Abstract
Although abortion is legal in Zambia under a variety of broad conditions, unsafe abortion remains common. The purpose of this project was to compare the financial costs for women when they have an induced abortion at a facility, with costs for an induced abortion outside a facility, followed by care for abortion-related complications. We gathered household wealth data at one point in time (T1) and longitudinal qualitative data at two points in time (T1 and T2, three-four months later), in Lusaka and Kafue districts, between 2014 and 2015. The data were collected from women (n = 38) obtaining a legal termination of pregnancy (TOP), or care for unsafe abortions (CUA). The women were recruited from four health facilities (two hospitals and two private clinics, one of each per district). At T2, CUA cost women, on average, 520 ZMW (USD 81), while TOP cost women, on average, 396 ZMW (USD 62). About two-thirds of the costs had been incurred by T1, while an additional one-third of the total costs was incurred between T1 and T2. Women in all three wealth tertiles sought a TOP in a health facility or an unsafe abortion outside a facility. Women who obtained CUA tended to be further removed from the money that was used to pay for their abortion care. Women’s financial dependence leaves them unequipped to manage a financial shock such as an abortion. Improved TOP and post-abortion care are needed to reduce the health sequelae women experience after both types of abortion-related care.
Highlights
Zambia is relatively unique in sub-Saharan Africa for having an abortion law that allows abortions to be legally performed under broad circumstances
The data were collected from women (n = 38) obtaining a legal termination of pregnancy (TOP), or care for unsafe abortions (CUA)
Women who obtained CUA tended to be further removed from the money that was used to pay for their abortion care
Summary
Zambia is relatively unique in sub-Saharan Africa for having an abortion law that allows abortions to be legally performed under broad circumstances. Called termination of pregnancy (TOP), can be legally provided in Zambia on the grounds of health, economic distress and rape, when three registered medical practitioners have signed off that these conditions have been met.[1]. There exists a lack of awareness among providers and women alike about the situations in which abortion can be legally provided.[2,3,4,5] In addition, negative social attitudes about abortion, and difficulties reaching facilities, inhibit women’s access to safe services.[4,5,6] women take significant risks to terminate unwanted pregnancies. Zambia has an estimated maternal mortality ratio of 398 deaths per 100,000 live births,[7] with 30% estimated to be due to unsafe abortion.[8]
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