Abstract
Based on research conducted in 2017, we estimated the cost to the Tanzanian health care system of providing postabortion care (PAC). PAC is an integrated service package that addresses the curative and preventive needs of women experiencing complications from abortion. PAC services include treating complications of miscarriage and incomplete abortion, providing voluntary family planning counseling and services, and engaging the community to reduce future unintended pregnancies and repeat abortions. Thirty-one public and private health facilities, representing 3 levels of health care, were selected for data collection from key care providers and administrators in 3 regions. We gathered data on the direct costs of PAC startup (i.e., training and capital costs), as well as the recurrent costs of medicines, supplies, hospitalization, and personnel, and the indirect costs of PAC provision. We also gathered data to estimate PAC clients' out-of-pocket expenses. Estimates of the average cost per client (i.e., unit cost) were calculated for treatment of routine and severe abortion complications, treatment at different levels of health care, postabortion contraception, and various available treatment methods. We found that the unit cost of PAC training per provider was US$163.43. The total unit cost was $72.91. The unit recurrent cost of treating routine complications, which included 81% of the cases in our sample, was $36.23. The cost of treating incomplete abortion through manual vacuum aspiration was $22.63, while the cost of treatment with misoprostol was $18.74. The average cost of providing voluntary postabortion family planning was $11.56. We estimated an average client out-of-pocket expenditure on PAC of $22.96. We applied our unit cost estimates to those on PAC utilization and provision and unmet need for PAC that were derived from research conducted in Tanzania in 2013-2016, and we estimated an annual national cost of PAC of $4,170,476. We estimated the cost of providing PAC for all women who have abortion complications, including those who do not access PAC, at $10,426,299. Investing more resources in voluntary family planning and PAC treatment of routine complications at the primary level would likely reduce health system costs.
Highlights
Based on research conducted in 2017, we estimated the cost to the Tanzanian health care system of providing postabortion care (PAC)
Better policy would be aimed at addressing the root cause of abortion—that is, the high incidence of unintended pregnancies, which reflects an unmet need for modern contraception among women who wish to delay, space, or limit future childbearing and who are not currently using a method
In Tanzania, approximately 1 million unintended pregnancies occur per year and 20% of women of reproductive age have an unmet need for family planning
Summary
Based on research conducted in 2017, we estimated the cost to the Tanzanian health care system of providing postabortion care (PAC). PAC services include treating complications of miscarriage and incomplete abortion, providing voluntary family planning counseling and services, and engaging the community to reduce future unintended pregnancies and repeat abortions. Caring for women that require treatment for abortion complications is often expensive in terms of skilled personnel, surgical procedures, drugs and supplies, and hospitalization.[8,9,10] Across countries, the financial burden of postabortion care (PAC) is considerable. Studies in Ethiopia, Rwanda, and Uganda suggested that treating abortion complications consumes between 4% and 6% of total expenditures on reproductive health in these countries.[11,12,13] In Uganda and Rwanda, such treatment accounts for 29% and 11%, respectively, of annual per capita income.[14] Prior research from this region has
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