Jessica Shearer

Estimates of Health Care System Costs of Unsafe Abortion In Africa and Latin America.

CONTEXT: Each year, 19 million unsafe abortions occur in developing countries, and an estimated five million women are treated for the resulting serious medical complications. Meanwhile, the economic impact of postabortion care on health care systems in Africa and Latin America is poorly understood (data for Asia are lacking). METHODS: Two main approaches were used to estimate the cost of postabortion care: calculating the average cost of care per patient, as represented in 20 empirical studies, and analyzing treatment costs using the WHO Mother-Baby Package model, which enumerates the costs of specific components of treatment related to postabortion complications. The average cost estimates from each approach were multiplied by the annual number of cases of hospitalization for postabortion care to generate regional cost estimates. Three methods (low severity, weighted severity, and inclusion of overhead and capital costs) were used to generate a range of perpatient and regional cost estimates. RESULTS: The average per-patient cost of postabortion care ranged from

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83 in Africa to

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94 in Latin America (2006 US

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); estimates based on the WHO Mother-Baby Package model were between

Costs of post‐abortion care in low‐ and middle‐income countries

57 and

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109 per case. The health system costs of postabortion care in the two regions combined ranged from

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159 million to

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333 million per year. The average estimates from the two approaches were similar:

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280 million and

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274 million, respectively. CONCLUSIONS: The costs of treating medical complications from unsafe abortion constitute a significant financial burden on public health care systems in the developing world, and postabortion complications are a significant cause of maternal morbidity. International Perspectives on Sexual and Reproductive Health, 2009,35(3):114-121 ********** Each year, an estimated 19 million unsafe abortions occur in the developing world, and around 66,500 women die from abortion-related causes. (1) In developing countries, an estimated five million women are treated annually for complications from unsafe abortion; (2) the cost of treating such complications burdens health care systems in these countries, where 97% of all unsafe abortions occur. (1) This treatment diverts scarce health resources and, as we will demonstrate, is more costly than the alternatives of safe abortion and contraceptive services. Therefore, quantifying the economic costs of unsafe abortion is critical for informing public policy. FRAMEWORK FOR ANALYSIS Unsafe abortion generates unnecessary costs to society on a variety of levels. A proportion of women who have unsafe abortions will experience complications; some of these women will seek care within the formal health care system, while many will seek care elsewhere or not at all (Figure 1). Where women obtain care determines who bears the direct medical costs. * In public facilities, costs may be shared between households and the government if fees are charged. The process of seeking care will also incur direct nonmedical costs, such as transport costs, which can be significant. (3), (4) [FIGURE 1 OMITTED] Women suffering from complications face three possible outcomes: survival with no long-term consequences, survival with long-term consequences or death. Each outcome generates indirect costs in the form of lost productivity, which will be borne by the households affected and, more broadly, by society. In economies with large pools of unemployed workers, these costs may be more easily offset at the societal level. That is, to the extent that unemployed persons take over the productive work not done by women who have suffered abortion complications, little or no net loss of productivity may be experienced by society. Indeed, even at the household level, some short-term productivity loss can be made up by the individuals themselves or by friends and family. However, long-term productivity losses cannot be offset at an individual or household level in the same way they can be at the societal level. …