In Rwanda, Treating Complications from Unsafe Abortion Drains Scarce Health Resources

Greater Investment in Contraception Needed to Reduce Unintended Pregnancy


In 2012, approximately 18,000 Rwandan women required treatment for complications resulting from unsafe abortion, costing an estimated $1.7 million. The finding comes in a new study, "The Health System Cost of Post-Abortion Care in Rwanda," by researchers at the Guttmacher Institute, the University of Rwanda’s School of Public Health and the Rwandan Ministry of Health. The cost of treating complications from unsafe procedures was approximately 11% of total public spending on reproductive health, representing a significant drain on the country’s scarce health resources.

Most postabortion care costs were incurred at health centers ($705,000) followed by district hospitals ($519,000) and referral hospitals ($235,000). These estimated costs include both direct costs such as drugs, supplies, tests, medical personnel and hospitalization fees, and indirect costs for overhead and capital expenses. The study’s findings are based on data collected in April and May 2012 from 39 public and private health facilities selected to be nationally representative.

The researchers found that the average cost of treating a woman for complications was approximately $93 (62,000 Rwf), an amount considerably higher than the cost of providing a woman with modern contraceptive methods for one year. Although recent data on the cost of family planning services in Rwanda is unavailable, assuming the cost is similar to that of neighboring countries (about $30 or 20,000 Rwf per user), every franc spent on family planning could save the health system more than three francs in postabortion care costs that would be averted.

The majority of women were treated for incomplete abortion (75%), and smaller proportions were treated for more serious complications such as sepsis (13%) and shock (9%). According to a 2012 study, about one-third of women who experienced postabortion complications that required treatment did not receive the needed care in a health facility.

"Unsafe abortion poses a serious threat to Rwandan women’s health and lives. It also places a significant and unnecessary burden on Rwanda’s health care system," said Michael Vlassoff, the study’s lead author. "The vast majority of these abortions could be avoided by preventing unintended pregnancy, which is the root cause of most abortions. Family planning services must be expanded to ensure all Rwandan women are able to plan their pregnancies."

While Rwanda has made impressive progress in improving the proportion of married women using modern contraceptives, an estimated 47% of all pregnancies in the country were unintended in 2012. The study finds that more spending on family planning services to reduce unintended pregnancy would not only improve women’s health, but substantially reduce spending on postabortion care.

"The results of the study are very informative and will be used to continue the government’s efforts to improve maternal health in Rwanda," said Dr. Fidele Ngabo, Director of Maternal and Child Health at the Ministry of Health. "Until recently, abortion was legally permitted in Rwanda only when two physicians certified that it was necessary to save a pregnant woman’s life or protect her physical health. However, the May 2012 revision of the law also permits abortion in cases of fetal abnormality, rape, incest and forced marriage, so the country has already made progress on this issue. Moreover, the Ministry of Health is also extending postabortion care provision for all cases of abortion and increasing access to modern contraceptives."

"The Health System Cost of Post-Abortion Care in Rwanda," is available online at Health Policy and Planning.

For more information:

Facts on Abortion in Rwanda (also available in French and Kinyarwanda)

Unintended Pregnancy and Induced Abortion in Rwanda: Causes and Consequences (also available in French)