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