At Jemo Health Centre on the outskirts of Addis Ababa, health worker Tewodros Tibebu says social stigma and limited awareness continue to delay access to comprehensive abortion care, despite Ethiopia legalizing broad abortion services more than two decades ago.

Tibebu, who has worked in comprehensive abortion care for four years, is among only three trained providers currently delivering the service at the facility. According to his account, many patients arrive after significant delays, often seeking help only after complications emerge from procedures carried out elsewhere.

“The biggest challenge is stigma,” Tibebu said in a feature published by the World Health Organization on May 5. “Many women are afraid someone will recognize them when they come here. Others do not even know the service exists.”Comprehensive abortion care has reportedly been available at Jemo Health Centre for nearly a decade.

However, Tibebu said access barriers remain widespread, particularly for women seeking confidential and medically supervised treatment.According to his account, many patients first visit private clinics where procedures may be carried out by practitioners lacking formal training in abortion care. By the time some women reach public facilities such as Jemo, they are already suffering from infections or sepsis that could have been prevented through earlier medical intervention.

Ethiopia expanded legal access to abortion in 2005 under revised provisions that allowed the procedure under broader circumstances than previously permitted. Despite the legal framework, health care providers and reproductive health organizations have continued to report uneven access across regions, driven by social stigma, provider shortages and gaps in public awareness.

Tibebu said the stigma surrounding abortion services affects providers as well as patients. “Some coworkers oppose the comprehensive abortion care department,” he said. “Some people in my community do not know what I do.”The social pressures attached to abortion care are a recurring issue in reproductive health systems globally, particularly in countries where legal reforms have outpaced shifts in public attitudes or health infrastructure.

Health workers often face professional isolation, ethical scrutiny and personal criticism while providing services that remain politically and culturally contested.Tibebu said professional training helped him better understand both the clinical and ethical dimensions of abortion care. “Before, it was difficult,” he said.

“After I received specific training, I understood the work differently and could provide the care women need.”The experiences described by Tibebu formed part of a broader announcement by the Human Reproduction Programme, known as HRP, regarding a new international training initiative on comprehensive abortion care.

The programme, launched through the WHO Academy platform, combines four separate learning modules focused on medical abortion, surgical abortion, post-abortion care and human rights integration in comprehensive abortion care. According to HRP, the courses are designed to provide modular and interactive learning environments that simulate real clinical decision-making scenarios encountered by frontline health workers.

WHO said the training initiative is intended to strengthen evidence-based care and improve consistency in abortion services across different health systems. The programme also places emphasis on privacy, non-discrimination and accountability within clinical practice.

The human rights integration component links medical treatment with broader principles related to patient dignity and access to care, according to WHO. Together, the courses are intended to establish a standardized framework for providers working in comprehensive abortion care settings.The launch reflects continuing international efforts by global health organizations to reduce preventable maternal complications associated with unsafe abortion procedures.

WHO has repeatedly stated in policy guidance that access to trained providers, accurate information and safe clinical environments are central to reducing maternal morbidity and mortality.At facilities such as Jemo Health Centre, providers say the gap between legal availability and practical access remains significant.

Tibebu noted that many patients learn about the service only through informal networks and word-of-mouth referrals rather than official health campaigns or referrals from primary care systems.That reliance on informal communication channels, he said, contributes to delays that can worsen medical outcomes.

The WHO feature also highlighted the operational pressures facing providers in facilities with limited staffing. With only three trained workers handling abortion care services at Jemo, workloads remain concentrated among a small number of clinicians.

Training programmes such as the one launched by HRP are intended in part to address those shortages by expanding provider knowledge and strengthening clinical capacity. WHO said the interactive nature of the courses allows health workers to engage with practical decision points similar to those encountered during patient care.

The organization has increasingly used digital and modular learning systems to expand access to specialized medical training, particularly in lower-resource health settings where formal clinical education opportunities may be limited.Tibebu said the training reinforced his understanding of abortion care not only as a technical medical service but also as direct patient support during periods of vulnerability and medical risk.

“People may not understand what we do,” he said. “But when you think about the woman in front of you, the decision is clear. You are helping someone.”WHO separately announced a webinar linked to the comprehensive abortion care learning programme scheduled for April 28, 2026.

The organization also published updated abortion-related fact sheets in December 2025 as part of its broader reproductive health guidance materials.The HRP programme operates jointly under the United Nations Development Programme, the United Nations Population Fund, the United Nations Children’s Fund, WHO and the World Bank, focusing on research, policy development and training in human reproduction and reproductive health services.

A growing body of research has linked exposure to per- and polyfluoroalkyl substances (PFAS) with adverse reproductive outcomes, including reduced sperm counts, prompting concern among residents in Bentham after blood tests revealed elevated levels of the chemicals. For some individuals, these findings have provided a possible explanation for longstanding health uncertainties.

One resident, Stephen, described the results as offering a form of clarity, saying they answered questions he had been grappling with regarding fertility issues.Scientific analysis of the Bentham blood samples has intensified scrutiny.

Dr David Megson, a forensic environmental scientist at Manchester Metropolitan University, compared the results with PFAS levels typically observed in the United States population and reported unusually high concentrations.

He stated that a majority of those tested exceeded average background levels, with approximately two-thirds falling within the highest five percent and a significant proportion surpassing levels normally recorded in population studies.

He characterized the findings as unexpected and markedly elevated relative to established benchmarks.Dr Shubhi Sharma, representing the environmental organization Chem Trust, described the detected PFAS concentrations as concerning, noting that existing research has associated these substances with a range of adverse health outcomes, including certain cancers.

However, the interpretation of such data remains contested within regulatory and industrial frameworks.Angus Fire, a manufacturer of firefighting foams with operations linked to the area, has disputed interpretations of the blood data.

A company spokesperson stated that there is no internationally standardized method for interpreting PFAS blood test results and emphasized the lack of consensus regarding the relationship between measured blood levels and specific health outcomes.

The company further argued that it is unfounded to characterize the Bentham results as unusually high within a UK context, pointing to the limited size of the tested group and cautioning against drawing definitive conclusions.

Residents have also raised concerns about environmental exposure pathways. Lindsay Young, who reported a PFAS level of 30 ng/ml, described routine fire testing activities at the Angus Fire site, stating that warning sirens often preceded the arrival of dense smoke in nearby residential areas.

She noted that the composition of the emissions was not disclosed to the community, contributing to uncertainty about potential health risks.In response, Angus Fire stated that it conducts routine fire tests as part of ensuring the effectiveness of firefighting products and maintained that such activities have been carried out responsibly.

The company added that it ceased testing PFAS-containing foams at the Bentham site in 2022 and asserted that historical operations at the facility were not the sole source of PFAS contamination in the surrounding environment.

An internal report by the Environment Agency in 2024 identified airborne emissions from foam testing as a potential pathway for PFAS exposure. The report indicated that aerial dispersal during testing could lead to contamination affecting both workers and nearby residents. It suggested that chemicals released into the air could settle over surrounding land, potentially entering soil and water systems and subsequently affecting locally grown produce.

Tony Fletcher, an epidemiologist at the London School of Hygiene and Tropical Medicine, noted that elevated PFAS levels among individuals with no direct occupational link to the factory pointed to community-wide exposure. He explained that airborne particles generated during foam testing could travel beyond the immediate site, eventually depositing onto land and entering food and water sources, thereby creating indirect exposure routes.

Regulatory oversight of these activities remains fragmented. The Environment Agency stated that fire testing was not covered under the site’s environmental permit, placing responsibility for regulation with local authorities. However, North Yorkshire council indicated that such testing activities were exempt from provisions of the Clean Air Act 1993 due to the company’s association with firefighting operations, which otherwise restrict emissions of dark smoke from commercial premises.

The issue of PFAS contamination extends beyond Bentham, with similar concerns emerging in other regions. Fletcher is part of a scientific advisory panel working with the Jersey government following contamination of private drinking water supplies linked to firefighting foam use at an airport.

The panel has recommended that individuals with elevated PFAS levels, particularly women of childbearing age and those above certain thresholds, may be considered for medical interventions.These include the use of colesevelam, a cholesterol-lowering medication shown in some cases to reduce PFAS concentrations in the body, as well as therapeutic blood removal as a secondary option.

Fletcher indicated that individuals in Bentham concerned about elevated PFAS levels could consult healthcare providers to explore these approaches, though such measures remain subject to clinical judgment.

Angus Fire acknowledged concerns related to historical operations and stated that it has been working with environmental consultants and regulatory authorities to assess the extent of contamination.

The company emphasized that its activities have adhered to existing regulatory guidelines and noted ongoing efforts to better understand the environmental impact of PFAS associated with its operations.

The absence of standardized international thresholds for PFAS exposure and the limited consensus on health implications continue to complicate regulatory and medical responses.

While emerging research has strengthened associations between PFAS and various health risks, officials and industry representatives maintain that further evidence is required to establish definitive causal relationships and to guide policy and enforcement frameworks.