The cost of unsafe abortion in Uganda: a study using decision analysis

Joseph Babijo, University of Washington

Background: The demand for induced abortions in Uganda is high despite legal and moral proscriptions. Abortion seekers usually go to illegal, hidden clinics where procedures are performed in unhygienic environments by under-trained practitioners. These abortions, which are usually unsafe, lead to a high rate of severe complications and use of substantial, scarce healthcare resources. This study was performed to estimate the costs associated with induced abortions in Uganda. Methods: A decision tree was developed to represent the consequences of induced abortion and estimate the costs of an average case. Data were obtained from a primary chart abstraction study, an on-going prospective study, and the published literature. Societal costs, direct medical costs, direct nonmedical costs, indirect (productivity) costs, costs to patients, and costs to the government were estimated. Monte Carlo simulation was used to account for uncertainty. Results: The average societal cost per induced abortion (95% credibility range) was $177 ($140 to $223). This is equivalent to $64 million in annual national costs. Of this, the average direct medical cost was $65 ($49 to $86) and the average direct non-medical cost was $19 ($16 to $23). The average indirect cost was $92 ($57 to $139). Patients incurred $62 ($46 to $83) on average while government incurred $14 ($10 to $20) on average. Conclusion: Induced abortions are associated with substantial costs in Uganda and patients incur the bulk of the healthcare costs. This reinforces the case made by other researchers – that efforts by the government to reduce unsafe abortions by increasing contraceptive coverage or providing safe, legal abortions are critical