Reducing abortion costs to health systems

Strategies to reduce health system costs of providing abortion and post-abortion care while simultaneously improving quality of care are well documented but infrequently applied.

These strategies include:

• using vacuum aspiration to remove tissue from the uterus rather than cervix dilation and scraping the uterine lining with a curette
• providing light sedation rather than general anesthesia
• using outpatient facilities rather than operating theatres
• employing mid-level providers instead of specialists to provide care.

Savings, a new Excel spreadsheet-based tool developed at Ipas (an international non-governmental organisation), allows users to design and estimate the costs to the health system of providing different strategies of abortion and post-abortion care. For example, Savings users can estimate the costs of the current system of abortion and post-abortion care service delivery in a country and compare these with estimates of the costs of implementing the WHO recommended approach to abortion and post-abortion care.

In the preliminary application of Savings, Ipas generated per case costs for four hypothetical policy and service delivery scenarios using available cost data primarily from Uganda. Two types of legal settings are assumed:

• A restrictive abortion law or policy – abortion is permitted only to save a woman's life.
• A liberal abortion law or policy – first-trimester abortion is available on request.

Within each type of legal setting, Ipas compared a recommended approach to providing abortion services using decentralised services and technically superior interventions with a conventional approach relying on care centralised at higher levels of the health system and more costly interventions (such as dilation and curettage performed by specialist physicians).

The mean per case cost of abortion care ranged from US$45 where heavy restrictions were placed on elective abortion and a conventional approach to service delivery was used, to US$6 within the liberal legal setting using recommended interventions (see Table 1 below).

Table 1: Mean per case cost of abortion care by health system level and scenario (US$) (Larger version)

Using recommended technical interventions substantially reduced costs regardless of the legal setting. The greatest reduction in costs (86 percent) occurred from using recommended interventions within a liberal legal setting rather than using conventional interventions within a restricted setting.

Savings workshops are planned in which policymakers and others will use the model at a country level to develop estimates of costs to the national health system of different strategies of abortion and/or post-abortion care service delivery.

The model could also include data on regional and developing world estimates of the costs to health systems of current strategies in abortion care and the difference in costs following a shift to WHO recommended strategies.

We would expect this exercise to provide compelling evidence to support a shift to safer, more accessible and less costly abortion and post-abortion care services to save women's health and lives.

Heidi Bart Johnston
ICDDR,B, GPO Box 128, Dhaka 1000, Bangladesh
hjohnston@icddrb.org

Janie Benson and Maria Gallo
Ipas, PO Box 5027, Chapel Hill, NC 27514, USA
bensonj@ipas.org

See also

'Reducing the Costs to Health Systems of Unsafe Abortion: a Comparison of Four Strategies', Journal of Family Planning and Reproductive Health Care 33(4), by Heidi Bart Johnston, Maria F. Gallo and Janie Benson, 2007

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