Estimating the incidence of induced abortion among women in refugee settings in Ethiopia.

Background: There is little evidence of the magnitude of unintended pregnancy and unsafe abortion in humanitarian settings, but the extent and consequences of unintended pregnancy and unsafe abortion are likely to be exacerbated among refugee populations. This study estimated the incidence of induced abortion among women in refugee settings in Ethiopia.

Methods: This study was conducted in 22 of the 24 refugee camps located in Ethiopia. We used data from a Health Facilities Survey (HFS) of 75 health facilities providing postabortion care (PAC) or safe abortion care (SAC) services within or outside the 22 refugee camps and a Knowledgeable Informant Survey (KIS) of 69 individuals knowledgeable about induced abortion among refugee populations. We estimated the annual postabortion caseload, the number of induced abortions, and the induced abortion rate per 1,000 women of reproductive age.

Results: We estimated that 9,044 (95% CI: 6,633 - 11,455) women in refugee settings received PAC across the 75 facilities in 2023, while some 2,946 (95% CI: 1,826-4,066) women received SAC. The overall induced abortion incidence rate among women in refugee settings living in camps in Ethiopia was estimated to be 38.3 per 1,000 women aged 15-49 years, with slight variations by region. The proportion of safe abortions obtained from the formal health system was 11.5% in all camps, with a slightly higher proportion of abortions estimated to take place within facilities in Western camps (12.9%) compared to Eastern and Northeastern camps (9.7%).

Conclusion: The study found that abortion incidence is high among women in refugee settings in Ethiopia, and only a small proportion of induced abortions were conducted through SAC services. There is an urgent need to improve family planning, SAC, and PAC services in refugee camps.