Perception towards Dilatation and Evacuation and Associated Factors among Abortion Service Providers in Ethiopia: A Cross Sectional Study

Affiliations

¹Department of Gynecology & Obstetrics, University of Global Health Equity, Rwanda

²Department of Reproductive Health, University of Gondar, Ethiopia

3 CIRHT Ethiopia, Senior Clinical Advisor, Addis Ababa, Ethiopia

⁴Department of Gynecology & Obstetrics, Wollo University, Ethiopia

*corresponding author

Email address

Birhanu Abera–birhanua31@gmail.com

Abebawu Addis -abebaw.addis@gmail.com

Abebawu Gebeyehu-gabebaw2worku@gmail.com

Yonas Getachewu -gyonas06@yahoo.com

Mulat Adefris- mulatadefrisw@gmail.com

Melkamu Abetea - ateklu72@gmail.com

Alula Teklu - melkamuab@gmail.com

 

 

 

 

 

 

 

 

Abstract

Background:

Globally, over 42 million abortions are performed annually, 10–15% of which occur in the second trimester. More than half of these are unsafe and disproportionately contribute to maternal mortality. In Ethiopia, medical abortion is the most commonly used method for second-trimester termination. However, dilatation and evacuation (D&E), which may be a better alternative in certain clinical scenarios, remains underutilized.

Objective:

To assess the perception of D&E in second-trimester abortion and identify associated factors among abortion service providers in Ethiopia

Methodology:

A facility-based cross-sectional study, complemented by a qualitative component, was conducted among gynecologists and obstetricians across Ethiopia

Result:

A total of 165 providers participated. Among them, 39 (23.6%) had never performed a safe second-trimester abortion. Of these, 7 (17.9%) cited fear of complications as the main reason. Only 38 (23%) had received specific training on D&E. Among those who had performed D&E, 38 (46.9%) reported challenges such as inadequate pain management and lack of appropriate materials. Barriers to providing D&E included lack of experience (39, 46.43%) and the perception that D&E is as unsafe as medical methods (38, 45.2%). A small number of participants considered D&E a "barbaric" procedure.

Overall, 111 participants (72.1%, 95% CI: 64.9%–81%) had a favorable attitude towards D&E for second-trimester abortion. However, multivariable analysis revealed no statistically significant factors associated with provider perception.

In the qualitative component, all respondents acknowledged a role for D&E in second-trimester abortion care, though opinions varied on its extent. Only one respondent advocated for D&E to have a role equal to medical abortion; the others supported its use as a backup method when medical abortion fails or is contraindicated.

Conclusion:

Most abortion service providers in Ethiopia hold a favorable view of D&E and acknowledge its potential positive contribution if carefully introduced. Further assessment of the socio-cultural context is essential, along with strategic interventions at all levels, to prevent unintended consequences and ensure integration without compromising existing services

Keywords: 

Dilatation and Evacuation, Provider Perception, Second Trimester Abortion, Ethiopia