Benefits of introducing medical methods for abortion related services: The case of Tigray, Ethiopia

The use of medication for abortion related services posits an opportunity for task shifting to midlevel providers, and service expansion to the lowest levels of the health care system that lack capacity for surgical interventions. A comprehensive abortion care (CAC) program was introduced in Tigray, Ethiopia. Services provided include both surgical and medication, and all of the levels of the health care system were involved, from health post to hospital. The CAC program provided services to women from June 2009 to December 2010 at selected sites. Data from patient records and exit interviews conducted with a subset of participants were analyzed to evaluate the overall feasibility of CAC services and patient satisfaction with the program. The majority of women utilizing services sought safe termination (92%). Since the introduction of medication methods, nurses have provided the majority of services at both hospitals (>95%) and health centers (66%), enabling clinical officers and doctors to focus more advanced surgical interventions and complicated cases. Treatment success rates for newly trained mid-level providers were as expected with medication. Additionally, they were able to follow up and re-assess need for further treatment accurately. Client satisfaction with the program was high: most women (97%) rated their overall experience as “good” (vs. “bad” or “so-so”). These preliminary findings show that introducing medication methods increases access to abortion-related services by allowing providers and or facilities without surgical capacity to provide services.