Between February 2002 and January 2004 in the Adigrat Zonal Hospital, covering one-fifth of the large Tigray region of North West Ethiopia, there were 907 admissions with a diagnosis of abortion. Among these, 521 were induced by traditional, unsafe methods.1 Unsafe abortion was the leading cause of admission, accounting for 12.6% of all bed occupancy throughout this general hospital and 60.6% of the gynecological admissions. About 57% of patients admitted with unsafe abortions had serious complications, including tubo-ovarian abscess, vaginal laceration, uterine perforation, generalised peritonitis and renal failure. Three women died from complications of unsafe abortion. Five years later in the same hospital, between July 2009 and September 2010 unsafe abortion cases had declined, becoming the tenth cause of hospital admission. There were no deaths and no severe complications.

This remarkable change in a poor rural area, with a weak infrastructure and where half of all women are illiterate, was the outcome of a pilot project testing whether all levels of health providers could be trained to provide medical abortion and to refer appropriately. The Comprehensive Abortion Care (CAC) project, conducted in the Tigray region of NW Ethiopia, was a partnership between the Regional Health Bureau, Venture Strategies Innovations and the Bixby Center for Population, Health and Sustainability at the University of California, Berkeley, USA.

In most of sub-Saharan Africa abortion remains illegal, but nevertheless abortion abounds, and it is a major cause of maternal mortality and morbidity. In 2005, …