Caring for women with abortion complications in Ethiopia: national estimates and future implications.

CONTEXT: Ethiopia liberalized its abortion law in 2005, primarily to reduce the incidence of unsafe abortion. However, little is known about the current extent and consequences of unsafe abortion. METHODS: Data were collected in 2007-2008 on 1,932 women seeking postabortion care at a nationally representative sample of 344 public and private health facilities. In addition, staff respondents at 337 facilities provided information on their facility's services and caseload. These data were used to examine patterns of abortion-related morbidity and treatment and to generate national estimates. RESULTS: Almost 58,000 women sought care for complications of induced or spontaneous abortion in 2008. Three-quarters of the women received care in government facilities. Forty-one percent had moderate or severe morbidity, such as signs of infection, that were likely related to an unsafe abortion. Seven percent of all women had signs of a mechanical injury or a vaginally inserted foreign body. More than 13,000 women seeking postabortion care required a hospital stay of at least 24 hours. The case fatality rate among women seeking postabortion care in public hospitals, where the most serious complications were seen, was 628 per 100,000. CONCLUSIONS: Postabortion care and safe abortion services should be further expanded and strengthened to make these services more accessible and affordable, which in turn may ease the financial burden on hospitals and allow the resources currently required for postabortion care to be used for other health needs. Ensuring that all women know that safe abortion is available and legal for many indications will further reduce morbidity from unsafe abortions. International Perspectives on Sexual and Reproductive Health, 2010,36(1):6-15 ********** Unsafe abortion continues to be common in Africa, despite global efforts to improve postabortion care and advance reproductive rights, rising contraceptive use and a continent-wide trend toward easing abortion restrictions. (1-3) Defined as a procedure for terminating an unwanted pregnancy that is performed by persons lacking the necessary skills or in an environment lacking minimal medical standards (or both), unsafe abortion remains a leading cause of maternal mortality and morbidity in Africa, accounting for an estimated 14% of maternal deaths. The World Health Organization (WHO) estimates that every year, nearly 5.5 million African women have an unsafe abortion; as many as 36,000 of these women die from the procedure, while millions more experience short-or long-term morbidity. (1) Ethiopia is a representative case. The second most populous country in Africa, Ethiopia is home to about 77 million people, most of whom live in rural areas. The country's maternal health statistics are grim: One in 27 women die from complications of pregnancy or childbirth, (4) the number of maternal deaths is fifth highest in the world (5) and the maternal mortality ratio, estimated to be 673 per 100,000 live births, is extremely high. (6) The extent to which unsafe abortion contributes to these maternal deaths is unknown. Death and disability from unsafe abortion can be prevented in three ways: by preventing unintended pregnancy, treating the complications of women who seek postabortion care or providing a safe, legal alternative to unsafe abortion. Until 2005, the Ethiopian penal code permitted abortion only to save the pregnant woman's life or to preserve her health from grave danger, and required diagnosis and certification by a medical practitioner, as well as confirmation by an obstetrician/gynecologist. In 2005, the penal code was amended to permit abortion under a much broader set of circumstances: in the case of rape, incest or fetal impairment; if pregnancy continuation or birth would endanger the health or life of the woman or fetus; if the woman has physical or mental disabilities; and if the. woman is a minor who is physically or mentally unprepared for childbirth. …