Bridging the Gaps: Implementation of Comprehensive Abortion Care in Ethiopia

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Bridging the Gaps: Implementation of Comprehensive Abortion Care in Ethiopia. Neesha Goodman Anna Sackett Rachel Vasilver. December 17, 2008. EngenderHealth. Leading international health organization - PowerPoint PPT Presentation


  • December 17, 2008

  • Leading international health organization improve the quality of health care in poor communitiesWomen and reproductive health

    DeliverablePolicy briefComprehensive Abortion Care (CAC) in Ethiopia

  • Meet with EngenderHealthGroup conference callsDraft initial international guidelines reportMidterm summary reportConduct interviewsSubmit draft brief Incorporate client feedback Submit final policy brief

  • Leading cause of maternal mortality and morbidity

    Maternal mortality ratio: 720 deaths per 100,000 live birthsSouth Africa: 400United States: 11

    Termination of unintended pregnancy by persons lacking the necessary skills or in an environment lacking the minimal medical standards, or both. (WHO)

  • 1,209 out of every 100,000 women will die as a result of abortion complications

    Unsafe abortion accounts for 30 percent of maternal mortality (Addis Ababa).

    Limited resources and knowledge of reproductive health rights hinder womens ability to seek safe abortion services.

    Only tuberculosis kills more women

  • Abortion was only permitted to save the life or the health of a woman (1957).Diagnosed and certified in writing by a providerHealth care provider held responsible Revised abortion law (2005):When pregnancy results from rape or incestHealth or life of a woman and fetus are in dangerFetal abnormalities, physical or mental disabilitiesMinors who are physically or psychologically unpreparedExtenuating circumstance:Extreme poverty

  • Circumstances for providing abortion:Within three days of a womans requestNo evidence required in cases of rape or incestNot required to show signs of ill healthNot required to prove she is under 18

  • Two areas where reform is necessary and possible: AWARENESSACCESS

    Additional factors contributing to the significant gaps between policy and implementation of CAC:High fertility ratesLow use of contraceptivesLow literacy rates of women Harmful traditional practices (HTP) Early marriageDomestic violence

  • 50 percent of girls do not have access to primary schoolsGirls drop out or repeat gradesOnly 18.5 percent of women are literateEducation demands literacy, knowledge and exposure to new ideas

    Government policies lack educational opportunities for girlsinhibits awareness

  • Limited knowledge of providers:Only 29 percent of the health workers knew correct provision of the penal codeObligation by law to refer a woman to an appropriate health facility Providers not held accountable if a woman produces erroneous informationNegative attitudes of health care providers

  • One midwife for every 3,756 expected deliveriesInsufficient number of OB/GYNsInsufficient supplies Only 635 health centers Over 50 percent of the population live more than 10 km from the nearest health facilityLack of transportation

    Constraints: human resources, infrastructure and supplies, geographical, training Poor referral linkagesPoorly equipped infrastructuresCost of abortion

  • Goal: government-led taskforce should create effective projects to ensure that Ethiopians are educated on their reproductive rights and that they have access to safe health facilities and trained providers

    Intersectoral Collaborations:FMOHCommunity leadersReligious leadersNGOs

  • Objective 1: design and create training curriculumsETS and CCGsObjective 2: appoint teams to facilitate various projects throughout the programTraining committee, CCG facilitators, RMC providersObjective 3: design and create a system of mobile clinics (Rural Mobile Clinics)Route, supplies and resourcesObjective 4: appoint a monitoring and evaluation teamAssess ETS, CCGs, RMCs, create checklists

  • Goal: educate health care providers on the recently revised penal code and the technical guidelines to safe abortion services

  • Objective 1: increase knowledge of abortion services among health care providersDisseminate information about the penal codeEducate on MVASensitive to needs of youth Objective 2: build sustainable networks (support system)Provide refresher seminars Up-to-date information on CACDiscuss successes, failures and challengesCommunity feedback

  • Goal: encourage self-determination and enable women to make healthy and safe decisions pertaining to their reproductive health, thereby elevating womens social and health status within their communities

  • Objective: raise awareness of revised penal code and reproductive rights, create support networks for women and encourage dialogueServe as safe spacesDisseminate knowledge of revised penal codeRaise awareness of where and how to access CAC

    Women may learn about coffee groups at:Markets, community wells, health facilities

    Distribute educational materials:Pamphlets with words and pictures Schedules of upcoming Rural Mobile Clinics

  • Goal: expand womens access to reproductive health and safe abortion services

  • Objective: provide safe abortion services to those who have no access to health facilities Serve as an extension of regional hospitalsMVA and medical abortionCounselingFamily planning servicesDistribute informational materials and resources

  • It is our sincere hope that these recommendations will encourage and support Ethiopia in modifying its safe abortion services and ultimately creating a higher quality of life for all Ethiopians.