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Expanding Access to Safe Abortion in Ethiopia Merrill Wolf and Saba Kidanemariam SALIN End of Programme Technical Forum The Hague, 5 November 2010. Presentation o verview. Ipas’s global work: Mission Strategies Impact Ipas’s collaborative work in Ethiopia: Background Impact

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  1. Expanding Access to Safe Abortion in EthiopiaMerrill Wolf and Saba KidanemariamSALIN End of Programme Technical ForumThe Hague, 5 November 2010

  2. Presentation overview • Ipas’s global work: • Mission • Strategies • Impact • Ipas’s collaborative work in Ethiopia: • Background • Impact • Lessons learned • Future directions

  3. Unsafe abortion 19.7 million each year – affecting >100 million women during their reproductive lifetimes 66,500 deaths per year, 91% in Africa and South-central Asia Almost half of deaths are young women <25 Source: WHO, 2007

  4. Ipas • Founded in 1973 To reduce abortion-related mortality and morbidity To increase women’s ability to exercise their sexual and reproductive rights • Leadership in comprehensive abortion care (CAC), expertise in clinical affairs, service delivery, policy, research and evaluation • Focus on capacity-building & sustainability • Strong on-the-ground presence

  5. Diverse partnerships Other RH Organizations Women’s Health Networks Ob-Gyns/ Midwives Associations Global Coalitions Ipas Government Ministries Media Groups Donors (European gov’ts, WHO, UNFPA) Research and Teaching Organizations Legal/Other Professional Groups

  6. Service delivery In the last 3 years: • >23,000 health professionals clinically trained in >30countries • Direct technical support to >1,200 service delivery facilities in 16 countries

  7. Technology access In the last 3 years: • >400,000 MVA aspiratorsand related instruments distributed – will result in >10 million women served • Facilitated approval, registration, availability of medical abortion drugs

  8. Policy In the last 3 years: • Supported local partners’ advocacy, including for reform of restrictive abortion laws • Keeping abortion on regional and international policy agendas

  9. Ethiopia

  10. Ethiopia • Population = 80million • CPR = 14% (modern methods) • Unmet need for FP = 36% • MMR = 673/100,000 Abortion: • Ipas magnitude study (2008) estimates 382,000/yr • Unsafe abortion still a major problem but … • About ¼ = safe abortions in health facilities, only 3 yrsafter legal reform

  11. Ipas in Ethiopia • From 1992, introducingpostabortion care (PAC) in public health facilities; 5 regions • Led advocacy for reform of abortion law (2005) • Helped develop national standards and guidelinesfor abortion (2006) • Scaling up comprehensive abortion care (CAC) including medical abortion • Research on magnitude and impact of abortion

  12. Partners • MOH and regional health bureaus • Health training institutions • Other RH organizations • CBOs including women’s and youth associations • UN agencies (UNFPA,WHO) • Donors

  13. Training and service delivery

  14. Training and service delivery

  15. Training and service delivery

  16. RH Technologies • Average annual MVA distribution = >5,000 aspirators • Contraception: >50,000 LAPM units distributed by DKT

  17. Medical abortion • Included in technical guidelines • DKT imported ~300,000 units of combination drugs with pre-registration permit • Approved for use but not yet registered • Integrated in CAC trainings: 14,250 services provided last year in Ipas-supported facilities (40% of all CAC) • Proven acceptable to women and providers

  18. Community awareness • Working with nearly 100 CBOs, reached > 1 million people mostly youth and women with information and services • Through “help points” in 3 universities and 2 high schools, reached 15,000 university and high school students • Journalist training and outreach

  19. Research • National study of abortion magnitude published in 2010 • Study partners: Federal Ministry of Health, regional health bureaus, Ethiopian Society Ob-Gyns, Ethiopian Public Health Association, Guttmacher Institute • Safe Abortion Care study in Tigray • Medical Abortion Acceptability Study

  20. Policy and advocacy • Legal reform • Technical guidelines • Regional advocacy • Advocacy skills-building • Sensitised decisionmakers Ongoing: • Updating guidelines • Informing providers and communities • Destigmatising abortion

  21. Lessons learned Value of comprehensive approach In restrictive settings,PAC effective inpreparing for legal reform Medical abortion feasiblein low-resource settings Policywork never ends Collaboration is essential Once the silence is broken, communities will talk about abortion

  22. Future directions Scaling-upCAC Increasing focus on youth Informing women and communities Policy advocacy Strengtheningpartnershipand coordination

  23. Unsafe abortion – Together, we are making a difference!

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