Access to Safe Abortion Care in Ethiopia Has Improved Following Expansion of Services
Despite Progress, Unsafe Abortion is Still Common
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.
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 coauthor 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.
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 coauthor 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 counseling and services as an effective way to reduce levels of unintended pregnancy and unsafe abortion.
The complete results of this study are available in two articles, both published in International Perspectives on Sexual and Reproductive Health:
Moore AM et al., The estimated incidence of induced abortion in Ethiopia, 2014: changes in the provision of services since 2008, International Perspectives on Sexual and Reproductive Health, 2016, doi: 10.1363/42e1816.
Gebrehiwot Y et al., Changes in morbidity and abortion care in Ethiopia after legal reform: national results from 2008 & 2014, International Perspectives on Sexual and Reproductive Health, 2016, doi: 10.1363/42e1916.
A fact sheet synthesizing the findings can also be found here.
Research article: The estimated incidence of induced abortion in Ethiopia, 2014: changes in the provision of services since 2008
Research article: Changes in morbidity and abortion care in Ethiopia after legal reform: national results from 2008 & 2014
Infographic: Abortion in Ethiopia, 2014
Infographic: Unintended Pregnancy in Ethiopia, 2014
Infographic: Abortion safety in Ethiopia
Fact sheet: Induced Abortion and Postabortion Care in Ethiopia
Also in this issue of International Perspectives:
IN THIS ISSUE (a summary of articles in this issue of International Perspectives)
Examining Progress and Equity in Information Received by Women Using a Modern Method in 25 Developing Countries
Anrudh K. Jain
The Experience and Impact of Contraceptive Stockouts Among Women, Providers and Policymakers in Two Districts of Uganda
Kate Grindlay, Eleanor Turyakira, Imelda T. Kyamwanga,
Adrianne Nickerson and Kelly Blanchard
Establishing a Referral System for Safe and Legal Abortion Care: A Pilot Project on the Thailand-Burma Border
Angel M. Foster, Grady Arnott, Margaret Hobstetter,
Htin Zaw, Cynthia Maung, Cari Sietstra and Meredith Walsh
Umbilical Cord Cleansing May Not Be Effective in Reducing Neonatal Mortality in African Settings
No Clear Relationship Found Between Circumcision and Age at Sexual Debut Among Men in Sub-Saharan Africa
In Burkina Faso, a Sharp Decline in HIV Prevalence Coincides with a Shift Toward Safer Sexual Behaviors
Primary Health Care Facilities in Sub-Saharan Africa Found to Provide Poor Basic Maternal Care
The Costs of Postabortion Care in Developing Countries Are Substantial and Vary Across Settings
Intervention Improved Health Workers’ Neonatal Resuscitation Skills and Knowledge, but Not Neonatal Mortality