The costs of post-abortion care for Tanzania

There is a lot of misinformation and misconception when it comes to reproductive health and the use of family planning methods.

In the end this costs the government Sh10.4 billion per year for treating a woman with post abortion care.

Post-abortion care (PAC) is treatment and counseling for women who have endured abortions and miscarriages.

It includes curative care, such as treating abortion-related complications, as well as preventative care, such as providing birth control to prevent future unplanned pregnancies.

Post-abortion care reduces morbidity and mortality associated with abortion.

A recent study conducted by researchers from the Muhimbili University of Health and Allied Sciences (MUHAS) and the Guttmacher Institute presented new estimates on the total annual cost per client to the Tanzanian health system for providing post-abortion care services.

The research shows that in order for Tanzania to meet all needs for PAC, the cost would rise to Sh25.7 billion.

Health experts recommend some of the best ways the country can follow to avoid the maternal mortality cases as well as the costs that are incurred when treating a patient with PAC complications.

Dr George Ruhago, a lecturer of health economics at MUHAS, is among the health experts who conducted the study.

He says, more awareness on the importance of family planning is needed to avoid unnecessary PAC complications as none of the patients will disclose if they actually wanted to terminate their pregnancies soon as they visit the hospital for PAC.

“We all know access to safe abortion is highly restricted in Tanzania. The penal code is interpreted to allow abortion to save the life or preserve the mental and physical health of the woman. However, access to safe abortion services even for legally authorized reasons is extremely limited,” says Ruhago.

He adds that given the legal aspect, no woman will dare open up to health experts that she was struggling with abortion from home and as a result if failed and she is in danger of losing her life.

This translates to the need for more awareness on family planning to avoid unwanted pregnancies and reduce the number of mortality deaths.

Martina Ngoya*,35,(not her real name) says getting access to family planning education is still challenging to some age groups especially for both primary and secondary schools and even for some university students.

She recalls 15 years back when she joined university and went through a traumatic situation after finding out she had fallen pregnant.

She was not ready to have a child.

She never wanted to disappoint her parents.

She had no money to support her pregnancy or the baby.

She never knew how to count her menstruation circle.

She knew she could fall pregnant but knew nothing in detail.

Her former boyfriend suggested they go for an abortion at the health center.

They both agreed but they did not get what they wanted as the health expert who attended them caused her heavy pain and the abortion was unsuccessful.

“I will never be able to forget that pain. It has been 15 years but I still feel it to date. I screamed so much that the entire health center heard my voice. By that time I was bleeding heavily. They had to call a taxi to take me to the central office while bleeding,” says Ngoya.

As we left for the hospital, the health center staff warned me to stay silent soon as we arrive at the central hospital and they will tell them that she had an accident that made her over bleed and she needed PAC services urgently.

The lie helped out and she was admitted and got all the medical attention she required but learnt that had she has known better, she would have been more careful.

According to the study, Ngoya would be among the 77,800 Tanzanian women who received post-abortion care in 2018 in public facilities that provided 64 percent of this care.

Another 114,300 women are believed to have required post-abortion care but did not receive it.

The national average per-patient cost for post-abortion care at any type of facility was Sh134,000.

The study revealed that an estimated 77,814 women in Tanzania receive PAC every year.

An additional 114,272 women need this care but do not receive it.

The question then is where do the rest of the women who are unable to receive the PAC go for help?

Dr Living Colman, a gynecologist at the Muhimbili National Hospital, says there are eleven types of family planning methods that can help the government save costs if they invest well in educating the society on the best usage of it.

Mentioning the family planning methods he says, there are both hormonal and non-homornal contraceptive methods which include oral contraceptives pills, injectable, and implants.

They all work to stop a woman’s ovaries from releasing eggs or implantation taking place.

There are oral contraceptive pills that are for daily intakes and injectable contraceptives that are taken periodically, once every three or six months.

He also adds that there are emergency contraceptive pills that can help prevent pregnancy if taken within 76 hours after unprotected sex.

However the sooner one takes them the more effective they become.

Intrauterine contraceptive devices (IUDs or IUCDs) are another form of family planning.

They are small and flexible plastic devices that are inserted into the woman’s uterus.

Other methods are barrier methods for both male and female (condoms) tha physically block sperm from reaching an egg.

Fertility awareness methods require a couple to know the fertile days of the woman’s menstrual cycle which are the days when pregnancy is most likely to occur.

There is also withdrawal method which involves a man withdrawing his penis during sex and releasing his sperm outside and the last one is female and male sterilization which are the more permanent methods of contraception.

“Majority of these methods tend to have some discomfort which requires a patient to well informed to avoid unnecessary misinformation among our society. The discomfort has been blown out of proportion by the majority and as a result, people shun the use of family planning,” said Colman.

Tecla Simon, 38, is one of the many women that shuns family planning.

She says, she has tried several methods and almost each of them came with a lot of side effects except for condoms.

She recalls three years back when she decided to use the intra-uterine method and she bled for up to three times in a month.

The flow was not heavy and the blood not as red as it should be.

However, all this came with intense pain in her stomach.

“I reached out to my doctor who promised me that it will change after six months. There was no change after two months. To make it worse, I started experiencing sharp pain even when not menstruating. I had to open up to my husband who took me to the hospital to remove it,” adds Simon.

Dr Colman explains that it is normal for some women to react that way.

Not all bodies react the same with something new in their bodies.

She was supposed to look for another method that would work for her instead.

Adding to that he says, such complaints need to be addressed in to avoid all this negative feedback on family planning.

According to a 2013 study conducted by the Guttmacher Institute and partners in Tanzania, Tanzania’s abortion rate was 36 per 1,000 women aged between 15–49 years.

The majority of abortions were unsafe with nearly 67,000 women being treated in health facilities for post-abortion care (PAC)

The health system cost of providing PAC to manage complications from unsafe abortion can be significant

These costs are largely avoidable and can free up resources to be spent elsewhere.

The government is committed to improving access to life-saving PAC services, as a means of reducing maternal mortality.

Post-Abortion Care Costing Methodology (PACCM) was first piloted in 2008. In Sub-Saharan Africa, it has been used in Ethiopia, Uganda, Rwanda and Senegal.

It is a bottom-up, ingredients-based methodology for estimating costs to health system.

It relies on data provided by key informants at the facility level.

It yields cost estimates, rather than exact values.