December 17, 2008

Leading international health organization › improve the quality of health

care in poor communities› Women and reproductive

health

Deliverable› Policy brief

Comprehensive Abortion Care (CAC) in Ethiopia

Meet with EngenderHealth Group conference calls Draft initial international guidelines report Midterm summary report Conduct interviews Submit 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 births› South Africa: 400› United 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 women’s 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 provider› Health care provider held responsible

Revised abortion law (2005):› When pregnancy results from rape or incest› Health or life of a woman and fetus are in danger› Fetal abnormalities, physical or mental disabilities› Minors who are physically or psychologically unprepared

Extenuating circumstance:› Extreme poverty

Circumstances for providing abortion:› Within three days of a woman’s request› No evidence required in cases of rape or incest› Not required to show signs of ill health› Not required to prove she is under 18

Two areas where reform is necessary and possible: › AWARENESS› ACCESS

Additional factors contributing to the significant gaps between policy and implementation of CAC:› High fertility rates› Low use of contraceptives› Low literacy rates of women › Harmful traditional practices (HTP)

Early marriage Domestic violence

50 percent of girls do not have access to primary schools

Girls drop out or repeat grades

Only 18.5 percent of women are literate

Education demands literacy, knowledge and exposure to new ideas

Government policies lack educational opportunities for girls

›inhibits awareness

Limited knowledge of providers:› Only 29 percent of the health workers knew correct

provision of the penal code› Obligation by law to refer a woman to an appropriate

health facility › Providers not held accountable if a woman produces

erroneous information› Negative attitudes of health care providers

› One midwife for every 3,756 expected deliveries

› Insufficient number of OB/GYNs

› Insufficient supplies › Only 635 health centers

› Over 50 percent of the population live more than 10 km from the nearest health facility

› Lack of transportation

Constraints: human resources, infrastructure and supplies, geographical, training

›Poor referral linkages›Poorly equipped infrastructures›Cost 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:› FMOH› Community leaders› Religious leaders› NGOs

Objective 1: design and create training curriculums› ETS and CCGs

Objective 2: appoint teams to facilitate various projects throughout the program› Training committee, CCG facilitators, RMC providers

Objective 3: design and create a system of mobile clinics (Rural Mobile Clinics)› Route, supplies and resources

Objective 4: appoint a monitoring and evaluation team› Assess 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 providers› Disseminate information about the penal code› Educate on MVA› Sensitive to needs of youth

Objective 2: build sustainable networks (support system)› Provide refresher seminars

Up-to-date information on CAC Discuss successes, failures and challenges Community feedback

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

Objective: raise awareness of revised penal code and reproductive rights, create support networks for women and encourage dialogue› Serve as safe spaces› Disseminate knowledge of revised penal code› Raise 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 women’s 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 hospitals

› MVA and medical abortion

› Counseling

› Family planning services

› Distribute 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.

THANK YOU