Medical Abortion in Ethiopia: Policy and Practice

1
Medical Abortion in Ethiopia Policy and
Practice

• Africa Regional Meeting on Medical Abortion
  Johannesburg, South
  Africa
• March 11-13rd,2009

2
Over View

• Some Demographic Indicators
• The Abortion Law of Ethiopia,2005
• Technical Procedural Guidelines for Safe
  Abortion
• Current Status Of Medical Abortion
• The Way Forward

3

Background Information on Ethiopia

• A. GENERAL
• Total population 74 million (CSA,2007)
• 50 of the population under 18 years (CSA)
• Population growth rate 2.6 (CSA)
• Primary health service coverage (MoH)70

4
B. MAJOR RH ISSUES

• TFR of 5.4 per woman (DHS,2005)
• Low Contraceptive prevalence 15
• High MMR ratio of 673/100,000
• 32 of maternal death is due to unsafe abortion
• Unsafe abortion accounts for up to 60 of all
  gynecological admissions

5
THE ABORTION LAW OF 2005

• Abortion still technically restricted but not
  punishable in cases of
• Rape and incest
• Pregnancy endangering womans life and /or health
• Indications of fetal abnormalities
• Physically or mental deficiency
• Minor physically or psychologically unprepared
  to raise a child

6
(Continued)

• MoH was mandated to issue a guideline
• In the case of rape and incest, mere declaration
  by the woman is a sufficient condition for her to
  get abortion services (Article 552)

7
TECHNICAL AND PROCEDURAL GUIDELINES FOR SAFE
ABORTION SERVICES

• Provides the official interpretation of the law
• Details directions for health service providers
  and facilities
• TOP can be conducted either in public or private
  facility
• A woman should get services within 3 working days

8
(Continued)

• All facilities with trained personnel,
  equipment can provide TOP up to 12 weeks
• TOP 13 to 28 weeks in a secondary or
• tertiary level
• Included alternative technologies like medical
  abortion
• Sanctions midlevel providers to perform MVA

9
Medical Abortion

• Up to 9 completed weeks
• Mifspristone 200 milligrams orally, followed 36
  to 48 hours later by
• Misoprostol 800 micrograms vaginally. Up to 7
  weeks 400 ug misprostol orally

10
Current Status of MA Drugs

• Regulatory authority has included the drugs in
  the essential drugs list of the country
• Process for registering the drugs going on since
  2007
• 100,000 units of Medabon imported by DKT with
  pre-registration permit (2008)

11
What has been done so far?

• 42 lead trainers trained
• Integrated MA in all Comprehensive Abortion Care
  training, since August /09
• 3,000 women received MA services in 102 (42
  public 20 MSIE clinics40 private) facilities
  in 3 months
• An introductory pilot study on process

12
Preliminary Reflections

• Providers
• Less work load
• Less risk of infections
• Women
• Provide privacy and less invasive
• Percieved less infection than surgical
  procedure

13
The Way Forward

• Ensure registration of drugs/availability in
  Ethiopia
• Complete pilot documentation study
• Continue to integrate MA in all CAC trainings
  and services
• Conduct MA stand alone trainings in selected
  facilities

14
(Continued)

• Conduct targeted community/ women education on
  MA
• Continue monitoring and supervision of services
• Advocacy for the implementation of abortion care
  to the limits of the law with the leadership of
  MOH

15

• THANK YOU