Medical Abortion in Ethiopia: Policy and Practice Africa Regional Meeting on Medical Abortion Johannesburg, South Africa March 11-13rd,2009

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

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% Background Information on Ethiopia

B. MAJOR RH ISSUES 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

THE 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) 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 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

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

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 Forward 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

(…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