Reducing the costs to health systems of unsafe abortion: a comparison of four strategies

Abstract

Background and methodology Strategies to reduce health systems costs of providing abortion and post-abortion care while simultaneously improving quality of care are well documented but infrequently applied. We created 'Savings', a spreadsheet-based tool that allows policymakers and other stakeholders to estimate and compare the feasibility and sustainability of different strategies of providing abortion and post-abortion care. By applying cost data primarily from Uganda, we showed the per-case costs under four policy and service delivery scenarios. ResultsThe mean per-case cost of abortion care (in US dollars) was $45 within the setting that placed heavy restrictions on elective abortion and used a conventional approach to service delivery; $25 within the restrictive legal setting that used recommended interventions for treating complications; $34 within the legal setting that allowed 250©FFPRHC IntroductionThe United Nations' Millennium Development Goal calling for the reduction of maternal mortality by 75% between 1990 and 2015 1 will not be met without addressing unsafe abortion. Unsafe abortion -defined as "a procedure for terminating unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking the minimal medical standards, or both" 2 -causes an estimated 13% of maternal mortality globally and is a leading cause of maternal morbidity, such as infection, hemorrhage, cervical laceration, and uterine perforation. 3 The unsafe abortion mortality ratio is highest in Africa at 100 per 100 000 live births. The ratio is 40 per 100 000 live births in Asia and 30 in Latin America and the Caribbean, whereas in developed countries it is only 3. 4 In some developing countries, as much as 50% of obstetricgynaecology budgets may be spent on treating abortion complications. 5 Abortion care has four components: (1) elective induced abortion services; (2) emergency treatment of complications of spontaneous or unsafely performed induced abortion; (3) post-abortion contraceptive counselling and method provision to prevent repeat unwanted pregnancy; and (4) links between elective or treatment services and other reproductive health care. During the last decade, international agreements have affirmed governmental obligations to make abortion services safe and accessible to the extent allowed by law. 4,6 The technical interventions needed to reduce costs to health systems and simultaneously improve the availability and quality of abortion-related care are well understood 3,7 Reducing the costs to health systems of unsafe abortion: a comparison of four strategies hjohnston@icddrb.org elective abortion and relied on a conventional approach to service delivery; and $6 within the liberal legal setting that used recommended interventions.Discussion and conclusions Using recommended technical interventions substantially reduced costs regardless of the legal setting. The greatest reduction in costs (86%) occurred from using recommended interventions within a liberal legal setting rather than usi...

Estimates of Health Care System Costs of Unsafe Abortion in Africa and Latin America

“…A recent study in Nigeria 10 estimated that the cost of contraceptive services to prevent unwanted pregnancies would have been only one-fourth of that expended in treating postabortion complications. Another study 21 showed that the cost of obtaining a safe abortion in Uganda was between $6 and $23, compared to the average cost of $89 that we calculated for treating a postabortion complication in Sub-Saharan Africa. Furthermore, a global study on the costs and benefits of reducing unmet need for contraception estimated that, in Sub-Saharan Africa in 2003, eliminating this unmet need would have cost about US$1 billion for additional contraceptive services, while averting 10.5 million unintended *The authors derived this figure using the United Nations Population Fund's Reproductive Health Costing Tool (<http://www.who.int/pmnch/ topics/economics/costing_tools/en/index15.html>).…”

The paradox of access - abortion law, policy and misoprostol

“…[53][54][55] Major physiological, financial and emotional costs are also incurred by the women who undergo unsafe abortion. 72 A study 56 found that the cost of management of abortion is lower in a legal setting that allowed elective abortion than in the restrictive legal setting. The cost also reduces when making services accessible at all service levels.…”

Caring for Women with Abortion Complications in Ethiopia: National Estimates and Future Implications

“…Postabortion care services have improved, 9-11 but deaths and suffering from unsafe abortion continue to occur, even though they are preventable with the appropriate information, education, training, technology and political commitment. Treating the complications of unsafe abortion often requires surgery, expensive drugs and supplies, and prolonged hospital stays, [12][13][14][15][16] and the cost of treating a septic abortion is estimated to be four times that of an assisted delivery. 12 In some developing countries, treating complications of unsafe abortion consumes up to 60% of the total annual budget for gynecologic care.…”