Comprehensive Abortion Care (CAC): An Investigation of Women's Acceptance and Satisfaction with a Pilot CAC Program in Tigray, Ethiopia

Unsafe abortion is a major cause of morbidity and mortality in Ethiopia, though access to safe abortion has increased following liberalization of abortion laws in 2005. In 2009 and 2010, the Tigray Health Bureau and partners implemented a pilot program of comprehensive abortion care (CAC), which provided care to approximately 5000 women over 15 months. This study aimed to assess the satisfaction and acceptability of CAC for 1700 participating women, each of whom was offered a 60-question survey at follow-up. Results show that 98% of women rated their overall experience as satisfactory, 99% were satisfied with the provider and method used, 95% said they were able to talk about their feelings, and 90% said counseling prepared them for the procedure. However, women attended by nurses and doctors had significantly higher odds of feeling that time with the provider was too short, as compared with those attended by a Health Extension Worker (OR 10.9, p = 0.000, [95% CI 3.1, 37.8]). This study shows that CAC service provision is highly satisfactory to women in the region and that well-trained lower level providers are satisfactory and acceptable for women seeking services. This program has the potential to reduce abortion related morbidity and mortality in a way that is acceptable to the women seeking services. It is recommended that in training providers, an emphasis be put on counseling women more extensively and for longer periods of time to reduce fear associated with home administration of abortion and to increase satisfaction with providers.