Abortion in Ethiopia

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In 2005, the Ethiopian Parliament liberalised the abortion law to grant safe abortions to women in specific circumstances.

Contents

Currently, abortion is legal in Ethiopia in cases of rape, incest, or maternal problems relating to foetal impairment.

Since 2008, Ethiopia has witnessed a rapid increase in healthcare facilities which provide legal abortion services. Abortions services in Ethiopian facilities includes medical abortion using misoprostol and Mifepristone, surgical abortion, manual vacuum aspiration and dilation and curettage.

In 2008, estimated 382,500 induced abortions were performed in Ethiopia, for annual rate of 23 abortions per 1,000 women aged 15–44. This has been doubled the proportion in 2014, with rate of 53% (some 326,000) in all health facilities. Most abortions occur in non-governmental organization and private hospitals within Ethiopia.

History

Ethiopia is the second most populated country in Sub-Saharan Africa (SSA). A central issue concerning the safety of its population is the access to health care including abortion services.

Historically, access to abortion in Sub-Saharan Africa has created controversy amongst some members of the public and its healthcare professionals, due to the existing religious practices and traditional beliefs. There exists a lack of medical knowledge and a cultural stigma surrounding the process of abortion.

From 1980 to 1999, the main cause of maternal mortality in Ethiopia at 31% was the unsafe nature or complications regarding abortion. [1]

In 1994, the International Conference on Population and Development (ICPD), organised by the United Nations, remarked the urge to reduce unsafe abortions in order to tackle these maternal mortality rates. Following this conference, African nations began to encourage the liberalisation of abortion laws. [2] African leaders put this in motion by updating national laws and policies, providing service-delivery rules and regulations, medical training programmes and community outreach programmes. [3]

The journey to safe abortions gained relevance within Ethiopia's political agenda throughout the 1990s. However, the various religious practices in Ethiopia soon expressed their resistance to these plans. The 2007 census demonstrates that 43.5% of citizens identified as Orthodox Christian, 33.9% identified as Muslim and 18.5% identified as Protestant Christian. [2] A study conducted in the same year proves that a high 67% considered induced abortion as 'never justifiable'. [2]

However, with Ethiopia's rapidly growing population, a Population Policy goal was implemented in 1993 to stabilise the rate of population alongside the economic growth. This Policy came to existence during a transition from the Imperial and Military regimes in Ethiopia, during which population and the reproductive health movement had largely been neglected as a national concern. [4] The policy's crucial goals were to reduce the fertility rate from 7.7 to 4, and promote the use of modern contraception among married women who were of child-bearing age from less than 5% to 44%. [4] Before 1993, the Ethiopian Government played a role in actively discouraging the administration and use of contraception. Hence, with this Population Policy, Ethiopia adopted the principle of providing safe abortions and seeking planned pregnancy.

Three years after the legalisation of abortion in Ethiopia, the WHO found that unsafe abortions contributed to 18% of maternal mortality in East Africa, a significant improvement from the previous 31%. [5] By 2014, the maternal mortality caused by unsafe abortions in Ethiopia had declined to 10%. [1]

Legality

In 2005, Ethiopia legalized abortion in cases of rape, incest, or foetal impairment. [6] [7] [8] [9] Woman can legally terminate her child life if the pregnancy or childbirth endanger her life. Although abortion is prohibited by Criminal Code, the Ethiopian Parliament approved it in the following circumstances: [10] [11]

A woman can terminate the child upon a difficulty of giving birth owing to minor or physical disability. [12] However, the law engendered almost six in ten unsafe abortions in Ethiopia. In 2006, the government started national standard for safe abortion guideline that utilizes medications such as misoprostol with or without mifepristone) to terminate pregnancies, in accordance with World Health Organization (WHO) clinical recommendations on safe abortion. [13] Available abortion services are: [14]

Incidents

In 2008, an estimated 382,500 induced abortions were performed in Ethiopia, for annual rate of 23 abortions per 1,000 women aged 15–44. [15] [16] The abortion rate in Ethiopia was lower than to African and Eastern African countries which has 29% and 39% respectively according to WHO estimates. [17] In urban areas, abortions rates is higher than in national average, such as Addis Ababa, Dire Dawa and Harar. Factors for these conditions include greater social and healthcare provision attracting women in these areas. [12]

Some of 35% women tend to undergo induced abortion whereas 27% of those obtaining post-abortion care report having had a previous abortion. [18] In 2014, about 620,300 abortions were performed in Ethiopia, corresponding to annual rate of 28 abortions per 1,000 women aged 15–49, an increase from 22 per 1,000 in 2008. [19] [20]

Provision of abortion and post-abortion care

In 2008, about 27% women induced abortions were safe performed by health facilities. [5] However, 15% (58,000 abortions) reported safe despite lack of clear survey from private and public hospitals. Some of these practices were legal and mostly performed by private and small facilities; about half of all health facilities provided induced abortions in Ethiopia. The proportion is higher than for public hospitals (76%) and private or non-governmental facilities (63%) than for public health centers (41%). [12]

This proportion is likely fluctuating, as there are abortion services in public facilities. Currently, private and NGO facilities mostly provide induced abortion aboard. Access to second trimester abortions is severely limited, in which 9–10% of all facilities only provide these services. [12]

In 2014, legally performed induced abortions were reached 53% (some 326,200) in all health facilities, nearly double the proportion in 2008 (27%). Between 2008 and 2014, shared abortion rate increased from zero to more than one-third. [13]

Unintended pregnancy and contraception

Modern contraceptive absorption is much higher than in Addis Ababa (57% among women aged 15–44) than in Ethiopia as whole (14%), while in rural areas is below national average (3–16%). One of root causes of abortion is the low level of contraceptive methods, which leads to unintended pregnancy. [12] 13% of unintended pregnancy ended in 2014, up slightly from 10% in 2008. [13]

Public Opinion

Despite the legalisation of abortion in 2005, many women in Ethiopia demonstrate little knowledge when it comes to the abortion process. This is due to a combination of factors including religious practices, cultural barriers, public stigma and moral beliefs that inherently values the life of the foetus.

A survey of women between the ages of 15-49 from Bahir Dar in North-Eastern Ethiopia shows that two-thirds were aware of the 2005 law, but 57% remained under-educated as to its purposes. [21]

A community-based cross-sectional survey from 2017 found that a woman's age can determine the level of knowledge held regarding the abortion law. Similarly, the woman's occupation can determine the attitude towards the abortion law. Overall, those with a lack of knowledge towards the abortion law are found likely to possess a conservative attitude towards abortion. [21] This highlights the nation's need for further education across all ages to break down the stigma and conservative attitudes concerning abortion in Ethiopia.

Related Research Articles

Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of all pregnancies. When deliberate steps are taken to end a pregnancy, it is called an induced abortion, or less frequently "induced miscarriage". The unmodified word abortion generally refers to an induced abortion. The most common reasons women give for having an abortion are for birth-timing and limiting family size. Other reasons reported include maternal health, an inability to afford a child, domestic violence, lack of support, feeling they are too young, wishing to complete education or advance a career, and not being able or willing to raise a child conceived as a result of rape or incest.

<span class="mw-page-title-main">Maternal death</span> Aspect of human reproduction and medicine

Maternal death or maternal mortality is defined in slightly different ways by several different health organizations. The World Health Organization (WHO) defines maternal death as the death of a pregnant mother due to complications related to pregnancy, underlying conditions worsened by the pregnancy or management of these conditions. This can occur either while she is pregnant or within six weeks of resolution of the pregnancy. The CDC definition of pregnancy-related deaths extends the period of consideration to include one year from the resolution of the pregnancy. Pregnancy associated death, as defined by the American College of Obstetricians and Gynecologists (ACOG), are all deaths occurring within one year of a pregnancy resolution. Identification of pregnancy associated deaths is important for deciding whether or not the pregnancy was a direct or indirect contributing cause of the death.

<span class="mw-page-title-main">Self-induced abortion</span> Abortion performed by a pregnant person themselves outside the recognized medical system

A self-induced abortion is an abortion performed by the pregnant woman herself, or with the help of other, non-medical assistance. Although the term includes abortions induced outside of a clinical setting with legal, sometimes over-the-counter medication, it also refers to efforts to terminate a pregnancy through alternative, potentially more dangerous methods. Such practices may present a threat to the health of women.

<span class="mw-page-title-main">Unsafe abortion</span> Termination of a pregnancy by using unsafe methods

An unsafe abortion is the termination of a pregnancy by people lacking the necessary skills, or in an environment lacking minimal medical standards, or both. An unsafe abortion is a life-threatening procedure. It includes self-induced abortions, abortions in unhygienic conditions, and abortions performed by a medical practitioner who does not provide appropriate post-abortion attention. About 25 million unsafe abortions occur a year, of which most occur in the developing world.

<span class="mw-page-title-main">Sexual and reproductive health</span> State of the reproductive system without evidence of disease, disorders, or deficiencies

Sexual and reproductive health (SRH) is a field of research, health care, and social activism that explores the health of an individual's reproductive system and sexual well-being during all stages of their life. Sexual and reproductive health is more commonly defined as sexual and reproductive health and rights, to encompass individual agency to make choices about their sexual and reproductive lives.

Abortion has been legal in India under various circumstances with the introduction of the Medical Termination of Pregnancy (MTP) Act, 1971. The Medical Termination of Pregnancy Regulations, 2003 were issued under the Act to enable women to access safe and legal abortion services.

<span class="mw-page-title-main">Women on Web</span> Canadian online abortion help service

Women on Web (WoW) is a Canadian non-profit organization that aims to increase access to safe abortion known for its online abortion service accessible in multiple countries. The organization was founded by Dr. Rebecca Gomperts, a Dutch physician, in 2005.

Abortion in Venezuela is currently illegal except in some specific cases outlined in the Venezuelan Constitution, and the country has one of Latin America's most restrictive laws.

Unintended pregnancies are pregnancies that are mistimed or unwanted at the time of conception, also known as unplanned pregnancies.

<span class="mw-page-title-main">Ipas (organization)</span> International non-governmental organization

Ipas is an international, non-governmental organization that seeks to increase access to safe abortions and contraception. To this end the organization informs women how to obtain safe and legal abortions and trains relevant partners in Africa, Asia, and Latin America on how to provide and advocate for these.

A medical abortion, also known as medication abortion or non-surgical abortion, occurs when drugs (medication) are used to bring about an abortion. Medical abortions are an alternative to surgical abortions such as vacuum aspiration or dilation and curettage. Medical abortions are more common than surgical abortions in most places around the world.

<span class="mw-page-title-main">Reproductive rights in Latin America</span>

Latin America is home to some of the few countries of the world with a complete ban on abortion and minimal policies on reproductive rights, but it also contains some of the most progressive reproductive rights movements in the world. With roots in indigenous groups, the issues of reproductive rights include abortion, sexual autonomy, reproductive healthcare, and access to contraceptive measures. Modern reproductive rights movements most notably include Marea Verde, which has led to much reproductive legislation reform. Cuba has acted as a trail-blazer towards more liberal reproductive laws for the rest of Latin America, while other countries like El Salvador and Honduras have tightened restrictions on reproductive rights.

Abortion is illegal in Bangladesh under most situations, but menstrual regulation is often used as a substitute. Bangladesh is still governed by the penal code from 1860, where induced abortion is illegal unless the woman is in danger.

Abortion in Uganda is illegal unless performed by a licensed medical doctor in a situation where the woman's life is deemed to be at risk.

Abortion is a controversial topic in Nigeria. Abortion in Nigeria is governed by the two laws that differs greatly depending on geographical location. Northern Nigeria is governed by The Penal Code and Southern Nigeria is governed by The Criminal Code. The only legal way to have an abortion in Nigeria is if having the child is going to put the mother's life in danger. However, sex-selective abortion has long had acceptance in Nigeria.

Nepal legalised abortion in March 2002, under the 11th Amendment to the Civil Code. The legal services were successfully implemented on December 25, 2003. The high maternal mortality rates in Nepal led to the government legalising it. More than 500,000 women sought abortion between 2004–2014. In 2014, 323,100 women in Nepal had the abortion; among this, only 42% of abortions were legal and 19% were treated for abortion complications. Similar study had found the rate of unintended pregnancy as 50%.

<span class="mw-page-title-main">Abortion in Kenya</span> Termination of pregnancy in Kenya

Abortion in Kenya is prohibited with the exception of certain circumstances including danger to the life and health of the expectant mother, and rape. Unsafe abortions are a major cause of deaths and health complications for women in Kenya.

<span class="mw-page-title-main">Women in Zambia</span> Overview of the status of women in Zambia

The status of women in Zambia has improved in recent years. Among other things, the maternal mortality rate has dropped and the National Assembly of Zambia has enacted multiple policies aimed at decreasing violence against women. However, progress is still needed. Most women have limited access to reproductive healthcare, and the total number of women infected with HIV in the country continues to rise. Moreover, violence against women in Zambia remains common. Child marriage rates in Zambia are some of the highest in the world, and women continue to experience high levels of physical and sexual violence.

Post-abortion care (PAC) is treatment and counseling for post-abortion women. It includes curative care, such as treating abortion complications, as well as preventative care, such as providing birth control to prevent future unwanted pregnancies. Post-abortion care reduces morbidity and mortality associated with abortion.

Abortion is illegal in Tanzania except to preserve the life of the mother. Under the Tanzanian penal code, health practitioners who perform illegal abortions may receive sentences of up to 14 years in prison, while those who procure abortions for themselves may be sentenced to up to seven years in prison.

References

  1. 1 2 Berhan, Yifru; Berhan, Asres (2014). "Causes of Maternal Mortality in Ethiopia: A Significant Decline in Abortion Related Death". Ethiopian Journal of Health Sciences. 24 (Special Issue): 15–28. doi:10.4314/ejhs.v24i0.3S. PMC   4249203 . PMID   25489180 – via African Journals Online.
  2. 1 2 3 Ewnetu, Demelash Bezabih; Thorsen, Viva Combs; Solbakk, Jan Helge; Magelssen, Morten (2020-02-11). "Still a moral dilemma: how Ethiopian professionals providing abortion come to terms with conflicting norms and demands". BMC Medical Ethics. 21 (1): 16. doi: 10.1186/s12910-020-0458-7 . ISSN   1472-6939. PMC   7014608 . PMID   32046695.
  3. ↑ Hessini, L.; Brookman-Amissah, E.; Crane, B. B. (2006). "Global Policy Change and Women\'s Access to safe abortion: The impact of the World Health Organization\'s guidance in African". African Journal of Reproductive Health. 10 (3): 14–27. doi:10.2307/30032468. ISSN   1118-4841. JSTOR   30032468.
  4. 1 2 Prata, Ndola; Summer, Anna (January 2015). "Assessing political priority for reproductive health in Ethiopia". Reproductive Health Matters. 23 (46): 158–168. doi:10.1016/j.rhm.2015.11.004. ISSN   0968-8080. PMID   26719007.
  5. 1 2 Dibaba, Yohannes; Dijkerman, Sally; Fetters, Tamara; Moore, Ann; Gebreselassie, Hailemichael; Gebrehiwot, Yirgu; Benson, Janie (2017-03-04). "A decade of progress providing safe abortion services in Ethiopia: results of national assessments in 2008 and 2014". BMC Pregnancy and Childbirth. 17 (1): 76. doi: 10.1186/s12884-017-1266-z . ISSN   1471-2393. PMC   5336611 . PMID   28257646.
  6. ↑ Singh, Susheela; Fetters, Tamara; Gebreselassie, Hailemichael; Abdella, Ahmed; Gebrehiwot, Yirgu; Kumbi, Solomon; Audam, Suzette (2010). "The Estimated Incidence of Induced Abortion In Ethiopia, 2008". International Perspectives on Sexual and Reproductive Health. 36 (1): 16–25. doi: 10.1363/3601610 . ISSN   1944-0391. JSTOR   20696526. PMID   20403802.
  7. ↑ "Playing it Safe: Legal and Clandestine Abortions". 10 September 2022.
  8. ↑ O’Connell, Kathryn A.; Kebede, Addisalem T.; Menna, Bereket M.; Woldetensay, Mengistu T.; Fischer, Sara E.; Samandari, Ghazaleh; Kassaw, Jemal K. (2022-06-13). "Signs of a turning tide in social norms and attitudes toward abortion in Ethiopia: Findings from a qualitative study in four regions". Reproductive Health. 19 (1): 198. doi: 10.1186/s12978-021-01240-6 . ISSN   1742-4755. PMC   9195190 . PMID   35698231.
  9. ↑ Alemu, Kidist; Birhanu, Solomon; Fekadu, Leta; Endale, Fitsum; Tamene, Aiggan; Habte, Aklilu (2022-08-18). "Safe abortion service utilization and associated factors among insecurely housed women who experienced abortion in southwest Ethiopia, 2021: A community-based cross-sectional study". PLOS ONE. 17 (8): e0272939. Bibcode:2022PLoSO..1772939A. doi: 10.1371/journal.pone.0272939 . ISSN   1932-6203. PMC   9387822 . PMID   35980966.
  10. ↑ Blystad, Astrid; Haukanes, Haldis; Tadele, Getnet; Haaland, Marte E. S.; Sambaiga, Richard; Zulu, Joseph Mumba; Moland, Karen Marie (2019-09-27). "The access paradox: abortion law, policy and practice in Ethiopia, Tanzania and Zambia". International Journal for Equity in Health. 18 (1): 126. doi: 10.1186/s12939-019-1024-0 . ISSN   1475-9276. PMC   6764131 . PMID   31558147.
  11. ↑ "Abortion law in Ethiopia: A comparative perspective" (PDF). 10 September 2022.
  12. 1 2 3 4 5 "Facts on Unintended Pregnancy and Abortion in Ethiopia" (PDF). 9 September 2022.
  13. 1 2 3 "Induced Abortion and Postabortion Care in Ethiopia". Guttmacher Institute. 2017-01-04. Retrieved 2022-09-09.
  14. ↑ "It is abortion legal in ethiopia? | HowToUseAbortionPill". www.howtouseabortionpill.org. Retrieved 2022-09-10.
  15. ↑ Singh, Susheela; Fetters, Tamara; Gebreselassie, Hailemichael; Abdella, Ahmed; Gebrehiwot, Yirgu; Kumbi, Solomon; Audam, Suzette (March 2010). "The estimated incidence of induced abortion in Ethiopia, 2008". International Perspectives on Sexual and Reproductive Health. 36 (1): 16–25. doi:10.1363/ipsrh.36.016.10. ISSN   1944-0391. PMID   20403802.
  16. ↑ Senbeto, Elias; Alene, Getu Degu; Abesno, Nuru; Yeneneh, Hailu (2005-06-24). "Prevalence and associated risk factoprs of Induced Abortion in Northwet Ethiopia". Ethiopian Journal of Health Development. 19 (1): 37–44. doi: 10.4314/ejhd.v19i1.9969 . ISSN   1021-6790.
  17. ↑ Megersa, Bikila Soboka; Ojengbede, Oladosu Akanbi; Deckert, Andreas; Fawole, Olufunmilayo Ibitola (2020-09-03). "Factors associated with induced abortion among women of reproductive age attending selected health facilities in Addis Ababa, Ethiopia: a case control study". BMC Women's Health. 20 (1): 188. doi: 10.1186/s12905-020-01023-4 . ISSN   1472-6874. PMC   7469090 . PMID   32883263.
  18. ↑ "Safe and unsafe induced abortion" (PDF). 10 September 2022.
  19. ↑ Moore, A. M.; Gebrehiwot, Y.; Fetters, T.; Wado, Y. D.; Bankole, A.; Singh, S.; Gebreselassie, H.; Getachew, Y. (10 September 2022). "The Estimated Incidence of Induced Abortion in Ethiopia, 2014". International Perspectives on Sexual and Reproductive Health. 42 (3): 111–120. doi:10.1363/42e1816. PMC   5568682 . PMID   28825902.
  20. ↑ Moore, Ann M.; Gebrehiwot, Yirgu; Fetters, Tamara; Wado, Yohannes Dibaba; Bankole, Akinrinola; Singh, Susheela; Gebreselassie, Hailemichael; Getachew, Yonas (2016). "The Estimated Incidence of Induced Abortion in Ethiopia, 2014: Changes in the Provision of Services Since 2008". International Perspectives on Sexual and Reproductive Health. 42 (3): 111–120. doi:10.1363/42e1816. ISSN   1944-0391. JSTOR   10.1363/42e1816. PMC   5568682 . PMID   28825902.
  21. 1 2 Muzeyen, R.; Ayichiluhm, M.; Manyazewal, T. (2017-07-01). "Legal rights to safe abortion: knowledge and attitude of women in North-West Ethiopia toward the current Ethiopian abortion law". Public Health. 148: 129–136. doi:10.1016/j.puhe.2017.03.020. ISSN   0033-3506. PMID   28482320.
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