World Health Organization
World Health Organization (WHO) defines unsafe abortion 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”(1). It is estimated out of 210 million pregnancies that occur each year, 80 million are unintended, which is a root cause of induced abortion (2,3). Abortion is one of the direct causes of maternal deaths which accounted for 7.9 percent of the deaths globally(4). Of the 42 million pregnancies that end in induced abortion each year; 20 million are unsafe(5).
In Africa, 5.5 million women had unsafe abortion in every year. Millions of them experienced long and short-term morbidity and disability, while around 36,000 of the women who had unsafe abortion died from the procedure(2). In Ethiopia, though maternal mortality declined during the past decades, women are still dying from unnecessary causes of death. The major causes of maternal death are primarily pregnancy related and preventable, six percent of all maternal deaths were attributable to complications from abortion (FMoH 2010). Unsafe abortion, one of the unnecessary causes of death could be prevented easily(6).
Earlier 2005, abortion was allowed in Ethiopia if only two physicians, one of them Gynecologist, decided that the pregnancy could endanger the woman’s life(7). Otherwise, it was not allowed to practice induced abortion for any other reason. However, it was the revised family law article 551, which came with the legalization of terminating pregnancy by a recognized health institution, within the acceptable time and acceptable reasons. The reasons included in the proclamation were, if she became pregnant through rape or incest, has physical or mental disabilities, would be putting her life or physical health at risk if she continues her pregnancy, or is younger than 18 and physically or mentally unprepared for childbirth (8).
The reform or legalization of terminating pregnancy which represents a step towards reducing maternal mortality in Ethiopia has resulted in the expansion of comprehensive abortion care(9). In addition comprehensive abortion care is mandatory in countries like Ethiopia where half a million of pregnancies ended in abortion annually. In spite of this, only 181, 812 clients received safe abortion care in 2013/14(10). Comprehensive abortion care includes components of post abortion care(PAC) which are treatment, counselling, contraceptive and family planning services, reproductive and other health services, and community and service provider partnership plus induced abortion for legally indicated pregnancies(5).
Health care providers who acquired basic knowledge and skill during preservice training and who get period updates through on the job training can effectively discharge their responsibility(11–14). This works for abortion which is not a complex procedure. Therefore, it is not must obstetricians or surgeons should be available to perform comprehensive abortion care. In a number of settings with appropriate training and support midlevel health workers like nurse and midwives can provide safe abortion and PAC safely(5,15–17). However, study revealed that in east Africa women are restricted from accessing abortion services due to shortage of health providers trained in comprehensive abortion care(18).
So far, studies done in Ethiopia focused mainly on meet need, the cause, magnitude, and distribution of abortion services, and patient satisfaction. In addition, while several studies have examined comprehensive abortion care, much of them are small pocket studies and there is limited information available about level of health workers clinical knowledge on comprehensive abortion care and its determinant factors. Therefore, this study was aimed to investigate level of health workers clinical knowledge on comprehensive abortion care and its determinant factors in Ethiopia