Academic journal article International Perspectives on Sexual and Reproductive Health

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

Academic journal article International Perspectives on Sexual and Reproductive Health

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

Article excerpt

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.

International Perspectives on Sexual and Reproductive Health, 2016, 42(3):121-130.

The Millennium Development Goals (MDGs) catalyzed efforts to reduce global maternal mortality, but while great progress has been achieved, much remains to be done. The number of maternal deaths worldwide has dropped by 45% since the launch of the MDGs in 2000; (1) however, each year, an estimated 47,000 women die and another 7,000,000 suffer from complications of an unsafe abortion--the vast majority of them in the developing world. (2-4) Complications of unsafe abortion are one of the top five causes of maternal mortality worldwide, (3) and the one that is the most realistically preventable with political will and proven low-cost technologies.

Despite the country's enormous improvements in contraceptive use over the past two decades, one in four married women in Ethiopia have an unmet need for contraception. (5) As a result, more than one in three pregnancies in Ethiopia are unintended. According to a national study on abortion conducted in 2008, 42% of unintended pregnancies ended in abortion--contributing to an abortion ratio of 13 abortions per 100 live births. (6) Of the 382,000 induced abortions in Ethiopia that year, as many as 73% were likely unsafe--that is, performed by someone lacking the necessary skills or knowledge, in an environment lacking minimal medical standards, or both. Despite a 2005 revision of Ethiopia's abortion law, followed by a liberal interpretation of those changes, the country's level of abortion-related complications remained high. (7,8) In 2008, nearly 58,000 women sought treatment in a health facility for complications resulting from an induced or spontaneous abortion, and tens of thousands more did not seek care for abortion-related complications from which they were suffering. (8) In this context, measurement of changes in the reproductive health of women in Ethiopia--the second largest country in Africa--is extremely important for policymakers and planners both in Ethiopia and elsewhere.

Standards and guidelines that first took effect in Ethiopia in 2006 now allow abortion to be performed legally in cases involving rape or incest, if the woman has a physical or mental disability, to preserve her life or health, or if she is a minor who is physically or mentally unprepared for childbirth. …

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