Direct and opportunity costs of comprehensive abortion care for women living in humanitarian settings in the Amhara Region, Ethiopia

Providing comprehensive abortion care (CAC), including induced abortion and post-abortion care (PAC), poses a financial challenge, particularly in humanitarian settings. Unsafe abortions and the costs of PAC impose a significant health and economic burden. This study aimed to assess the direct and opportunity costs of CAC for women in humanitarian settings.

A stratified sampling approach was used to select 31 public health facilities in the conflict-affected northern Amhara region of Ethiopia. Structured surveys were administered to 1,642 women aged 13–49 who received care for induced abortions and incomplete abortions between September 2023 and March 2024. Direct costs were assessed for termination attempts, facility visits, post-procedure needs, and re-visits, alongside opportunity costs based on local daily wages.

The total direct cost for women undergoing all stages of CAC, including termination attempts, transportation, drugs, diagnostic tests, and caregiver expenses, was ETB 7,416.8 (US$134.16). Direct costs for the facility visit and post-procedure period were ETB 3,273.4 (US$59.21). Opportunity costs totalled ETB 2,024 (US$36.61). Incomplete abortions (ETB 8,540.8, US$154.5) were costlier than induced abortions (ETB 7,282.3, US$131.7). Women treated in general hospitals incurred the highest costs (ETB 11,038.0, US$199.7), while costs were lowest at primary hospitals (ETB 7,635.8, US$138.1).

Women in humanitarian settings in the Amhara Region face significant financial burdens when seeking CAC, despite availability through public services. The burden is pronounced for those treated for incomplete abortions. These findings highlight the need for policy measures to reduce financial barriers and ensure equitable access to safe, affordable abortion care.