Reducing the costs to health systems of unsafe abortion: a comparison of four strategies

Background and methodology 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 spreads heet-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. Discussion and 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.