The individual level cost of pregnancy termination in Zambia: a comparison of safe and unsafe abortion

Abstract

Zambia has one of the most liberal abortion laws in sub-Saharan Africa. However, rates of unsafe abortion remain high with negative health and economic consequences. Little is known about the economic burden on women of abortion care-seeking in low income countries. The majority of studies focus on direct costs (e.g. hospital fees). This article estimates the individual-level economic burden of safe and unsafe abortion care-seeking in Zambia, incorporating all indirect and direct costs. It uses data collected in 2013 from a tertiary hospital in Lusaka, (n = 112) with women who had an abortion. Three treatment routes are identified: (1) safe abortion at the hospital, (2) unsafe clandestine medical abortion initiated elsewhere with post-abortion care at the hospital and (3) unsafe abortion initiated elsewhere with post-abortion care at the hospital. Based on these three typologies, we use descriptive analysis and linear regression to estimate the costs for women of seeking safe and unsafe abortion and to establish whether the burden of abortion care-seeking costs is equally distributed across the sample. Around 39% of women had an unsafe abortion, incurring substantial economic costs before seeking post-abortion care. Adolescents and poorer women are more likely to use unsafe abortion. Unsafe abortion requiring post-abortion care costs women 27% more than a safe abortion. When accounting for uncertainty this figure increases dramatically. For safe and unsafe abortions, unofficial provider payments represent a major cost to women.This study demonstrates that despite a liberal legislation, Zambia still needs better dissemination of the law to women and providers and resources to ensure abortion service access. The policy implications of this study include: the role of pharmacists and mid-level providers in the provision of medical abortion services; increased access to contraception, especially for adolescents; and elimination of demands for unofficial provider payments.

Does supportive legislation guarantee access to pregnancy termination and postabortion care services? Findings from a facility census in Central Province, Zambia

“… 11 Economic and social costs are high, and the procedure is strongly socially stigmatised. 12 Women must often travel long distances to reach a health facility that can provide the procedure. There is a shortage of health providers: in Central Province, where our study took place, there is one medical doctor for every 111 648 people.…”

Factors Associated with Unsafe Induced Abortion among Women who attended Fitche Hospital, Oromia, Ethiopia: Cross-sectional study

“…This finding is approximately in line with study done in Zambia (39%). [14] However, it is lower than the finding of study conducted in Ghana (64.1%) and higher than the finding of study conducted in Mexico (16.5%). [12,25] The difference might be due to the economic inequality, educational level of women, and abortion policies of these countries.…”

“…Study conducted by Tiziana Leone also reported that poor women are more likely to practice unsafe abortion. [14] Study conducted in Mexico also revealed that socio-economic gradients have a significant association with practicing unsafe abortion, which means poorer women are more likely to have unsafe induced abortion than wealthy women. [12] So, women's economy level play important role in the health and outcomes of pregnancy.…”

“…[9,10] According to reports by different literature; socio-economic, educational level, lack of contraceptive methods, and contraceptive failure are mainly associated to unsafe induced abortion. [1,[11][12][13][14] Women who have low income are more likely to experience unsafe abortion than women who are 4 financially stable. [12][13][14][15][16] Nowadays, availability and accessibility of modern contraceptives are increasing in many countries including Ethiopia, although it varies according to the types of contraceptives.…”

Moving from legality to reality: how medical abortion methods were introduced with implementation science in Zambia

“…Until recently, legal abortion services have not been widely available in health centers or hospitals, compelling women to continue to turn to illegal providers and unsafe methods and confirming that just the existence of a law, with insufficient political will or guidance for implementation may not be effective in improving maternal health [ 6 , 10 – 12 ]. Unsafe abortion – the termination of an unintended pregnancy either by persons lacking the necessary skills or in an environment lacking the minimal medical standards, or both – contributes to 8-13% of global maternal mortality [ 13 , 14 ].…”