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Induced abortion in Zambia: a comparativemixed methods analysis of women seekingsafe abortion with those seeking postabortioncare after an unsafe abortion

Coast, Ernestina, Vwalika, Bellington, Leone, Tiziana, Murray, Susan and Freeman, Emily (2015) Induced abortion in Zambia: a comparativemixed methods analysis of women seekingsafe abortion with those seeking postabortioncare after an unsafe abortion. In: XXI FIGO World Congress of Gynaecology and Obstetrics, 2015-10-04 - 2015-10-09. (Submitted)

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Abstract

Objectives: Induced abortion has been legal in Zambia since 1972. Levels of unsafe abortion remain high and it is estimated that 30% of maternal deaths are attributed to unsafe abortion. This study seeks to understand why the investment in safe abortion services is not being fully realised and meets this objective by answering three research questions: • How do the characteristics of women seeking safe abortion differ from women seeking care following an unsafe abortion? • What influences a woman’s decision making in abortion-seeking? • How do perceptions of risk and service access influence decisionmaking for abortion? Method: Hospital-based recruitment of women (n=112) presenting for either a safe induced abortion or post-abortion care following an unsafe induced abortion. Women were recruited, with informed consent, and were interviewed in-depth about their abortion-seeking experiences. The medical records for most women (n=96) were analysed to triangulate women’s own accounts of their care-seeking. The in-depth interview covered: socio-demographic characteristics; (non-)use of contraception; sources of abortion information; the influence of knowledge (law and abortion services) and risk; and, the role of others (partner, family, friends). Quantitative and qualitative data were collected. Qualitative data were analysed used framework analyses of verbatim translated transcripts. Results: Significant differences by socio-demographic characteristics; younger women (<20 years) and poorer women (lowest wealth quintiles) are more likely to seek an unsafe abortion. Social networks are important; women who knew someone who worked for the health service were more likely to be able to find out about safe abortion services. Women unable to disclose their pregnancy, and could not access information about safe services, were likely to resort to unsafe abortion, including: herbalists; non-registered doctors; and, purchase of medical abortion drugs under the counter. Low knowledge of abortion legality led to medical practitioner extortion of money for safe abortions. Conclusions: Zambian women are not accessing safe and legal abortion services because of low levels of knowledge. This is being exploited by registered doctors who extort money for services that should be provided for free. Increased population sensitisation of the circumstances under which safe abortion is available would decrease the use of unsafe abortions, and associated sequelae. Availability of medical abortion drugs in the retail sector mean that substantial proportions of women are self-inducing abortions without appropriate advice or support. The health system burden of post-abortion care following unsafe abortions could be reduced if women knew their rights.

Item Type: Conference or Workshop Item (Other)
Official URL: http://figo2015.org/
Additional Information: © 2015 The Authors.
Divisions: Social Policy
Subjects: H Social Sciences > HQ The family. Marriage. Woman
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RG Gynecology and obstetrics
Sets: Departments > Social Policy
Date Deposited: 21 Oct 2015 11:07
Last Modified: 09 Apr 2019 23:00
Projects: ES/I032967/1
Funders: Economic and Social Research Council
URI: http://eprints.lse.ac.uk/id/eprint/64070

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