Providers' roles in policy change: Maternal mortality, unsafe abortion and Ethiopia's 2005 abortion law reform

Liberalization of abortion law has the potential to reduce maternal mortality through expansion of access to safe and legal abortion care. Countries liberalizing their abortion law have increased in number in recent decades; however, the phenomenon is still relatively rare. Providers, particularly those with high status such as obstetrician-gynecologists, can play important roles in furthering health policy reform, especially related to reproductive health. Ethiopia has one of the highest maternal mortality rates in the world, a significant proportion of which is due to unsafe abortion, particularly in urban areas. In 2005, Ethiopia greatly expanded legal access to abortion through liberalization of its stringent 1957 law. The medical profession, particularly the Ethiopian Society of Obstetricians & Gynecologists (ESOG), was a central actor in legal reform efforts. This qualitative research explores the nature of ob-gyn attitudes and engagement in the legal reform process through 25 hour-long in-depth interviews with ob-gyns and other policy leaders in Addis Ababa, the capital of Ethiopia. These research findings provide empirical data about provider attitudes and the ways providers can effectively engage in abortion law reform, with the aim of reducing maternal mortality by increasing women's access to safe abortion.