The costs and cost effectiveness of providing first-trimester, medical and surgical safe abortion services in KwaZulu-Natal Province, South Africa.

Naomi Lince-Deroche,Kelly Blanchard,Jack Moodley,Jaymala Devjee,Tamara Fetters,Edina Sinanovic,Angel M Foster

doi:10.1371/journal.pone.0174615

Abstract

BackgroundDespite a liberal abortion law, access to safe abortion services in South Africa is challenging for many women. Medication abortion was introduced in 2013, but its reach remains limited. We aimed to estimate the costs and cost effectiveness of providing first-trimester medication abortion and manual vacuum aspiration (MVA) services to inform planning for first-trimester service provision in South Africa and similar settings.MethodsWe obtained data on service provision and outcomes from an operations research study where medication abortion was introduced alongside existing MVA services in public hospitals in KwaZulu-Natal province. Clinical data were collected through interviews with first-trimester abortion clients and summaries completed by nurses performing the procedures. In parallel, we performed micro-costing at three of the study hospitals. Using a model built in Excel, we estimated the average cost per medical and surgical procedure and determined the cost per complete abortion performed. Results are presented in 2015 US dollars.ResultsA total of 1,129 women were eligible for a first trimester abortion at the three study sites. The majority (886, 78.5%) were eligible to choose their abortion procedure; 94.1% (n = 834) chose medication abortion. The total average cost per medication abortion was $63.91 (52.32–75.51). The total average cost per MVA was higher at $69.60 (52.62–86.57); though the cost ranges for the two procedures overlapped. Given average costs, the cost per complete medication abortion was lower than the cost per complete MVA despite three (0.4%) medication abortion women being hospitalized and two (0.3%) having ongoing pregnancies at study exit. Personnel costs were the largest component of the total average cost of both abortion methods.ConclusionThis analysis supports the scale-up of medication abortion alongside existing MVA services in South Africa. Women can be offered a choice of methods, including medication abortion with MVA as a back-up, without increasing costs.

Highlights

Achieving universal access to sexual and reproductive health services was a target under the Millennium Development Goals (MDGs) [1] and is part of the newly ratified Sustainable Development Goals (SDGs) framework [2]
Personnel costs were the largest component of the total average cost of both abortion methods. This analysis supports the scale-up of medication abortion alongside existing manual vacuum aspiration (MVA) services in South Africa
Women can be offered a choice of methods, including medication abortion with MVA as a back-up, without increasing costs

Summary

Introduction

Achieving universal access to sexual and reproductive health services was a target under the Millennium Development Goals (MDGs) [1] and is part of the newly ratified Sustainable Development Goals (SDGs) framework [2]. Abortion-related costs have been addressed, but generally the costs included have been those associated with unsafe abortion, i.e. costs to be averted through increases in contraception or reductions in unwanted pregnancy. This is important, given the magnitude of unsafe abortion globally and its associated costs [8]. We aimed to estimate the costs and cost effectiveness of providing first-trimester medication abortion and manual vacuum aspiration (MVA) services to inform planning for first-trimester service provision in South Africa and similar settings

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Methods

Conclusion