ACCEPTABILITY OF THE INVOLVEMENT OF HEALTH EXTENSION WORKERS (HEWS) IN MEDICAL ABORTION (MA): THE PERSPECTIVES OF CLIENTS, SERVICE PROVIDERS AND TRAINED HEWS IN EAST SHOA AND ARSI ZONES, OROMIYA REGION, ETHIOPIA
Background: Involvement of health extension workers (HEWs) in Ethiopia, is a vital step in increasing access and utilization of medical abortion and related services.
Objective: To explore the acceptability of involvement of HEWs in medical abortion by women who seek services, by abortion service providers, and assess willingness and confidence of HEWs.
Methods: In-depth interview was conducted at three purposively selected health facilities in Ethiopia ; namely Marie Stopes Clinic (MSI) Adama clinic, MSI Asella clinic and Adama Government Health Centre from July-August, 2013. The interviews were transcribed verbatim and analysis was done using Atlas ti software. Themes were abstracted from coded text segments. The findings are presented using quotations, Atlas ti networks and queries.
Results : Thirty eight (26 eligibility, 12 follow up) women participated in the study and 9 HEWs and 7 service providers were interviewed. Almost all of the interviewed women, service providers and HEWs accepted HEWs involvement in medical abortion services. The HEWs expressed readiness and confidence. Concerns related to the involvement of HEWs included confidentiality, privacy, over dependence on abortion rather than preventing unwanted pregnancy, quality and poor referral system.
Conclusions: Expansion of medical abortion services by involving HEWs can contribute to the reduction of abortion related morbidity and mortality. Concerns of the study population should be addressed by training of HEWs for medical abortion, creating better awareness and advocacy among women and communities, addressing quality and referral issues with proper planning, implementing and monitoring of activities.
Key words: Medical abortion, Eligibility, Follow up, Health extension worker, Ethiopia
Singh S., Fetters T., Gebreselassie H., Abdella A., Gebrehiwot Y., Audam S. The estimated incidence of induced abortion in Ethiopia, 2008. Int Perspect Sex Reprod Health. 2010 Mar;36(1):16-25 2010.
Federal Ministry of Health, UNICEF, UNFPA, WHO, AMDD. National Baseline Assessment for emergency and Newborn and Newborn Care, Ethiopia. 2008: 65-67.
Federal Ministry of Health, Ethiopia. Health & Health Related Indicators, 2011
Gebrehiwot Y, Liabsuetrakul T. Trends of abortion complications in a transition of abortion law revisions in Ethiopia. J Public Health (Oxf) 2009;31:81–87.
Ethiopian Ministry of Health, Technical and Procedural Guidelines for Safe Abortion Services in Ethiopia, Addis Ababa, Ethiopia: Ministry of Health, 2006.
Kuller R, Gülmezoglu AM, Hofmeyr GJ, Cheng LN, Campana A. Medical methods for first trimester abortion. Cochrane database of systematic reviews, 2011, 1:(CD002855).
World Health Organization. Safe Abortion: Technical and policy guidance for health systems. 2nd Edition. Methods of Abortion. 2012: 37-59 Geneva.
Winkoff B, Sivin I, Coyaji, Cabezas E, Xiao B, Gu S et al. Safety, efficacy and acceptability of medical abortion in China, Cuba and India: a comparative of mifepresitone – misoprostol versus surgical abortion. Amercan Journal of Obstetrics and Gynecology. 1997, 176:431-437.
Ngoc T, Winkoff B, Clark S Ellertson C, Am KN, Hieu DT, Safety, efficacy and acceptability of Mifeprostone- Misoproatol Medical Abortion in Vietnam. International Family planning perspectives 1999;25(1): 10-14.
Baggaley RF, Burgin J, Campbell OMR (2010) The Potential of Medical Abortion to Reduce Maternal Mortality in Africa: What Benefits for Tanzania and Ethiopia? PLoS ONE 5(10): e13260. doi:10.1371/journal.pone.0013260.
Federal Ministry of Health. Health Extension Program in Ethiopia: Profile. Addis Ababa 2004
Federal Ministry of Health. Health extension and Education Center. Health Extension Program in Ethiopia. Profile. June 2007.
Medical Abortion: An International Forum on Policies, Programmes and Services: Johannesburg, 2004. “Medical abortion: expanding access to safe abortion and saving women's lives. Consensus statement: Medical Abortion: An International Forum on Policies, Programmes and Services, 17-20 October 2004, Johannesburg, South Africa”. (Consensus Statement). 2005. Reproductive Health Matters, 13(26):11-12.
Prata N, Gessessew A, Campbell M, Potts M. “A new hope for women”: medical abortion in a low-resource setting in Ethiopia. J Fam Plann Reprod Health Care 2011;37:196–197.
Woldetsadik MA, Sendekie TY, White MT, Zegeye DT. Client preferences and acceptability for medical abortion and MVA as early pregnancy termination method in northwest Ethiopia. Reproductive Health, 2011, Jun 3: 8-19.
Center for National Health Development in Ethiopia, Columbia University. Ethiopia Health Extension Program Evaluation Study, 2007-2010: Health post and HEWs Performance Survey. Volume-II. 2011. Addis Ababa, Ethiopia.