A new study finds that the cost of providing legal abortion services and postabortion care at higher-level medical facilities in Colombia is far greater than the cost of similar services at primary-level private specialized facilities. In great part, the cost differential can be attributed to the use by primary-level specialized facilities of more appropriate methods that are safer and noninvasive. The study, "The Cost of Postabortion Care and Legal Abortion in Colombia" by Elena Prada and Guttmacher colleagues, finds the cost of abortion and postabortion care services within the national health system is unnecessarily high, costing the Colombian health systems tens of millions of dollars each year.

The researchers found that medical providers at higher-level facilities routinely rely on dilation and curettage (D&C)—a costly and invasive procedure—to perform legal abortions and provide postabortion care notwithstanding the WHO recommendation that safer, less invasive and less expensive methods be used. Not only is D&C more invasive and costly, it is also more time-consuming, requires general anesthesia and, in Colombia, often an overnight hospital stay (though an overnight hospital stay is not standard practice elsewhere). In sharp contrast, primary-level specialized facilities routinely use manual vacuum aspiration (MVA) and medication abortion, methods recommended by the WHO for first-trimester abortions, to perform legal abortion services and provide postabortion care. Seven years after Colombia overturned an absolute ban on abortion, there are no government guidelines in place on recommended methods of care for the provision of legal abortions.

The average direct cost of a legal abortion provided at a high-level facility is US$200 per patient, while the estimated direct cost of a legal abortion at a specialized private facility is just US$45. The difference in cost is in part due to the methods used and in part due to the length of hospital stays at secondary and tertiary facilities, which often admit patients having a legal abortion procedure for one or more nights. In contrast, private facilities provide services on an outpatient basis only.

According to projections from 2008 data, approximately 102,000 women were treated for complications at higher-level health facilities in Colombia in 2012. While all health facilities are required to provide abortions in accordance with the law, many women entitled to legal procedures face unnecessary barriers in accessing services, which force them to obtain abortions later in gestation than necessary, increasing both the cost and level of risk. As a result, many women resort to clandestine and unsafe procedures, putting their health and lives at risk.

"Much more needs to be done to reduce the incidence of unsafe abortion and the number of women who suffer complications from unsafe procedures," said Elena Prada, the report’s lead author. "Women need to be educated about their right to safe and legal abortions. No less important, though, is the need to improve family planning services and counseling to help women avoid the unintended pregnancies that so often end in abortion."

The authors conclude that it is critically important to reconsider how legal abortion services and postabortion care are provided in Colombia. The cost of providing such services could be significantly reduced by providing services at specialized private facilities rather than higher-level facilities and using MVA and medication abortion rather than D&C. In addition, nonspecialized providers, including doctors who are general practitioners, should be encouraged to provide abortion services within the bounds of the law, making it easier for women to access services.

"The Cost of Postabortion Care and Legal Abortion in Colombia" is currently available in the most recent issue of International Perspectives on Sexual and Reproductive Health. The article is also available in Spanish.

Click on the links below for additional information, available in both English and Spanish.

Fact Sheets:
English: Facts on Unintended Pregnancy and Induced Abortion in Colombia
Spanish: Datos sobre el embarazo no deseado y aborto inducido en Colombia

Report:
English: Unintended Pregnancy and Induced Abortion in Colombia: Causes and Consequences
Spanish: Embarazo no deseado y aborto inducido en Colombia: causas y consecuencias

Also in this issue of International Perspectives on Sexual and Reproductive Health:

"Contraception and Abortion in a Low-Fertility Setting: The Role of Seasonal Migration," by Arusyak Sevoyan et al.;

"Reducing Unmet Need by Supporting Women with Met Need," ," by Anrudh K. Jain et al.;

"Effectiveness of a Behavior Change Communication Intervention to Improve Knowledge and Perceptions About Abortion in Bihar and Jharkhand, India," by Sushanta K. Banerjee et al.;

"Risk and Protective Correlates of Young Women's First Sexual Experiences in Rakai, Uganda," by Kristin N. Mmari et al.