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With proper post abortion care, costs can be reduced

With proper post abortion care, costs can be reduced

WHEN Ester (not her real name) missed her period that month, she did not think much about it, but as days turned into weeks, she knew she was in trouble.

It took her enough courage to go to the hospital to confirm her fears, and when the results came in, apart from knowing that she was in trouble, she knew her life was ruined.

Weighing her options, they did not look attractive, because apart from living with a father who is short tempered, she had the challenge of knowing the father of her unborn child, considering that she was raped by three men, all strangers to her.

Two weeks after she was informed about her condition, Ester’s lifeless body was found near her home, and the results indicated that she bled to death….. after she attempted to terminate her pregnancy. In medical and professional terms, an unsafe abortion is defined as a procedure for terminating an unintended pregnancy carried out either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both.

In the first nationally representative study of the incidence of abortion and the provision of postabortion care in Tanzania, researchers found that clandestine abortion is common and is a major contributor to maternal death and injury.

A study conducted by researchers at the U.S.- based Guttmacher Institute and Tanzania’s National Institute for Medical Research and Muhimbili University of Health and Allied Sciences, found that an estimated 405,000 abortions were performed in the country in 2013, the vast majority of which were clandestine procedures that put women’s well-being at risk.

Because of an abortion law that is both highly restrictive and ambiguous, Tanzanian women generally seek clandestine abortions that are unsafe. Although pregnancy termination is restricted by law in Tanzania, it is widely practiced and almost always unsafe, and contributes to the country’s high maternal morbidity and mortality.

Yet the majority of abortion-related deaths are preventable, as are the unintended pregnancies associated with abortion. According to a 2013 study conducted by the Guttmacher Institute and partners in Tanzania, it indicates that Tanzania’s abortion rate was 36 per 1,000 women aged 15–49.

It further states that majority of abortions were unsafe, with nearly 67,000 women being treated in health facilities for post abortion care (PAC). Better access to contraceptives, more comprehensive post abortion care and greater availability of safe abortion services within the current legal framework are critical.

In the first nationally representative study of the incidence of abortion and the provision of post abortion care in Tanzania, researchers found that clandestine abortion is common and is a major contributor to maternal death and injury. Tanzania’s national abortion rate-36 per 1,000 women of reproductive ageis similar to that in other East African countries.

During a one-day workshop titled ‘The health System Costs of Post Abortion Care in Tanzania’ organized by Chama cha Uzazi na Malezi Bora Tanzania (UMATI) and graced by Deputy Speaker of Parliament, Dr Tulia Ackson, participants heard the causes of unsafe abortion in Tanzania, including financial costs involved. Unsafe abortion represents one of the leading causes of maternal deaths in Tanzania.

According to the Ministry of Health and Social Welfare, 16 per cent of maternal deaths are due to complications from abortion; this is comparable to the proportion of maternal deaths from unsafe abortion in Eastern Africa (18 per cent).

Opening the workshop, Dr Tulia said that the government continues to address the issue of unsafe abortion to prevent maternal deaths and improve women’s health, saying that increasing access to family planning, intensifying family planning education and offering a wide range of methods and counseling can reduce the incidence of unsafe abortion and its consequences by preventing unintended pregnancies.

She said that it is critical to raise health care providers’ awareness of the content and scope of the Tanzanian abortion law and to equip them with appropriate training to provide safe abortion services within legally permitted circumstances.

“In 2018, an estimated 77,800 Tanzanian women received post abortion care, and public facilities provided 64 percent of this care, while another 114,300 women are believed to have required post abortion care but did not receive it,” said Umati Managing Director, Elifuraha Matafu.

He said that the total national cost associated with post abortion care in 2018 was estimated to be 10.4 bn/-, and that the majority of the total costs were incurred at midlevel facilities.

“Between facility fees and out-of-pocket expenses for supplies like ffod, each patient pays an average of 15,800/ for post abortion care, while costs to patients totaled 88.2mn/-,” said Matafu, citing figures obtained from the study conducted by the Guttmacher Institute. He said that regional hospitals had the highest annual post abortion care caseload, and district hospitals’ caseloads were the second highest.

“This situation highlights the need for the government to make deliberate efforts to provide these services at lower level facilities, which will reduce the need for women to travel to regional and district hospitals for care, thus minimizing congestion and patient costs,” he said.

In Tanzania, maternal mortality is estimated at 524 deaths per 100,000 live births.

Although slightly lower than the average rate in Sub-Saharan Africa (542 per 100,000), significant effort will be required to meet the SDG goal of reducing maternal mortality to under 70 per 100,000 live births by 2030.

Reducing unintended pregnancy is an important intervention for reducing maternal mortality. In 2013, the unintended pregnancy rate in Tanzania was estimated to be 93 per 1000 women of reproductive age.

Addressing the level of unsafe abortion occurring in the country will also be important for reducing maternal mortality. A recent estimate suggests that unsafe abortion accounts for 11% of national maternal mortality figures.

DID YOU KNOW? Mangi Meli

MANGI (Chief) Meli (or Mangi Meli Kiusa ...

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Author: ANTHONY TAMBWE

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