Bridging the Gaps: Implementation of Comprehensive Abortion Care in Ethiopia

1. Bridging the Gaps:Implementation of Comprehensive Abortion Care in Ethiopia Neesha Goodman Anna Sackett Rachel Vasilver December 17, 2008

2. EngenderHealth • 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

3. Methodology • 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

4. Unsafe Abortion Facts • 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)

5. Unsafe Abortion Facts • 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

6. Penal Code of Ethiopia 1957 and 2005 • 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

7. Technical and Procedural Guidelines • 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

8. Gaps in Implementation • 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

9. Obstacles to Raising Awareness Girls and Women • 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

10. Obstacles to Raising Awareness Health Care Providers • 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

11. Obstacles to Increasing Access • Constraints: human resources, infrastructure and supplies, geographical, training • 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 • Poor referral linkages • Poorly equipped • infrastructures • Cost of abortion

12. Ethiopian Oversight Taskforce (EOT) • 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

13. Ethiopian Oversight Taskforce • 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

14. Ethiopian Training System (ETS) • Goal: educate health care providers on the recently revised penal code and the technical guidelines to safe abortion services

15. Ethiopian Training System • 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

16. Community Coffee Groups (CCGs) • 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

17. Community Coffee Groups • 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

18. Rural Mobile Clinics (RMCs) • Goal: expand women’s access to reproductive health and safe abortion services

19. Rural Mobile Clinics • 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

20. Final Remarks 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