A new report on post-abortion care (PAC) says government spends, on average, $1.7 million (about Rwf1.1 billion) on treatment for complications resulting from unsafe abortion. 

The research finding, released last week, was conducted by the Guttmacher Institute in New York, in partnership with the University of Rwanda’s School of Public Health and the Ministry of Health. 

The researchers used 2012 data from 39 public and private healthcare facilities across the country and sampled 18,000 women who reported to health facilities with abortion defects. 

"We found that the average annual PAC cost per client, across five types of abortion complications, was $93 (about Rwf62,000). The total cost of PAC nationally was estimated to be $1.7 million per year, 49 per cent of which was expended on direct non-medical costs,” the report says.  

Satisfying all demands for PAC would raise the national cost to $2.5 million (about Rwf1.1bn) per year. 

It also adds that post-abortion care consumes a significant share of total expenditure in reproductive health and proposes investing more resources in provision of contraceptives to prevent unwanted pregnancies. 

The study says 75 per cent of women who reported to health facilities with post-abortion complication were treated for incomplete abortion and smaller proportions were treated for serious complications such as sepsis (13 per cent) and shock (9 per cent). 

The cost of treating complications from unsafe procedures was about 11 per cent of total public spending on reproductive health, representing a significant burden on the country’s health resources. 

Cost breakdown

Most post-abortion care costs were incurred at health centres (Rwf479 million), followed by district hospitals (Rwf353 million) and referral hospitals (about Rwf160 million), the report says.

The estimates include both direct costs such as drugs, supplies, tests, medical personnel and hospitalisation fees, and indirect costs for overhead and capital expenses. 

Lead author Michael Vlassoff said abortion poses a significant and unnecessary burden on Rwanda’s healthcare system. 

"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 women are able to plan their pregnancies,” said Vlassoff. 

The director of maternal and child health in the Ministry of Health, Dr Fidele Ngabo, said Rwanda is making progress on handling cases of post-abortion treatments. 

"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 foetal abnormality, rape, incest and forced marriage. The ministry is also increasing access to modern contraceptives,” said Ngabo.

The head of communication in Rwanda Biomedical Centre, Nathan Mugume, told The New Times that government has policies in place to reduce unwanted pregnancies. 

"We have a new curriculum on reproductive health and schools have matrons to help girls with necesary information on reproductive health,” Mugume said.