The Zambia Association of Gynaecologists and Obstetricians (ZAGO) rolled out Implementation of 2022 WHO Guidelines on Self-Management of Abortion. The project, with the support from the Ministry of Health and the International Federation of Gynaecology and Obstetrics (FIGO) is a one-year being implemented in three Provinces: Eastern, Copperbelt, and Lusaka Provinces – covering ten (10) districts: Chipata, Petauke, and Sinda; Kitwe, Ndola, Chingola, and Mufulira; and Lusaka, Kafue, and Chongwe districts.

ZAGO began project implementation with onsite debrief to Provincial Health Office (PHO) teams in Eastern, Copperbelt and Lusaka Provinces.

The organisation shared with PHO teams details of the project, emphasising that the project is based on successful implementation of the “Zambia Prevention of Unsafe Abortion” project which gains should be strengthened. The ZAGO team further stressed that the current project seeks to advocate for self-managed abortion (medical abortion) using scientifically approved drugs, and therefore falls within the legal abortion framework.

The debriefs also included statistics on maternal mortality arising from unsafe abortions – which the project seeks to reduce further by employing strategies in order to increase access to safe abortion services among women and girls. The ZAGO team highlighted some of the challenges and barriers faced by women and girls in accessing the service – which could be addressed through self-managed abortion. It was emphasized that the project would identify and remove any unforeseen barriers to safe abortion service, with the aim to contribute to further reduction of morbidity and mortality arising from unsafe abortions. The PHO teams were assured that the project will be implemented within the confines of the law.

ZAGO further highlighted that the overall bearing of the project is to reduce maternal deaths in Zambia arising from unsafe abortions. The PHO teams were also briefed that the aspect of monitoring and evaluation would be taken very seriously throughout the project: with reporting to be done quarterly. During the implementation phase, ZAGO would be working closely with district CAC focal persons and DHIOs for data reporting. PHOs would be responsible to identify persons to conduct onsite visits and mentorship on behalf of ZAGO.

The Eastern PHO team welcome the project with high expectations, given the high number of cases of teenage pregnancies and unsafe abortions in the province. The team urged ZAGO to work closely with traditional leaders, among other stakeholders in order to increase awareness and impact of the project – stressing that ZAGO has a critical role to play in promoting reproductive health rights.

The Copperbelt Province Health team expressed optimism about the efficacy, and potential impact of the project insofar as reducing existing maternal morbidity and mortality is concerned. The team however shared with ZAGO major challenges such as unavailability of medical supplies in health facilities, which could potentially affect project sustainability if not attended to. It was stressed that, obviously, when implementing an advocacy project, one of the expected outcomes is the rising number of people accessing a service. However, the absence of drugs in health facilities could affect build-up of the project narrative and sentimental value.

The Lusaka Province Health Office team was delighted that the project had started off. The team shared how Chipata, Matero and Mtendere townships recorded the highest cases of unsafe abortions between 2019 and 2020, which cases have since dropped due to awareness campaigns.

The Lusaka team further hoped that the trainings, particularly of healthcare providers would be done within the legal and ethical boundaries to avoid unscrupulous individuals taking advantage of the good cause to continue charging clients seeking the service.

The Zambia Self-Managed Medical Abortion project comes at a right time when barriers to accessing safe and legal abortion are still many, forcing women and girls to seek unsafe abortions. Self-managed abortion care therefore presents many opportunities through which such barriers could be overcome. Following debrief meetings with Provincial Health Office teams, ZAGO learnt valuable insights and lessons to help remodel the formular and realign implementation strategy. For example, ZAGO was not aware of the local council as part of the key stakeholders. With this new information, ZAGO is now able to reposition itself with regard to stakeholders as the project is being implemented.