Case study: Unsafe abortion in Zambia

Author

Dr Stephen Mupeta
Zambia Clinical Services Manager
Unsafe abortion is a major issue here in Zambia. And the consequences are devastating for our young women. The Ministry of Health estimates that it’s the cause of nearly one-third of maternal deaths in the country, with young women particularly at risk.
Yet here in Zambia, we have some of the most liberal abortion laws in sub-Saharan Africa. On the surface, it doesn’t make sense. 

Barriers to accessing safe services

Speak to anyone in Zambia, however, and you begin to piece together the complex set of reasons that make so many women risk their lives to end unwanted pregnancies. You hear how many women don’t realise the procedure is legal.
 
You hear about providers’ prejudices that mean women aren’t always offered the services they should be – even women who get the courage to go to a health centre for a safe abortion can be turned away by providers due to personal beliefs.
 
You hear about the limited number of places that women can go to access a safe abortion. And about the shortage of medical staff, which makes getting permission from three physicians, as stated in the Zambian law, nearly impossible.
 
You also realise just how widespread the problem is. You find that most people know of a friend, or a friend of a friend who’s been injured – or worse still died – as a result of an unsafe abortion.
 
The stories are shocking: cassava roots, sticks and wire hangers forced into women’s own uteruses; herbs and poisons ingested; and women who’ve thrown themselves down stairs or attempted other physical injury. Women, and girls, go to extraordinary lengths in an attempt to end pregnancies in secret. Often they know how risky it might be, but they do it anyway.

Educating communities and increasing access

We’re working to change this – firstly by preventing unplanned pregnancies from happening, and secondly by tackling barriers that prevent women from accessing safe services.
 
We’re educating communities about the voluntary family planning and safe abortion services that we provide using modern, internationally recognised methods that are also recommended by the local ministry of health standards and guidelines.
 
And through our seven outreach teams, we’re taking contraception to communities which have previously had no access to it – mainly the rural areas of Zambia and densely populated slum areas of major cities. We offer the full range of contraceptive methods – short term, long term and permanent methods.

Partnering with others

We’re also partnering with others who believe that this situation cannot continue. For example, youth groups, specifically to reach those most at risk. Through a partnership with Africa Directions, we’ve been able to reduce the number of women turning to unsafe abortion in the Mtendere and surrounding compounds in Lusaka.
 
Using sport, drama and group activities as a platform to broach sensitive issues, and counteract the hearsay, we’re showing women exactly what their options are.