Health System Costs of Menstrual Regulation and Care for Abortion Complications in Bangladesh

By Johnston, Heidi Bart; Oliveras, Elizabeth et al. | International Perspectives on Sexual and Reproductive Health, December 2010 | Go to article overview

Health System Costs of Menstrual Regulation and Care for Abortion Complications in Bangladesh


Johnston, Heidi Bart, Oliveras, Elizabeth, Akhter, Shamima, Walker, Damian G., International Perspectives on Sexual and Reproductive Health


CONTEXT: Treatment of complications of unsafe abortion can be a significant financial drain on health system resources, particularly in developing countries. In Bangladesh, menstrual regulation is provided by the government as a backup to contraception. The comparison of economic costs of providing menstrual regulation care with those of providing treatment of abortion complications has implications for policy in Bangladesh and internationally.

METHODS: Data on incremental costs of providing menstrual regulation and care for abortion complications were collected through surveys of providers at 21 public-sector facilities in Bangladesh. These data were entered into an abortion-oriented costing spreadsheet to estimate the health system costs of providing such services.

RESULTS: The incremental costs per case of providing menstrual regulation care in 2008 were 8-13% of those associated with treating severe abortion complications, depending on the level of care. An estimated 263,688 menstrual regulation procedures were provided at public-sector facilities in 2008, with incremental costs estimated at US$2.2 million, and 70,098 women were treated for abortion-related complications in such facilities, with incremental costs estimated at US$ 1.6 million.

CONCLUSION: The provision of menstrual regulation averts unsafe abortion and associated maternal morbidity and mortality, and on a per case basis, saves scarce health system resources. Increasing access to menstrual regulation would enable more women to obtain much-needed care and health system resources to be utilized more efficiently.

International Perspectives on Sexual and Reproductive Health, 2010, 36(4): 7 97-204

Abortion-related mortality and morbidity result in significant health system costs. Approximately 42 million induced abortions occur around the world each year, (1) of which an estimated 22 million are conducted under unsafe conditions--that is, by an unqualified provider, in unsanitary conditions or both. (2) At least 65,000 women die annually from complications of unsafe abortion, and close to five million suffer temporary or permanent disability. (3) A recent analysis suggests that in Africa and Latin America, the annual cost of caring for women with complications of unsafe abortion ranges from US$159 million to US$333 million. (4) According to studies from a number of countries where the incidence of unsafe abortion is high, treatment of abortion complications can account for as much as 50% of hospital budgets for obstetrics and gynecology. (5)

Abortion-related mortality and morbidity--and their associated health system costs--can largely be avoided through the prevention of unwanted pregnancy and through the provision of safe abortion services and menstrual regulation. (6) The technical and clinical interventions needed to provide safe, accessible and high quality abortion and menstrual regulation services are well known and include using vacuum aspiration or medication abortion instead of dilation and curettage for uterine evacuation; providing services in outpatient facilities, rather than in operating theaters; having midlevel providers instead of specialists provide care; and providing contraceptive counseling and services. (7-21) Each of these interventions has been shown to reduce the cost of care at the individual, facility or health system levels. (9), (12), (15), (17-21) Despite the advantages of these interventions in terms of safety and cost, they are often not implemented or are used inconsistently, preventing measurement of costs of services at facility or health system levels.

Savings--an abortion-oriented costing spreadsheet--was developed by Ipas to generate estimates of the costs of different strategies of providing abortion care. The initial application of the Savings model used published data primarily from Uganda; (22) however, because the abortion law in Uganda is restrictive, some data from other African countries were used to project costs of providing safe and legal abortion-related care. …

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