Changes in Morbidity and Abortion Care in Ethiopia After Legal Reform: National Results from 2008 and 2014

Abstract

CONTEXT In Ethiopia, liberalization of the abortion law in 2005 led to changes in abortion services. It is important to examine how levels and types of abortion care—i.e., legal abortion and treatment of abortion complications—changed over time. METHODS Between December 2013 and May 2014, data were collected on symptoms, procedures and treatment from 5,604 women who sought abortion care at a sample of 439 public and private health facilities; the sample did not include lower-level private facilities—some of which provide abortion care—to maintain comparability with the sample from a 2008 study. These data were combined with monitoring data from 105,806 women treated in 74 nongovernmental organization facilities in 2013. Descriptive analyses were conducted and annual estimates were calculated to compare the numbers and types of abortion care services provided in 2008 and 2014. RESULTS The estimated annual number of women seeking a legal abortion in the types of facilities sampled increased from 158,000 in 2008 to 220,000 in 2014, and the estimated number presenting for postabortion care increased from 58,000 to 125,000. The proportion of abortion care provided in the public sector increased from 36% to 56% nationally. The proportion of women presenting for postabortion care who had severe complications rose from 7% to 11%, the share of all abortion procedures accounted for by medical abortion increased from 0% to 36%, and the proportion of abortion care provided by midlevel health workers increased from 48% to 83%. Most women received postabortion contraception. CONCLUSIONS Ethiopia has made substantial progress in expanding comprehensive abortion care; however, eradication of morbidity from unsafe abortion has not yet been achieved.

The implementation of safe abortion services in Ethiopia

“…Interviewees reported concern that the centralized data are overly aggregated and inadequate to effectively monitor the provision of abortion services. Parallel monitoring systems exist in the private and NGO clinic networks; periodic studies combine retrospective and prospective methodologies and use both public and private data to fill the gaps in the public surveillance system . Interviewees stressed the value of publishing periodic assessments of national data to document the impact of the law.…”

“…Parallel monitoring systems exist in the private and NGO clinic networks; periodic studies combine retrospective and prospective methodologies and use both public and private data to fill the gaps in the public surveillance system. 16,17,[23][24][25][26] Interviewees stressed the value of publishing periodic assessments of national data to document the impact of the law. abortion be administered in a healthcare facility, which is difficult for those who must travel long distances and remain at the clinic to take the multidose regimen.…”

Willingness to perform induced abortion and associated factors among graduating Midwifery, Medical, Nursing, and Public health officer students of University of Gondar, Northwest Ethiopia: Institution based Cross sectional study

“…The government of Ethiopia revised and liberalized the abortion law in 2005 to increase the accessibility of safe termination services by taking the amount of Unsafe abortion and its health detrimental consequences on maternal health (7). However, a major reduction of morbidity and mortality from the complication of unsafe abortion has not yet been achieved (8). The shortage of health care providers who can provide comprehensive abortion care (CAC) is still critical and this is again exacerbated by the unwillingness of some health care providers to provide induced abortion services due to various religious, cultural and biological factors (9,10).…”

Estimating Abortion Incidence: Assessment of a Widely Used Indirect Method

“…The results show that the HFS past month estimate is substantially higher than the PMS estimate in Ethiopia (a difference of 24%) and much closer (and in the opposite direction) in the two other countries (− 6% Table 6 Comparison of annual number of PAC Cases estimated by HFS and PMS surveys for four surveys in three countries with available data. Sources Gebrehiwot et al (2016), Moore et al (2016), Mohamed et al (2015), Ziraba et al (2015), Madziyire et al (2018) (Table 6). Overall, it is likely to be more difficult to ensure complete coverage of all patients, especially in larger facilities, because greater caseloads combined with multiple points of admission and treatment may make it difficult to achieve 100% coverage of incoming patients.…”