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Liberal laws and accessible services enable the biggest cost savings


November 20, 2007
A Ugandan nurse cares for a woman.

Unsafe abortion causes an estimated 13 percent of world maternal mortality and is a leading cause of maternal morbidity. The cost of treating abortion complications in developing countries can be enormous — indeed, as much as 50 percent of ob-gyn budgets, according to 1999 data from the Guttmacher Institute.

An October Journal of Family Planning and Reproductive Health Care article, “Reducing the costs to health systems of unsafe abortion: a comparison of four strategies,” by Heidi Johnston, Maria Gallo — both former Ipas staff members — and Janie Benson, vice president/director for research and evaluation at Ipas, proves that liberalizing abortion laws and changing the way services are delivered can produce major cost savings for health systems. For example, the World Health Organization (WHO) recommends that countries implement effective and cost-efficient technical interventions, such as replacing dilatation and curettage (D&C) for uterine evacuation with vacuum aspiration; using outpatient facilities rather than large hospitals; and using mid-level providers to perform services, rather than relying on specialists.

The study authors developed “Savings,” a Microsoft Excel ™ spreadsheet-based tool, to comprehensively compare the relative costs of implementing different strategies of abortion care in particular geopolitical settings. In this study, they applied cost data primarily from Uganda to show four different policy and service-delivery scenarios for abortion care.

There are several pieces inherent to abortion care:

In U.S. dollars, the mean per-case cost of abortion care in Uganda was $45 in a heavily restricted legal setting using conventional service-delivery approaches (D&C performed by a physician in a high-level hospital to treat complications from abortion). Using the same conventional approach in a less- restrictive legal environment incurred a cost of $34. When recommended interventions (vacuum aspiration for induced abortion performed by a mid-level provider in an outpatient or lowel-level facility) were substituted in that same environment, the cost fell to $25. And finally, in a liberal legal setting using recommended interventions, the cost fell to $6 — an 86 percent reduction in costs.

Obviously, in places where abortion is legally permitted and interventions, such as manual vacuum aspiration (MVA), are used, the cost of abortion care is greatly reduced. The authors point out, however, that even in settings where abortion is restricted, replacing D&C with MVA in an outpatient facility can still reduce costs.

As is the case in many developing countries, Uganda’s government spends roughly $8 per person annually on health care (the U.S. spends approximately $2,000), according to 2001 data from the WHO. For such a stressed health system, the reductions illustrated in this research could represent significant savings. Meanwhile, such changes in abortion care would mean improved service quality and greater access to safe induced abortions for women. This is potentially big news for Ugandan women; out of an estimated 297,000 induced abortions, nearly 85,000 women are treated for abortion complications each year.

“This creates truly a win-win situation,” says co-author Benson. The recommended approaches to abortion care, especially when offered in liberal legal settings, save health systems money and save women from unsafe abortions.

For more information, contact:
Kirsten Sherk
Senior Associate, Media Relations
e-mail: sherkk@ipas.org
phone: 919.960.5612
fax: 919.929.0258