title: Medical abortion and manual vacuum aspiration for legal abortion protect women's health and reduce costs to the health system: findings from Colombia.
abstract: The majority of abortions in Colombia continue to take place outside the formal health system under a range of conditions, with the majority of women obtaining misoprostol from a thriving black market for the drug and self-administering the medication. We conducted a cost analysis to compare the costs to the health system of three approaches to the provision of abortion care in Colombia: post-abortion care for complications of unsafe abortions, and for legal abortions in a health facility, misoprostol-only medical abortion and vacuum aspiration abortion. Hospital billing records from three institutions, two large maternity hospitals and one specialist reproductive health clinic, were analysed for procedure and complication rates, and costs by diagnosis. The majority of visits (94%) were to the two hospitals for post-abortion care; the other 6% were for legal abortions. Only one minor complication was found among the women having legal abortions, a complication rate of less than 1%. Among the women presenting for post-abortion care, 5% had complications during their treatment, mainly from infection or haemorrhage. Legal abortions were associated not only with far fewer complications for women, but also lower costs for the health system than for post-abortion care. We calculated based on our findings that for every 1,000 women receiving post-abortion care instead of a legal abortion within the health system, 16 women experienced avoidable complications, and the health system spent US $48,000 managing them. Increasing women's access to safe abortion care would not only reduce complications for women, but would also be a cost-saving strategy for the health system.
authors.affiliation: Assistant Professor, Oregon Health & Science University, Portland, OR, USA. Electronic address: rodrigma@ohsu.edu.
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: Rodriguez
authors.affiliation: Manager and Director, ESE Clínica de Maternidad Rafael Calvo, Cartagena, Colombia.
authors.forename: Willis Simancas
authors.initials: WS
authors.lastname: Mendoza
authors.affiliation: Medical Specialist in Obstetrics and Gynaecology, Hospital General de Medellín, and Medical Doctor, Profamilia, Medellín, Colombia.
authors.forename: Camilo
authors.initials: C
authors.lastname: Guerra-Palacio
authors.affiliation: Director, Grupo de Investigación y Docencia, Facultad de Ciencias Economicas, Universidad de Cartagena, Cartagena, Colombia.
authors.forename: Nelson Alvis
authors.initials: NA
authors.lastname: Guzman
authors.affiliation: Associate Professor, Oregon Health & Science University, and Founder, Global Network for Perinatal & Reproductive Health, Portland, OR, USA; and Coordinator, FUNDARED-MATERNA, Bogotá, Colombia.
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Tolosa
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use; D000028:Abortion, Induced / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D000029:Abortion, Legal / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D000328:Adult; D000554:Ambulatory Care Facilities; D003105:Colombia; D003661:Decision Support Techniques; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D018166:Health Care Reform; D006771:Hospitals, Maternity; D006801:Humans; D016595:Misoprostol / Q000627:therapeutic use; D011247:Pregnancy; D014619:Vacuum Curettage; D016387:Women's Health
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol
keywords: Colombia; decision analysis; dilatation & curettage (D&C); health care costs; medical abortion; post-abortion care; unsafe abortion; vacuum aspiration abortion