The Estimated Incidence of Induced Abortion in Ethiopia, 2014: Changes in the Provision of Services Since 2008

Abstract

CONTEXT In 2005, Ethiopia’s parliament amended the penal code to expand the circumstances in which abortion is legal. Although the country has expanded access to abortion and postabortion care, the last estimates of abortion incidence date from 2008. METHODS Data were collected in 2014 from a nationally representative sample of 822 facilities that provide abortion or postabortion care, and from 82 key informants knowledgeable about abortion services in Ethiopia. The Abortion Incidence Complications Methodology and the Prospective Morbidity Methodology were used to estimate the incidence of abortion in Ethiopia and assess trends since 2008. RESULTS An estimated 620,300 induced abortions were performed in Ethiopia in 2014. The annual abortion rate was 28 per 1,000 women aged 15–49, an increase from 22 per 1,000 in 2008, and was highest in urban regions (Addis Ababa, Dire Dawa and Harari). Between 2008 and 2014, the proportion of abortions occurring in facilities rose from 27% to 53%, and the number of such abortions increased substantially; nonetheless, an estimated 294,100 abortions occurred outside of health facilities in 2014. The number of women receiving treatment for complications from induced abortion nearly doubled between 2008 and 2014, from 52,600 to 103,600. Thirty-eight percent of pregnancies were unintended in 2014, a slight decline from 42% in 2008. CONCLUSIONS Although the increases in the number of women obtaining legal abortions and postabortion care are consistent with improvements in women’s access to health care, a substantial number of abortions continue to occur outside of health facilities, a reality that must be addressed.

Changes in Morbidity and Abortion Care in Ethiopia After Legal Reform: National Results from 2008 and 2014

“…Methods and procedures relevant to the examination of facility-based abortion care—that is, legal abortion procedures and postabortion care related to complications of unsafe or spontaneous abortions—are provided here in detail; measures of abortion incidence and of changes in the health system’s capacity to provide abortion care are provided elsewhere. 22,23 Ethical approval for this study was obtained from the Guttmacher Institute’s Institutional Review Board in the United States and from the National Ethics Review Committee of the Ministry of Science and Technology in Addis Ababa.…”

The implementation of safe abortion services in Ethiopia

“…One NGO and several private facilities integrated abortion services into existing services. Interviewees representing NGOs viewed themselves as supporting the Ministry by providing technical expertise and by administering small networks of clinics to demonstrate best practices and perform operational research …”

“…Interviewees reported concern that the centralized data are overly aggregated and inadequate to effectively monitor the provision of abortion services. Parallel monitoring systems exist in the private and NGO clinic networks; periodic studies combine retrospective and prospective methodologies and use both public and private data to fill the gaps in the public surveillance system . Interviewees stressed the value of publishing periodic assessments of national data to document the impact of the law.…”

“…Initially, the medical community did not focus on abortion, as there was a misperception that abortion affected a small proportion of the population. One interviewee recalled that 16,17 Interviewees reported that information was primarily disseminated to the general population through the healthcare system by health extension workers supplemented by community meetings through community-based organizations. Interviewees stressed the importance of integrating safe abortion care into family planning education.…”

“…Parallel monitoring systems exist in the private and NGO clinic networks; periodic studies combine retrospective and prospective methodologies and use both public and private data to fill the gaps in the public surveillance system. 16,17,[23][24][25][26] Interviewees stressed the value of publishing periodic assessments of national data to document the impact of the law. abortion be administered in a healthcare facility, which is difficult for those who must travel long distances and remain at the clinic to take the multidose regimen.…”