Background Despite the advancements in health technologies

Despite the advancements in health technologies, health evidence and human rights justification for providing comprehensive abortion care, unsafe abortion remains a major public health concern. According to the WHO, Each year, 22 million unsafe abortions are performed; nearly all of them (98%) occur in developing countries, resulting in the death of approximately 47 000 women. Some 5 million women suffer injury as a result of complications due to unsafe abortion, often leading to chronic disability (Best Practice, 2015). In addition, globally, one in seven women will face a complication during pregnancy or childbirth. There are over 500 000 maternal deaths each year, 99% of which occur in the developing world (Inter agency field manual, 2010).

Ethiopia is one of developing country with disproportionately high morbidity and mortality as compared to their counterparts in other parts of the world. It is estimated that there are 3.27 million pregnancies in Ethiopia every year, of which approximately 500,000 end in either spontaneous or unsafely induced abortion (Technical and Procedural Guidelines for Safe, 2006). Furthermore, the major causes of maternal death in Ethiopia are primarily pregnancy related and preventable, six percent of all maternal deaths were attributable to complications from abortion (FMoH 2010).

Lack of access to adequate family planning services is a major contributor to the problem of unsafe abortion. Conversely, unwanted pregnancy and, in many cases, unsafe abortion are prime indicators of the unmet need for safe and effective family planning services (Inter agency field manual, 2010). Globally, 222 million women would like to prevent or delay pregnancy but have no access to contraception. Meeting this need would allow women to control their own fertility and reduce maternal deaths by one third (Best Practice, 2015).

Availability of comprehensive abortion care services at all levels of the healthcare system, including medical abortion, has the potential to increase access to safe abortion thereby reducing the burden of unsafe abortion (Ndola Prata etal 2013). However, in Ethiopia, achievement in meeting the comprehensive abortion care needs of the population is poor, and less than one quarter of the recommended number of facilities can provide all of these essential services (Ahmed Abdella, 2013). In addition, Ethiopian women face major obstacles in attaining comprehensive abortion care (Neesha Goodman etal 2008).

Abortion is not a complex procedure, a range of providers, including nurses and midwives are competent to deliver abortion services safely in a number of settings (Best Practice, 2015). Comprehensive abortion care services need was not dependent on the availability of obstetricians or surgeons, with appropriate training and support midlevel health workers can safely provide safe abortion and PAC services (Inter agency field manual, 2010), (Patty Skuster_ WHO, 2015). Safe abortion services and post abortion care, offered by well-trained providers are fundamental to accelerated progress in women’s reproductive health and well-being (Janie Benson etal 2017). In order to effectively discharge their responsibilities, providers should acquire basic knowledge and skills during their preservice training and get periodic updates through on-the-job training. (Technical and Procedural Guidelines for Safe, 2006), (SJ Etuk etal 2003), (Willingness of RHP 2015), (Manohar Pradhan etal 2016).

However, study revealed, shortage of health-care providers trained in comprehensive abortion care is severely restricting women’s access to abortion (lancet 2016). Most maternal deaths are due to a failure to get skilled help in time to address complications of pregnancy and delivery (Inter agency field manual, 2010).

So far studies done in Ethiopia have focused mainly on meet need, the cause, magnitude, and distribution of abortion services, and patient satisfaction. In addition, while several studies have examined comprehensive abortion care, much of them are small pocket studies and there is limited information available about level of health workers clinical knowledge on comprehensive abortion care and its determinant factors in Ethiopia. Therefore, this study was aimed to investigate level of health workers clinical knowledge on comprehensive abortion care and its determinant factors in Ethiopia.