At the onset of the Self-managed medical abortion care project, ZAGO felt the need to understand the parameters surrounding issue. To this end, ZAGO conducted two baseline surveys in ten (10) target districts to collect data on barriers to self-managed medical abortion, while the second survey was aimed at assessing the knowledge, attitudes and practices of the healthcare providers on self-managed medical abortion. The two surveys were critical to the project, as the findings would inform activities for implementation.

With specific objectives in mind, ZAGO thus conducted training of key data collectors to undertake the task. The data collectors were drawn from all the ten target districts, tasked to collect information from 31 healthcare facilities. The data collectors had specific objectives, inter alia:

1. To document the knowledge of the providers on self-management of medical abortion
2. To determine the attitudes of the providers towards self-management of medical abortion
3. To determine the practices of providers with regards to self-management of abortion

While for the barriers survey, the data collectors had the following objective:

1. To document the specific barriers to self-management of abortion
2. To review the barriers and strategize on overcoming them

Data was collected in three provinces: Copperbelt, Eastern and Lusaka, covering ten (10) target districts and thirty-one (31) health facilities. These districts and facilities were selected based on the high caseload of abortion clients that seek the service, and the availability of trained CAC providers in the health facilities.

The survey questionnaire for the barriers assessment contained two sections: one for hospital (health facility) and another one for the community level. Respondents for both were purposively selected. A formatted hard copy questionnaire was used. The questionnaire was administered by trained CAC providers, and in some cases, respondents self-administered the questionnaire.

A total of 78 CAC Providers/facility managers provided responses for the hospital/health facility section, while 78 community members provided responses for the community section. The community members included members of the Safe Motherhood Action Group (SMAGs), Community Based Distributors (CBDs), Community Health Workers (CHWs) and women/girls who had received medical abortion care service.

Regarding the KAP survey, the questionnaire was online-based using kobo toolbox. The questionnaire was administered by CAC trained providers, and/or sometimes self-administered. The respondents were purposively selected, and included medical officers, medical licentiates, clinical officers, midwives and general nurses. A total of 82 CAC providers were interviewed/responded to the questionnaire.

The KAP survey found that that 68.3% of healthcare providers had high knowledge; 78% had positive attitude while only 42.7% of healthcare providers had good practice towards self-managed medical abortion. The survey revealed that some health facilities only had one healthcare provider trained to provide abortion care services to women and girls.

For the barrier assessment survey, 95% of the facilities did not have telemedicine services for women and girls; 74.7% had no option for virtual appointment with healthcare provider to discuss options and prescribe medical abortion. In addition, more than three-quarters (76.0%) of the facilities offer options to take first medication (Mifepristone) at home. About 37% of CAC providers indicated that there are no job aids in place to support the provision of self-managed abortion care, while more than three-quarters (86.7%) indicated that there are no information materials on self-managed abortion care for clients to read and take home. This implies that provision of safe abortion care is not guaranteed as providers do not have reference materials. At the same time, women and girls do not have adequate information on self-managed medical abortion since there are no reading materials available in the health facilities.

On drugs, 86.7% of the health facilities have no adequate stocks of mifepristone as well as misoprostol for provision of safe self-managed abortion. The erratic supply of medical abortion drugs has serious consequences on the effectiveness of the self-managed medical abortion advocacy project.

Regarding provision of staff training on self-managed abortion to help women and girls handle medical abortion at home and to self-assess effectiveness, two-thirds (66.7%) of providers have not received training. 37% indicated that clients pay for abortion services, especially if drugs are out of stock. The amounts range from K250 to K1,000 depending on reasons given for seeking an abortion. The charges are a huge barrier to accessing safe abortion services, with some women opting to get illegal and unsafe abortion services from traditional healers and quacks where cost is far much lesser than in health facilities.

For the community respondents, (54.7%) indicated that women and girls consider self-managed abortion care socially acceptable, 66.7% prefer having consultation by phone on taking drugs to manage the abortion; and more than three-quarters (76.0%) prefer taking medication for abortion at home rather than in the health facility.

Furthermore, about (50.7%) of the respondents believed that woman and girls would prefer assessing the effectiveness of medical abortion at home rather than in the health facility and more than three-quarters (80.0%) thought that there are reasons why woman or girl may not be able to receive self-managed abortion care from a facility, even if they are eligible.

Majority (84.0%) indicated that in cases were the facilities are unable to provide self-managed abortion care services, women and girls are referred to other facilities providing services in an appropriate and timely way. However, almost three-quarters (73.3%) reported that there are no trained community health volunteers that provide health education on self-managed abortion care services.