medical abortion in ethiopia: policy and practice africa regional meeting on medical abortion...
TRANSCRIPT
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Medical Abortion in Medical Abortion in Ethiopia: Policy and Ethiopia: Policy and
PracticePractice
Africa Regional Meeting on Medical Abortion
Johannesburg, South Africa March 11-13rd,2009
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Over ViewSome Demographic IndicatorsThe Abortion Law of Ethiopia,2005
Technical & Procedural Guidelines for Safe Abortion
Current Status Of Medical Abortion
The Way Forward
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A. GENERALTotal population = 74 million (CSA,2007)
50% of the population under 18 years (CSA)
Population growth rate = 2.6% (CSA)
Primary health service coverage (MoH)≈70%
Background Information on EthiopiaBackground Information on Ethiopia
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B. MAJOR RH ISSUESB. MAJOR RH ISSUES
TFR of 5.4 per woman (DHS,2005)Low Contraceptive prevalence = 15%High MMR ratio of 673/100,000
32% of maternal death is due to unsafe abortion
Unsafe abortion accounts for up to 60% of all gynecological admissions
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THE ABORTION LAW OF 2005THE ABORTION LAW OF 2005
Abortion still technically restricted but not punishable in cases of:
Rape and incest
Pregnancy endangering woman’s life and /or health
Indications of fetal abnormalities
Physically or mental deficiency
Minor :physically or psychologically unprepared to raise a child
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……(Continued)(Continued)
MoH was mandated to issue a guideline
In the case of rape and incest, mere declaration by the woman is a sufficient condition for her to get abortion services (Article 552)
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TECHNICAL AND PROCEDURAL GUIDELINES TECHNICAL AND PROCEDURAL GUIDELINES FOR SAFE ABORTION SERVICESFOR SAFE ABORTION SERVICES
Provides the official interpretation of the law
Details directions for health service providers and facilities:
TOP can be conducted either in public or private facility
A woman should get services within 3 working days
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• All facilities with trained personnel, equipment can provide TOP up to 12 weeks
• TOP 13 to 28 weeks in a secondary
or tertiary level
Included alternative technologies like medical abortion
Sanctions midlevel providers to perform MVA
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Up to 9 completed weeks
Mifspristone 200 milligrams orally, followed 36 to 48 hours later by
Misoprostol 800 micrograms vaginally. Up to 7 weeks 400 ug misprostol orally
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Current Status of MA DrugsCurrent Status of MA Drugs
Regulatory authority has included the drugs in the essential drugs list of the country
Process for registering the drugs going on since 2007
100,000 units of Medabon imported by DKT with pre-registration permit (2008)
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What has been done so far?What has been done so far? 42 lead trainers trained
Integrated MA in all Comprehensive Abortion Care training, since August /09
3,000 women received MA services in 102 (42 public + 20 MSIE clinics+40 private) facilities in 3 months
An introductory pilot study on process
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Providers: Less work load Less risk of infections
Women Provide privacy and less invasive Percieved less infection than surgical
procedure
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The Way ForwardThe Way Forward:
Ensure registration of drugs/availability in Ethiopia
Complete pilot documentation study
Continue to integrate MA in all CAC trainings and services
Conduct MA stand alone trainings in selected facilities
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(…Continued)(…Continued) Conduct targeted community/
women education on MA
Continue monitoring and supervision of services
Advocacy for the implementation of abortion care to the limits of the law with the leadership of MOH
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THANK YOU