married women still express an unmet need for contraception, and contraceptive use is far lower among single and young women. The high proportion of unintended pregnancies still contributes to maternal mortality—of 100,000 live births, 676 women die. Many of these deaths are a result of complications from unsafe abortion and could be prevented.


Providing high-quality safe and legal abortions close to a woman’s home is likely the most important step towards preventing mortality and morbidity from an unsafe abortion in the country, the researchers note. “Overall, Ethiopia has made steady progress in a relatively short time,” says Fetters. “We’re preparing to go into the field to replicate this study soon and I expect we’ll find significant improvements in 2013.”