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Reducing the costs to health systems of unsafe abortion: a comparison of four strategies
  1. Heidi B Johnston, PhD, Social Scientist1,
  2. Maria F Gallo, PhD, Researcher and
  3. Janie Benson, DrPH, Vice-President, Research and Evaluation2
  1. ICDDR,B, Public Health Sciences Division, Dhaka, Bangladesh
  2. Ipas, Research and Evaluation, Chapel Hill, NC, USA
  1. Correspondence to Dr Heidi Johnston, ICDDR,B, Public Health Sciences Division, Mohakhali, Dhaka 1212, Bangladesh. E-mail: hjohnston{at}


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 spreadsheet-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.

  • abortion
  • costs
  • economics
  • post-abortion care
  • reproductive health services

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