After liberalizing Ethiopia’s abortion law in 2005, the government implemented programs designed to train health care providers, to equip facilities and expand the services they offer and to integrate abortion care into broader reproductive health services. These efforts have resulted in significant improvements in access to abortion and postabortion care in the country. A new study reveals that, although many procedures continued to occur outside health facilities, often under unsafe conditions, the share of abortions that took place in health facilities nearly doubled between 2008 and 2014.
These findings come from two new articles based on a study by the Guttmacher Institute and Ipas. The study was conducted in collaboration with the Ethiopian Society of Obstetricians and Gynecologists and the Ethiopian Public Health Association, with the support of Ethiopia’s Federal Ministry of Health.
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According to the new study, 38% of pregnancies in Ethiopia were unintended in 2014, and 13% of all pregnancies ended in abortion. An estimated 620,300 abortions took place in Ethiopia in 2014, which corresponds to an annual rate of 28 per 1,000 women of reproductive age. The abortion rate varied by region and rates are highest in urban areas. Ethiopia’s national abortion rate remains lower than the rates in most other countries in the East Africa region.
“It is promising to see that abortion services in Ethiopia have improved significantly following the government’s investment in resources to improve access and provision of services,” said Yirgu Gebrehiwot, Addis Ababa University researcher and co-author of the study.
More than half, 53% of abortions in Ethiopia took place in a health facility in 2014, compared with only 27% in 2008. The share of abortion services provided by midlevel health workers increased from 48% in 2008 to 83% in 2014, primarily due to government efforts to train such providers and expand abortion services into more primary health centers.
Since the last abortion incidence study in 2008, medication abortion was introduced, providing an additional option to women seeking safe abortion in a health facility. In 2014, medication abortion accounted for 36% of abortions in the country.
“The government’s investment is paying off, as Ethiopian women are increasingly able to access abortion and postabortion care at health facilities under safe conditions,” said Ann Moore, Guttmacher researcher and coauthor of the study.
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Contraceptive access has also improved in recent years. In 2014, 40% of married women in Ethiopia were using a modern method of contraception, up from 19% in 2011. Of the women who received abortion care at health facilities in 2014, 77% left the facility with a modern contraceptive method.
Despite these advances, 47% of abortions took place outside of health facilities in 2014. That same year, 19% of women seeking postabortion care had complications severe enough to warrant hospitalization. About 3.4 out of every 1,000 women of reproductive age in 2014 received treatment in health facilities for abortion-related complications, an increase from 5.7 per 1,000 in 2008. This measure indicates that unsafe abortion is still occurring in Ethiopia, but it also reflects that an increasing number of women have access to health services to treat abortion-related complications.
“Access to safe abortion care has improved, yet many women continue to have unsafe abortions outside of health facilities,” said Tamara Fetters, Ipas researcher and co-author of the study. “Despite government efforts, some women don’t know that safe abortion services are available, or they may fear the stigma associated with abortion.”
The authors recognize that Ethiopia has made significant progress in improving access to safe abortion services, but additional improvements are still necessary. Many Ethiopian women continue to obtain abortions under unsafe circumstances despite the expanded availability of safe services, contributing to persistently high complication rates. The authors recommend a continued focus on postabortion contraceptive counselling and services as an effective way to reduce levels of unintended pregnancy and unsafe abortion.