Understanding the Ethiopian policy landscape on abortion services using a health policy triangle framework.

backgroundThe World Health Organization emphasises the importance of prioritising women’s health and rights in abortion policies. In 2005, the Ethiopian government revised the legal framework to expand the circumstances under which abortion is legally permitted. This study investigated and described the current policy landscape in Ethiopia over the last two decades.

methodsInformed by the Walt and Gilson health policy triangle framework, this study employed a complementary document content analysis and key informant interviews. In our study, a policy document was defined as a document that involved laws, policies, policy directives, national strategies, clinical guidelines, and working documents. To identify relevant policy documents, we searched the Ethiopian Federal Ministry of Health (FMoH) website, national academic institution platforms, and the grey literature. We also contacted stakeholders working at the FMoH to identify if there were relevant documents that had not been published online. Furthermore, we undertook key informant interviews with individuals actively involved in policy reform or implementation processes. Participants were selected using purposive sampling techniques. A semi-structured questionnaire was used during the interviews, and both deductive and inductive thematic analyses were employed. Findings are presented under four predetermined themes: context, actors, process, and content.

resultsEight policy documents were included in the final synthesis and analysis. Political transition, the government’s desire to avert high maternal deaths, and civil society pressures were key contextual factors that triggered the policy reforms. The Federal government, civil society and a few international organisations were frequently mentioned as actors in policy reforms. Following the 2005 legal reform that lessened the hurdles for receiving safe abortion services, the FMoH initiated a range of implementation programmes aimed at expanding abortion services to primary facilities and private sectors. Despite the enabling legal framework, access to abortion services remains challenging due to persistent stigma, lack of awareness about the legal provisions, and the burden placed on healthcare providers associated with policy dilemmas.

conclusionsEthiopia has made significant strides in liberalising abortion laws, but access to safe abortion services remains a major challenge. Comprehensive strategies that align with international reproductive health rights are recommended to improve policy implementation.