Post-abortion care services in Zambian health facilities: a qualitative study of users' experiences and perceptions

Author:

Lubeya Mwansa Ketty1,Munakampe Margarate Nzala2,Mwila Meek3,Makasa Musonda1,Mukosha Moses4,Jacobs Choolwe5,Phiri Christabel Chigwe6,Vwalika Bellington1,Sichone Victor7,Mangala Benedictus8,Haketa Melisa3,Kumwenda Andrew9,Kaonga Patrick9

Affiliation:

1. University of Zambia, School of Medicine

2. University of Zambia School of Public Health

3. Young Emerging Scientists Zambia

4. University of Zambia, School of Health Sciences

5. University of Zambia, School of Public Health

6. Levy Mwanawasa University Teaching Hospital

7. Kitwe Teaching Hospital

8. Zambia Association of Gynecologist and Obstetrician

9. University of Zambia

Abstract

Abstract Background: Despite attempts to increase Universal Health Coverage, availability, accessibility, acceptability and quality-related challenges remain barriers to receiving essential services by women who need them. We aimed to explore the experiences and perceptions of women receiving post-abortal care services in Zambia, within a human-rights framework. Methods: A qualitative case study was conducted between August and September 2021 in Lusaka and Copperbelt provinces of Zambia. Fifteen (15) individual interviews with women seeking post-abortion care services were` conducted using audio recorders; transcribed data was analyzed using thematic analysis. Results: We report women's experiences and perceptions of the healthcare system, their experiences of abortion, and healthcare-seeking behavior. We used the availability, accessibility, acceptability, and quality (AAAQ) framework to understand how women claimed their right to healthcare as they sought and utilized abortion care services. Women who experienced spontaneous abortions delayed seeking health care by viewing symptoms as 'normal pregnancy symptoms' and not dangerous. Women also delayed seeking care because they feared the negative attitudes from their communities and the health care providers towards abortion in general, despite it being legal in Zambia. Some services were considered costly, impeding their right to access quality care. Conclusions: Women delayed seeking care compounded by fear of negative attitudes from the community and healthcare providers. To ensure the provision and utilization of quality abortion-related healthcare services, there is a need to increase awareness of the availability and legality of safe-abortion services, the importance of seeking healthcare early for any abortion-related discomfort, and the provision and availability of free services at all levels of care should be emphasized.

Publisher

Research Square Platform LLC

Reference23 articles.

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3. World Health Organisation. Why we need to talk about losing a baby. [cited 2022 Jan 30]. Available from:https://www.who.int/news-room/spotlight/why-we-need-to-talk-about-losing-a-baby Frederiksen LE, Ernst A, Brix N, Lauridsen LLB, Roos L, Ramlau-Hansen CH, et alRisk of adverse pregnancy outcomes at advanced maternal age Obstetrics & Gynecology, 131 (3) (2018), pp. 457–463 Bearak J, Popinchalk A, Ganatra B, Moller A-B, Tunçalp Ö, Beavin C, et al. Unintended pregnancy and abortion by income, region, and the legal status of abortion: Estimates from a comprehensive model for 1990–2019 The Lancet Global Health, 8 (9) (2020), pp. e1152-e116.

4. Coast E, Murray SF. "These things are dangerous": Understanding induced abortion trajectories in urban Zambia. Soc Sci Med [Internet]. 2016 Mar 1 [cited 2022 Jan 30];153:201–9.Available from: https://www.sciencedirect.com/science/article/pii/S0277953616300806.

5. Leone T, Coast E, Parmar D, Vwalika B. The individual level cost of pregnancy termination in Zambia: a comparison of safe and unsafe abortion. Health Policy Plan [Internet]. 2016 Sep 1 [cited 2022 Jan 30];31(7):825–33. Available from: https://doi.org/10.1093/heapol/czv138.

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