Medical Abortion in Medical Abortion in Ethiopia: Policy and Ethiopia: Policy and

PracticePractice

Africa Regional Meeting on Medical Abortion

Johannesburg, South Africa March 11-13rd,2009

Over ViewSome Demographic IndicatorsThe Abortion Law of Ethiopia,2005

Technical & Procedural Guidelines for Safe Abortion

Current Status Of Medical Abortion

The Way Forward

A. GENERALTotal 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%

Background Information on EthiopiaBackground Information on Ethiopia

B. MAJOR RH ISSUESB. 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

THE ABORTION LAW OF 2005THE ABORTION LAW OF 2005

Abortion still technically restricted but not punishable in cases of:

Rape and incest

Pregnancy endangering woman’s life and /or health

Indications of fetal abnormalities

Physically or mental deficiency

Minor :physically or psychologically unprepared to raise a child

……(Continued)(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)

TECHNICAL AND PROCEDURAL GUIDELINES TECHNICAL AND PROCEDURAL GUIDELINES FOR SAFE ABORTION SERVICESFOR 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

• 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

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

Current Status of MA DrugsCurrent 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)

What has been done so far?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 clinics+40 private) facilities in 3 months

An introductory pilot study on process

Providers: Less work load Less risk of infections

Women Provide privacy and less invasive Percieved less infection than surgical

procedure

The Way ForwardThe 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

(…Continued)(…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

THANK YOU