Ethiopia’s new abortion and self-care guidelines: women can self-use abortion medication under ten weeks

When WHO launched the new Abortion Care Guidelines in 2022, the Ethiopian Ministry of Health started to think about updating their own guidelines in order to stay in line with global best practice.

​MSI Ethiopia was on the frontline of this advocacy. Teams engaged in key stakeholder interviews, bringing in expertise on abortion care in the humanitarian sector to advocate for the inclusion of humanitarian and outreach provisions in the guidelines.

MSI Ethiopia also advocated for the increased role of pharmacists and for steps to be put in place so women could self-use injectable contraception (Sayana Press) and self-manage medical abortion (MA). The Pharmacy Essential Drug List was updated in 2022 to permit pharmacists to prescribe MA medication, but women were not permitted to use the prescription until changes were reflected in the Self-Care Guidelines and Comprehensive Abortion Care Guidelines (CAC).

Both of the guidelines were reviewed in parallel. The Self-Care Guidelines took over two years for approval, as resistance to women self-injecting was prevalent in the Ministry of Health (MoH), and there was concern over the lack of local evidence. To combat the resistance, MSI and PSI conducted a research study. Despite a successful pilot in Addis Ababa, the Ministry was reluctant to roll this out beyond the capital.

The CAC Guidelines also took a lot longer than anticipated. Initially, the legal team in the MoH raised objections, claiming that they were not authorized to issue such guidelines and that the process should be led by the Ministry of Justice (MoJ). MSI Ethiopia undertook Values, Clarification, and Attitudes Training (VCAT) with key stakeholders to mitigate some of this opposition.

The Safe Motherhood Technical Working Group was organized into small groups to work on different parts of the guidelines, one of which was led by MSI’s Dr Nega, where the group reviewed and debated several drafts of the text.

The working group and consultants hired by the MoH signed off the guidelines in October 2023. However, it took a further ten months for the MoH to approve them, with legal experts claiming they should be opened up for public consultation. To overcome this opposition, the Coalition for Comprehensive Abortion Care (COCAC) (which includes MSI Ethiopia as an active member) stepped in to advocate to senior levels in the MoH for their approval and launch, including the Director for Maternal and Child Health.

The rise of anti-rights activity in Ethiopia

Ethiopia has one of the most liberal abortion laws in Africa, and MoH has always backed the law and collaborated well with partners to ensure it is fully operationalized. Despite this, Ethiopia is experiencing a massive increase in resistance and anti-rights activity, much of which is supported, funded, and amplified by far-right Christian groups in the United States.

Family Watch International, an anti-abortion group, has opened an office in Addis Ababa and is using social media, direct relationships, and evangelical church networks to directly and aggressively advocate to government officials to revoke the law and develop allies in the MoH.

Heartbeat International, who pioneered the use of pregnancy crisis centers in the US, has now exported the model to East Africa to spread abortion misinformation. They have links with a taxi driver who rents a room opposite an MSI Ethiopia facility, with the sole purpose of harassing clients and driving his taxi around covered in anti-choice messages. 

Though the updated guidelines are a huge step forward, we must remain vigilant to ensure anti-rights groups do not regress abortion provisions. 

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