The toll on women is clear, but health care systems also suffer

The cost of unsafe abortion to women’s health is heartbreakingly clear: worldwide, an estimated 5 million women are hospitalized each year for treatment of abortion-related complications. About 68,000 women die annually from unsafe procedures carried out in unhygienic conditions or by people who lack proper training and skills.

What’s less clear is how much unsafe abortions cost health care systems—and whether providing access to safe and legal methods of abortion can reduce health system costs.

PATH’s safe abortion team is looking at these questions and has carried out research in two developing regions with markedly different approaches to abortion services: Mexico City and Vietnam.

In Mexico City, battling the costs of complications

Until 2007, when first-trimester abortion was legalized, access to legal abortion was restricted in Mexico City. Much easier to obtain were illegal abortion services—some safe, some unsafe.

Unsafe abortions can lead to serious complications, including incomplete abortion, hemorrhage, infection, and uterine perforation. All of these problems require treatment, and often hospitalization. In addition, Mexican women, like others in Latin America, have begun to use an over-the-counter drug to induce abortion. Once the bleeding begins, they seek treatment.

Before the reform of Mexico City’s abortion law, PATH and our partners collected data from three public hospitals and a private clinic to estimate the costs to the health care system of restricting access to abortion. The cost assessment included both direct costs—charges for medical personnel, drugs, and supplies, for example—and indirect costs—the money women themselves lost through missing work and paying for child care and transportation.

In 2004, about 92 percent of women who arrived at the health facilities after an abortion were treated for incomplete abortions. The cost of their treatment varied both by facility and the method used to complete the procedure. On average, costs of treating incomplete abortion ranged from US$46 to $143.The average costs of treating women with severe complications were much higher, ranging from $601 to $2,140.

Next, the research team looked at ways the health care system potentially could reduce costs. For example, they estimated that if the complication rate for unsafe abortions in Mexico City—7.9 percent—was reduced to the complication rate in parts of the world where abortion is safe and legal—1.1 percent—the health care system could save as much as $600,000 a year.

Further, the research team concluded that by using less expensive approaches for treating incomplete abortion and improving access to safe and legal abortion, Mexico City hospitals could save as much as $1.6 million a year.

In Vietnam, expanding services with costs in mind

In Vietnam, abortion is legal and widely available. Most procedures are performed using manual vacuum aspiration (MVA) or, to a lesser extent, dilation and curettage (D&C). Relatively few women have access to medical abortion (MA), a nonsurgical method which uses medicines to induce abortion.

Working with the Ministry of Health, PATH researchers set out to estimate the cost of providing medical abortion, develop a pricing strategy for the method, and provide cost data to help Vietnamese health officials make decisions on expanding the availability of medical abortion.

The researchers found that, as in Mexico City, costs varied depending on the health care facility and procedure. In general, though, the cost of medical abortion proved higher than more invasive surgical procedures. The price of the drugs raised the cost of the method, the researchers found. Also adding to the cost was some Vietnamese physicians’ use of ultrasound before medical abortion, a test that does not harm women but is not required.

The researchers concluded that the price of medical abortion might be brought closer in line with surgical procedures if the government works to lower the price of the drugs and encourages doctors not to use ultrasound unnecessarily.

Now, the Ministry of Health is considering adding medical abortion to services offered at district-level health care facilities, giving women a safe and legal option that also keeps costs in check.

Photo: Courtesy of the David and Lucile Packard Foundation.