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

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

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.

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

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 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

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