The first national estimate of the direct cost of treating postabortion complications in Ethiopia shows the country spent US$7.6 million in 2008 to provide postabortion care, an average of $36 per woman treated. The findings come from a new study, "The Health Systems Cost of Post-Abortion Care in Ethiopia," by Michael Vlassoff of the Guttmacher Institute, et al., which also found that every dollar spent on family planning services would save $6 in postabortion care services.

Drawing on data from a national sample of health facilities and knowledgeable key informants, the researchers found that the treatment of incomplete abortions is both the most common and the least costly postabortion care procedure, costing an average of $24 per procedure. Treatment of shock and sepsis costs approximately $40, while treating the most serious complications, such as uterine perforation and related illnesses, costs almost $153 per intervention. Women suffering from complications that arise from unsafe abortion pay more than 75% of the total cost of their treatment, a much higher proportion than they pay for other reproductive health services.

While the study only looked at the direct costs of postabortion care, such as drugs, supplies, personnel and hospitalization fees, the authors noted that including indirect costs, such as capital and overhead, which were not investigated in the study, would bring the national total cost of postabortion care provision to at least $11.5 million.

There were an estimated 382,000 abortions in Ethiopia in 2008, and about three-fourths of these procedures were carried out under unsafe conditions. The researchers found that 220,000 women, 58% of those who had had an abortion, experienced complications that required medical treatment. However, approximately 170,000 of these women did not receive the medical care they required, indicating that current service provision is insufficient. The researchers also noted that despite growing modern contraceptive use in Ethiopia, about 1.7 million unintended pregnancies occur every year, largely due to unmet need for contraception.

"Reducing unintended pregnancies—which are the cause of most abortions—would reduce abortion incidence and the need for postabortion care," says Michael Vlassoff, the study’s lead author. "Each dollar spent on family planning services saves $6 in postabortion care services. It’s a common sense investment in basic health care.… Ensuring that postabortion care is available to all women who need it would significantly improve the health and well-being of Ethiopian women and their families."

Dr. Vlassoff and colleagues suggest that the Ethiopian government should increase the availability of postabortion care in government hospitals and health centers, and provide additional resources to reduce out-of-pockets expenses. Furthermore, they highlight the urgent need for the country to expand access to modern contraceptive methods and counseling as a cost-effective method of reducing unintended pregnancy and unsafe abortion.

"The Health Systems Cost of Post-Abortion Care in Ethiopia," appears in the September 2012 special supplement to the International Journal of Gynecology and Obstetrics and is currently available online.