Ipas Collaboration: Comprehensive Abortion Care Report
Report Overview
This technical report documents the outcomes and lessons learned from the collaboration between HEAL Ethiopia and Ipas to improve access to comprehensive abortion care (CAC) services in Ethiopia. The collaboration focused on strengthening health systems, building provider capacity, and increasing community awareness about safe abortion services within the legal framework of Ethiopia.
The report presents key achievements, challenges, and recommendations for expanding access to safe abortion and post-abortion care services.
Project Period
January 2019 - June 2022
Geographic Coverage
3 regions: Addis Ababa, Oromia, and SNNPR
Target Population
Women of reproductive age, with a focus on young women and underserved communities
Program Components
Health system strengthening, provider training, community awareness, and policy advocacy
Background & Context
Ethiopia reformed its abortion law in 2005 to allow for legal abortion under specific circumstances, including rape, incest, fetal abnormality, and when the woman's physical or mental health is at risk. Despite this legal framework, many women still lack access to safe abortion services due to limited awareness, provider shortages, and stigma.
Unsafe abortion remains a significant cause of maternal mortality in Ethiopia, accounting for approximately 10% of maternal deaths. The collaboration between HEAL Ethiopia and Ipas aimed to address these challenges by strengthening the health system's capacity to provide safe abortion and post-abortion care services within the legal framework.
Key Achievements
Health System Strengthening
- Upgraded 25 health facilities to provide comprehensive abortion care
- Established referral networks between primary and secondary facilities
- Improved supply chain management for essential medicines and equipment
- Strengthened quality assurance and monitoring systems
Provider Capacity
- Trained 120 healthcare providers in comprehensive abortion care
- Provided values clarification workshops for 200+ health workers
- Established mentorship programs in 15 facilities
- Developed clinical protocols and job aids
Community Awareness
- Conducted community dialogues in 50 communities
- Trained 150 community health workers on legal provisions and referrals
- Developed and distributed information materials in local languages
- Engaged religious and community leaders to reduce stigma
Policy Advocacy
- Participated in national technical working groups on reproductive health
- Contributed to the revision of national guidelines on safe abortion
- Advocated for inclusion of medical abortion in primary healthcare
- Supported documentation of best practices for policy influence
Key Outcomes
Service Availability
Target facilities providing comprehensive abortion care
Service Utilization
Women received safe abortion or post-abortion care
Complication Rate
Complication rate for abortion procedures
Contraceptive Uptake
Post-abortion contraceptive acceptance rate
Challenges & Lessons Learned
The collaboration faced several challenges and generated important lessons for future programming:
- Stigma and misconceptions: Persistent stigma around abortion required continuous community engagement and provider values clarification
- Provider turnover: High staff turnover in public facilities necessitated ongoing training and mentorship
- Supply chain issues: Inconsistent availability of medical abortion drugs required strengthening procurement systems
- Documentation challenges: Providers were sometimes reluctant to document abortion services due to concerns about legal interpretation
- Youth access: Young women faced additional barriers to accessing services, requiring specialized approaches
Recommendations
Based on the collaboration experience, the report makes the following recommendations:
- Expand task-sharing to mid-level providers to increase service availability, especially in rural areas
- Integrate comprehensive abortion care into pre-service education for healthcare providers
- Strengthen community-facility linkages through community health workers and referral systems
- Develop youth-friendly services that address the specific needs and barriers faced by young women
- Improve data systems to better track service provision and outcomes while maintaining confidentiality
- Continue advocacy efforts to clarify legal provisions and reduce administrative barriers to service access
Conclusion
The collaboration between HEAL Ethiopia and Ipas has made significant contributions to improving access to comprehensive abortion care services within the legal framework of Ethiopia. Through a multi-faceted approach addressing health systems, provider capacity, community awareness, and policy, the program has increased the availability and quality of safe abortion and post-abortion care services.
The lessons learned and recommendations from this collaboration provide valuable guidance for future efforts to reduce maternal mortality and morbidity from unsafe abortion in Ethiopia and similar contexts. HEAL Ethiopia remains committed to supporting women's reproductive health and rights through evidence-based interventions and partnerships.
Report Citation
HEAL Ethiopia & Ipas (2022). Improving Access to Comprehensive Abortion Care in Ethiopia: Outcomes and Lessons from a Multi-Year Collaboration. Addis Ababa, Ethiopia.