These things are dangerous

Understanding induced abortion trajectories in urban Zambia

Bibliographic Data

ID4600631
AuthorsErnestina Coast (0000-0002-8703-307X, London School of Economics and Political Science, corresponding author), Susan F Murray (0000-0003-0093-3815, King's College London)
Year2016
Volume153
Pages201-209
Publication date2016-03-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueSocial Science & Medicine (JOURNAL)
Journal identifiersISSN: 0277-9536 • E-ISSN: 1873-5347
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2016.02.025
PMID26921835
OpenAlexW2275931567
LanguageEN
Citations received33
References cited42

Unsafe abortion is a significant but preventable cause of global maternal mortality and morbidity. Zambia has among the most liberal abortion laws in sub-Saharan Africa, however this alone does not guarantee access to safe abortion, and 30% of maternal mortality is attributable to unsafe procedures. Too little is known about the pathways women take to reach abortion services in such resource-poor settings, or what informs care-seeking behaviours, barriers and delays. In-depth qualitative interviews were conducted in 2013 with 112 women who accessed abortion-related care in a Lusaka tertiary government hospital at some point in their pathway. The sample included women seeking safe abortion and also those receiving hospital care following unsafe abortion. We identified a typology of three care-seeking trajectories that ended in the use of hospital services: clinical abortion induced in hospital; clinical abortion initiated elsewhere, with post-abortion care in hospital; and non-clinical abortion initiated elsewhere, with post-abortion care in hospital. Framework analyses of 70 transcripts showed that trajectories to a termination of an unwanted pregnancy can be complex and iterative. Individuals may navigate private and public formal healthcare systems and consult unqualified providers, often trying multiple strategies. We found four major influences on which trajectory a woman followed, as well as the complexity and timing of her trajectory: i) the advice of trusted others ii) perceptions of risk iii) delays in care-seeking and receipt of services and iv) economic cost. Even though abortion is legal in Zambia, girls and women still take significant risks to terminate unwanted pregnancies. Levels of awareness about the legality of abortion and its provision remain low even in urban Zambia, especially among adolescents. Unofficial payments required by some providers can be a major barrier to safe care. Timely access to safe abortion services depends on chance rather than informed exercise of entitlement

Abortion · Business · Environmental health · Family medicine · Family planning · Government (linguistics · Health care · Medical emergency · Political science · Population · Pregnancy · Psychological intervention · Qualitative research · Receipt · Sociology · Unsafe abortion · Adolescent Sexual and Reproductive Health · Global Maternal and Child Health · Law · Medicine · Nursing · Reproductive Health and Contraception

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