Research conducted by the Zambia Association of Gynaecologists and Obstetricians (ZAGO) reveals that in every five women who have had a termination of pregnancy, one is an unsafe.
ZAGO had embarked on a research in the second quarter of this year to understand “determinants, health care service provision barriers and facilitators and patients perceptions and experiences regarding abortions” in selected health facilities in Lusaka and Copperbelt Provinces.
Findings for Ndola and Kitwe were disseminated on Friday, November 19, while for Lusaka would be disseminated on Tuesday and Wednesday, November 23 and 24 respectively.
During the dissemination of the findings for Ndola and Kitwe, ZAGO President Dr Swebby Macha informed journalists at a media breakfast in Kitwe that the findings revealed that unsafe abortions were more prevalent in highly-density areas, among unmarried woman, and among those with little or no knowledge that health facilities provide safe abortion services at no cost.
Dr Macha said unsafe abortions still remained high on the Copperbelt Province generally.
“Our research findings included 364 participants (overall for Lusaka and Copperbelt Provinces respectively) and revealed that the prevalence of unsafe abortions is 20.1%, meaning in every five (5) women having a miscarriage or abortion, one (1) is abortion unsafe. Approximately 60 % of all participants, translating to 3 in every 5 women were not aware that safe abortion is legal in Zambia. We further had in depth interviews with 15 women to understand their experiences and perceptions of abortion related health care services. Using the Acceptability, Accessibility Availability and Quality framework for understanding the ways in which women claimed their right to healthcare as they sought and utilized abortion care services, it was revealed that women delay to seek health care because they fear the negative attitudes from their communities and the health care system towards abortions care in general, despite it being legal. Also, some services are viewed as costly, with a high out of pocket expenditure, therefore impeding on their right to access quality health care,” the findings revealed which were disseminated by Dr Mwansa Lubeya on behalf of the Association President Dr Macha. Dr Lubeya is also ZAGO Vice-Publicity Chairperson.
“For women who experienced spontaneous abortions, health-seeking delay because most women consider “pregnancy complication symptoms” as normal and not dangerous. This study further revealed that women used various herbal medications or concoctions, sticks and sharp objects to terminate pregnancies in their communities (unsafe).”
Dr Macha called for increased public awareness on the legality of safe abortion services in order to prevent increasing numbers of unsafe abortions.
“We recommend the need to consider incorporating CAC services into the pre-service training to ensure that more trained and skilled providers are available in all health facilities,” stressed Dr Macha.
ZAGO was motivated to embark on this critical research by the findings of previous studies indicating that an estimated one in every five pregnancies worldwide ends up as an abortion, of which approximately 40% are carried out under unsafe conditions.
The World Health Organisation (WHO) define an unsafe abortion as termination of pregnancy carried out by either an unskilled individual or in an environment that does not meet the minimum medical standards or both. Unsafe abortion rates have been reported to be high in low income settings such as sub Saharan Africa (SSA) to which Zambia belongs due to several factors including poor health seeking behaviour, stigma, poor knowledge regarding laws on abortions etc.
According to SDG 3.8, Attaining Universal Health Coverage entails the provision of services to all that need them, in the right packages and without financial strain.
In Zambia, the abortion law known as the Termination of Pregnancy (ToP) Act was passed in 1972 and allows for a woman to have a termination of pregnancy or abortion in a prescribed facility with a trained provider given the right circumstances. There are a number of legal frameworks that support provision of abortion services in Zambia. These include the Republican constitution, the Maputo protocol, the Penal code and other documents developed by the ministry of health.