Abstract
BackgroundEthiopia has one of the highest maternal mortality ratios in the world (420 per 100,000 live births in 2013), and unsafe abortion continues to be one of the major causes. To reduce deaths and disabilities from unsafe abortion, Ethiopia liberalized its abortion law in 2005 to allow safe abortion under certain conditions. This study aimed to measure how availability and utilization of safe abortion services has changed in the last decade in Ethiopia.MethodsThis paper draws on results from nationally representative health facility studies conducted in Ethiopia in 2008 and 2014. The data come from three sources at two points in time: 1) interviews with 335 health providers in 2008 and 822 health care providers in 2014, 2) review of facility logbooks, and 3) prospective data on 3092 women in 2008 and 5604 women in 2014 seeking treatment for abortion complications or induced abortion over a one month period. The Safe Abortion Care Model was used as a framework of analysis.ResultsThere has been a rapid expansion of health facilities eligible to provide legal abortion services in Ethiopia since 2008. Between 2008 and 2014, the number of facilities reporting basic and comprehensive signal functions for abortion care increased. In 2014, access to basic abortion care services exceeded the recommended level of available facilities providing the service, increasing from 25 to 117%, with more than half of regions meeting the recommended level. Comprehensive abortion services increased from 20% of the recommended level in 2008 to 38% in 2014. Smaller regions and city administrations achieved or exceeded the recommended level of comprehensive service facilities, yet larger regions fall short. Between 2008 and 2014, the use of appropriate technology for conducting first and second trimester abortion and the provision of post abortion family planning has increased at the same time that abortion-related obstetric complications have decreased.ConclusionTen years after the change in abortion law, service availability and quality has increased, but access to lifesaving comprehensive care still falls short of recommended levels.
Highlights
Ethiopia has one of the highest maternal mortality ratios in the world (420 per 100,000 live births in 2013), and unsafe abortion continues to be one of the major causes
In 2008, World Health Organization (WHO) estimated that 18% of maternal deaths in East Africa as compared to 13% globally were caused by unsafe abortions [4]
As the public health infrastructure in Ethiopia grew over the past decade, so did the capacity of these facilities to perform lifesaving services for basic and comprehensive abortion care
Summary
Ethiopia has one of the highest maternal mortality ratios in the world (420 per 100,000 live births in 2013), and unsafe abortion continues to be one of the major causes. Unsafe abortion was the highest contributor to maternal death in Ethiopia between 1980 and 1999, accounting for approximately a third of maternal mortality, but it has declined substantially since to about 10% in 2014 [2]. Such a decline in the contribution of unsafe abortion to global maternal mortality has been evidenced by a recent WHO systematic analysis which showed that by 2013 the contribution of unsafe abortion to maternal mortality was 10% in SSA as compared to 7.9% worldwide [5]
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