Reducing the costs to health systems of unsafe abortion: a comparison of four strategies.
METHODS
Strategies to reduce health systems costs of providing abortion and post-abortion care while simultaneously improving quality of care are well documented but infrequently applied. We created 'Savings', a spreadsheet-based tool that allows policymakers and other stakeholders to estimate and compare the feasibility and sustainability of different strategies of providing abortion and post-abortion care. By applying cost data primarily from Uganda, we showed the per-case costs under four policy and service delivery scenarios.


RESULTS
The mean per-case cost of abortion care (in US dollars) was $45 within the setting that placed heavy restrictions on elective abortion and used a conventional approach to service delivery; $25 within the restrictive legal setting that used recommended interventions for treating complications; $34 within the legal setting that allowed elective abortion and relied on a conventional approach to service delivery; and $6 within the liberal legal setting that used recommended interventions.


CONCLUSIONS
Using recommended technical interventions substantially reduced costs regardless of the legal setting. The greatest reduction in costs (86%) occurred from using recommended interventions within a liberal legal setting rather than using conventional interventions within a restricted setting. These findings should support policy and practice efforts to reform abortion laws and to offer accessible, safe abortion services.
Johnston
Heidi B
HB
ICDDR,B, Public Health Sciences Division, Dhaka, Bangladesh. hjohnston@icddrb.org
Gallo
Maria F
MF
Benson
Janie
J
D000028:Abortion, Induced / Q000009:adverse effects / Q000191:economics*; D003363:Cost Control / Q000379:methods; D003695:Delivery of Health Care / Q000191:economics* / Q000458:organization & administration; D005260:Female; D006801:Humans; D017146:Models, Organizational; D011247:Pregnancy; D014454:Uganda