"They come when you build it": the impact of introducing a model abortion clinic on safe abortion care access expansion in Ethiopia.

Current strong evidence supports that making abortion legal, safe, and accessible significantly reduces unsafe abortion-related maternal morbidity and mortality. We conducted a decade-long (2009 - 2019) trend-analysis study of safe abortion care and post abortion care services in relation to introduction of a new abortion clinic at St. Paul's Hospital in Ethiopia. There were 9491 total abortions (6449 post-abortion care cases and 3042 safe abortion cases) during the study period (between September 2009 to August 2019). Following the opening of a model abortion clinic, access to safe abortion care significantly increased, and post-abortion care abortion service dominance was replaced by safe abortion care. Before the introduction of the clinic in 2016, only 1 in 3 abortions were safe abortions, the rest being post-abortion care cases. During the years 2017-2018 and 2018-2019, safe abortion care increased to 6 in 10 and 7 in 10 of all comprehensive abortion care provided, respectively. This "They come when you build it" effect on the trends of safe abortion - a paradigm shift of post-abortion care into safe abortion care - can be implemented in other Sub-Saharan settings.