Unsafe abortion is common in Senegal, but postabortion care (PAC) is not accessible to some women who need it, and the cost to the health care system of providing PAC is unknown.
The cost to Senegal's health system of providing PAC in 2016—at existing service levels and if access were hypothetically expanded—was estimated using the Post-Abortion Care Costing Methodology, a bottom-up, ingredients-based approach. From September 2016 to January 2017, face-to-face interviews were conducted with PAC providers and facility administrators at a national sample of 41 health facilities to collect data on the direct and indirect costs of care provision, as well as the fees charged to patients. A sensitivity analysis was conducted to examine the precision of the results.
In total, 1,642 women received PAC at study facilities in 2016, which translates to 18,806 women receiving PAC nationally. Public facilities provided nearly all services. The average cost per patient at study facilities was US$26.68; nationally, the estimated cost was US$24.72. The estimated total national cost of providing PAC at existing levels was US$464,928; direct costs accounted for more than three-quarters of the cost. Charges to PAC patients amounted to 20% of all incurred costs. If service provision had been expanded to meet all PAC needs, estimated total costs to the health system would have been US$804,518.
The annual costs of PAC are substantial in Senegal. Greater investment in ensuring access to contraceptives could lower these costs by reducing the number of unintended pregnancies that often lead to unsafe abortion.
Naomi Lince-Deroche and Onikepe Oluwadamilola Owolabi are senior research scientists, Emma Pliskin is senior research assistant and Akinrinola Bankole is senior fellow—all at the Guttmacher Institute, New York. Ibrahima Sene is affiliated with the African Bureau for Consulting and Management, Dakar, Senegal.
This study was made possible by grants to the Guttmacher Institute from The William and Flora Hewlett Foundation and the Dutch Ministry of Foreign Affairs. The views expressed in this article are those of the authors and do not necessarily reflect the positions and policies of the donors. The authors would like to acknowledge the contributions of Michael Vlassoff, who conceptualized the PACCM and designed this study protocol; unfortunately, he passed away in 2016 and was not able to complete this work. The authors would also like to acknowledge Alioune Diallo, who helped conceptualize the study protocol, and Bocar Daff, who helped with local study approvals.