“They come when you build it”: the impact of introducing a model abortion clinic on safe abortion care access expansion in Ethiopia

Abraham Fessehaye Sium, Abrham Getachew, Lemi B. Tolu, Sarah Prager

Abstract

Current strong evidence supports that making abortion legal, safe, and accessible significantly reduces unsafe abortion-related maternal morbidity and mortality. We conducted a decade-long (2009 – 2019) trend-analysis study of safe abortion care and post abortion care services in relation to introduction of a new abortion clinic at St. Paul’s Hospital in Ethiopia. There were 9491 total abortions (6449 post-abortion care cases and 3042 safe abortion cases) during the study period (between September 2009 to August 2019). Following the opening of a model abortion clinic, access to safe abortion care significantly increased, and post-abortion care abortion service dominance was replaced by safe abortion care. Before the introduction of the clinic in 2016, only 1 in 3 abortions were safe abortions, the rest being post-abortion care cases. During the years 2017-2018 and 2018-2019, safe abortion care increased to 6 in 10 and 7 in 10 of all comprehensive abortion care provided, respectively. This “They come when you build it” effect on the trends of safe abortion - a paradigm shift of post-abortion care into safe abortion care - can be implemented in other Sub-Saharan settings.

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References

Kulczycki A. The imperative to expand provision, access and

use of misoprostol for post-abortion care in sub

Saharan Africa. African journal of reproductive

health. 2016 Nov 15;20(3):22-5.

Sedgh G, Bearak J, Singh S, Bankole A, Popinchalk A,

Ganatra B, Rossier C, Gerdts C, Tunçalp Ö, Johnson

BR and Johnston HB. Abortion incidence between

and 2014: global, regional, and subregional

levels

and trends. The Lancet. 2016 Jul

;388(10041):258-67.

Shah IH, Åhman E and Ortayli N. Access to safe abortion:

progress and challenges since the 1994 International

Conference on Population and Development (ICPD).

Contraception. 2014 Dec 1;90(6):S39-48.

Bearak JM, Popinchalk A, Beavin C, Ganatra B, Moller AB,

Tunçalp Ö and Alkema L. Country-specific estimates

of unintended pregnancy and abortion incidence: a

global comparative analysis of levels in 2015–2019.

BMJ global health. 2022 Mar 1;7(3):e007151.

Berhan Y and Berhan A. Causes of maternal mortality in

Ethiopia: a significant decline in abortion related

death. Ethiopian journal of health sciences. 2014 Sep

;24:15-28.

Faúndes A and Shah IH. Evidence supporting broader access

to safe legal abortion. International Journal of

Gynecology & Obstetrics. 2015 Oct;131:S56-9.

Bridgman‐Packer

D

and Kidanemariam S. The

implementation of safe abortion services in Ethiopia.

International Journal of Gynecology & Obstetrics.

Oct;143:19-24.

Feyssa MD and Gebru SK. Liberalizing abortion to reduce

maternal mortality: expanding access to all

Ethiopians.

Reproductive Health. 2022 Jun

;19(Suppl 1):151.

Gebremedhin LT, Nigatu B, Bekele D, Fisseha S and

Gebremeskel BG. Integrating Family Planning

Training into Medical Education: A Case Study of St.

Paul's

Hospital

Millennium Medical College

(SPHMMC), Addis Ababa. Michigan Publishing;

Sium AF, Prager S, Wolderufael M, Abubeker FA, Tufa TH

and Grentzer JM. Foley catheter for cervical

preparation prior to second trimester dilation and

evacuation: a supply-based alternative for surgical

abortion: a case series. Contraception: X. 2022 Jan

;4:100085.

https://www.moh.gov.et/sites/default/files/2024

/Technical%20and%20Procedural%20Guideline%

for%20Abortion%20care%20services%20in%20E

thiopia_2023.pdf

Gebremedhin M, Semahegn A, Usmael T and Tesfaye G.

Unsafe abortion and associated factors among

reproductive aged women in Sub-Saharan Africa: a

protocol for a systematic review and meta-analysis.

Systematic reviews. 2018 Dec;7:1-5.

Cates W, Grimes DA and Schulz KF. The public health

impact of legal abortion: 30 years later. Perspectives

on Sexual and Reproductive Health. 2003 Jan

;35(1):25-8.

Fuentes L and Jerman J. Distance traveled to obtain clinical

abortion care in the United States and reasons for

clinic choice. Journal of Women's Health. 2019 Dec

;28(12):1623-31.

Wada T. Abortion law in Ethiopia: a comparative

perspective, Mizan Law Review, vol. 2. Addis Ababa:

St. Mary’s University; 2008. p. 1–32

Feyssa MD andGebru SK. Liberalizing abortion to reduce

maternal mortality: expanding access to all

Ethiopians.

Reproductive Health. 2022 Jun

;19(Suppl 1):151.

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