Unsafe Abortion in Sierra Leone: An Examination of Costs and Burden of Treatment on Healthcare Resources

Objectives: Maternal mortality in Sierra Leone is one of the highest in the world and complications from unsafe abortion are one of the leading causes. This article reports the results of a 2012 study to assess the impact and costs of treatment of abortion complications on the country’s public health system, and estimate the costs of a shift to safe, legal abortion. Methods: Records of postabortion care (PAC) cases treated in 19 public hospitals in 2011 were reviewed to estimate the number of cases and clinical severity of presenting complications. Personnel time and amounts of supplies and medications to treat PAC cases were estimated by a panel of 16 experienced health care providers and applied to cost information from Ministry of Health records and international sources. The cost of safe abortion services was based on a team of experienced abortion provider estimates of time and supplies needed to provide first trimester induced abortion services. Results: Deaths from unsafe abortion made up 10% of maternal mortality with a high abortion case-fatality rate of 1.73%. An estimated 3,379 women were treated for abortion complications in the hospitals, 21% of whom presented with clinically-moderate or severe complications. The proportion of cases with clinically moderate or severe complications was 32% at rural secondary facilities, compared to 18% at urban secondary facilities. The mean per-PAC-case cost overall was USD 68. Sierra Leone Government spends an estimated USD 231,000 annually to treat women with abortion complications in public hospitals. This cost could be reduced by an estimated 53% with a shift to safe induced abortion service provision. Conclusion: Unsafe abortion creates an undue treatment and economic burden on the health system of Sierra Leone. A shift to safe, legal abortion would dramatically reduce the current costs of PAC.