Comparing women’s financial costs of induced abortion at a facility vs. seeking treatment for complications from unsafe abortion in Zambia

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.

Cost of Utilising Maternal Health Services in Low- and Middle-Income Countries: A Systematic Review

“…Ten studies were published between 2000 and 2010 25,27,28,38,39,41,48,[51][52][53] while the remaining 26 were published post-2010. 26,[29][30][31][32][33][34][35][36][37]40,[42][43][44][45][46][47]49,50,[54][55][56][57][58][59][60] Figure 2 shows the geographical distribution of LMICs having at least one published study on the cost of maternal health service utilisation. Fifteen lowincome countries have published costing studies focused on maternal health service utilisation.…”

“…This includes three each in Nepal 42,46,53 and Tanzania, 37,41,52 two each in Ethiopia 32,55 and Mali, 40,57 and one each in Benin, 51 Burkina Faso, 38 Madagascar, 43 Pakistan, 36 and Rwanda. 50 Twenty lowermiddle income countries have published costing studies including nine studies published on India, 25,[28][29][30]33,34,47,48,56 four studies in Nigeria, 27,45,49,59 two each in Bangladesh, 31,39 and Zambia, 58,60 and one each in Ghana, 51 Kenya, 41 Lao PDR, 44 and Morocco. 54 One study was conducted in an upper-middleincome country, South Africa.…”

“…25,28,30,31,35,37,47,49,51,59 Five studies focused on cost of utilising PNC 25,28,30,31,49 with another five costing the use of safe abortion or PAC. 27,32,55,58,60 Two studies costed utilisation of at least one of the nondelivery-related EmOC signal functions. 26,40,51 Details of the services for which utilisation costs have been reported in each study are presented in the data extraction sheet attached as Supplementary file 3.…”

“…35,[37][38][39][40]51,54,59 Thirteen studies were conducted within a single facility. 26,33,36,[42][43][44][45][46]48,55,56,58,60 Quality Assessment of Included Studies Quality assessment of included studies is detailed in Supplementary file 4. Seventeen studies were assessed as high quality.…”

“…Seventeen studies were assessed as high quality. 25,26,30,34,36,37,40,42,44,46,47,[50][51][52]54,58,60 Fourteen studies were assessed to be of average quality. 29,[31][32][33]38,39,41,43,45,49,53,55,57,59 Five studies were judged to be of low quality.…”