Geary CW, Gebreselassie H, Awah P, Pearson E. Attitudes towards abortion in Zambia. Int J Gynecol Obstet. 2012;118(Supp 2):S148–51. Contraception plays a crucial role in reducing the need for abortion services, and nearly half of women who received abortion treatment left the company using a method of contraception. Acceptance of contraceptives after abortion was better in health centres than in hospitals; However, contraceptive counselling and methods should be better integrated into all abortion services. If these women had tried to induce their own abortions or had instead turned to unsafe providers, it would be unlikely that they would have received advice on contraception or a method. However, when asked directly about their procedures, there were still women who wanted a method who left the facility without a method, and many who received a method said they “wanted to know more about family planning.” Article 21(2) (and perhaps Article 21(1)(e) above) above is clearly a step towards pro-choice. However, this provision is not a separate provision, as it is subject to what “any other written Act” says. This means that a woman has the right to choose whether to keep or terminate a pregnancy or not to get pregnant at all.
There would usually be no legal problems if she decided not to get pregnant at all. But if she becomes pregnant and decides to terminate her pregnancy, this right will only be protected if it does not violate the Bill of Rights, the Penal Code and the Abortion Act, all of which have been reviewed before. Integrated components of the comprehensive implementation of abortion care in Zambia Scientific introduction and expansion The study showed that trained mid-level providers can provide safe abortion services. However, a clarification of values seemed necessary to change the attitudes of many groups (e.g., providers, facility managers, the general public, pharmacists, and pharmacy staff) to improve abortion care and increase awareness of these services. Health workers continue to face resistance in their facilities, and management must continue to create an enabling environment for abortion care. In addition, a more open debate on safe and unsafe abortions at the community level by volunteers and the media will further normalize abortion care and place it in the context of basic maternal health care as a whole. Further efforts are needed to support and normalize abortion services and integrate them into the rest of the public health system. Although Zambia`s TOP Act was ratified in 1972, very little was done in the period following legalization to inform the public or improve access to services. The law itself was passed quietly and no technical guidelines were followed to facilitate implementation. Even today, most legislators and judges are not aware of the nuances of the TOP law [11]. In addition, dilation and curettage remained the outdated standard of abortion care for much of the three decades since the law was passed, long after World Health Organization (WHO) technical guidelines on abortion technologies recommended manual vacuum aspiration (MVA) and induced abortion drugs.
In the early 1990s, limited training for lawful dismissals was introduced in the country with material support from NGOs and USAID. [5, 29–31] However, due to a lack of funding and sustained government support, vast resource and infrastructure needs, and a loss of health workers in the early years of the AIDS crisis, access to legal abortions never went beyond the University Hospital (UTH), and by the mid-1990s, UTH was the only institution offering induced abortion services in the country [29, 31, 32]. Coast E, Murray SF. “These things are dangerous”: Understanding induced abortion processes in Zambia`s urban areas. Soc Sci Med. 2016;153:201–9. doi:10.1016/j.socscimed.2016.02.025. If it is instead the image of a liberal abortion law that allows abortion for broad socio-economic reasons that prevails, it is likely that medical professionals will feel safer and more comfortable performing legal abortions, including for socio-economic reasons. At the same time, however, the image of abortion law as liberal may distract from actual access to legal abortion services, as it focuses on legality rather than access. As a result, the image of a liberal law can lead to more confusion and distress among girls and women seeking abortion services. If a woman in a rural area gives the impression that Zambia has a liberal abortion law and wants a legal abortion in a district hospital, she runs the risk of being refused for several reasons.
The professional she meets may believe that the service is illegal or may have decided to make use of her conscientious objection, or the institution simply does not meet the required need for signatures. Confusion over the legal status of abortion emerged as a strong theme in our interviews, and health workers, activists, and policymakers highlighted how they encounter confusion about abortion law in their work. Speeches are powerful and determine what people believe to be true.[23] If the truths established by two contradictory discourses, on the one hand to the discourse of the Zambian liberal abortion law and on the other hand to the discourse of the restrictive law, confusion is likely to prevail. The impact of recent maternal health interventions on the incidence of unwanted pregnancies and unsafe abortions remains unclear. Early delivery is still very common, with nearly 60% of Zambian women giving birth at the age of 19 [9]. Young women in poor rural areas are the most affected by morbidity due to early births, are twice as vulnerable to complications during pregnancy as older women, and training opportunities that lift women and their families out of poverty are very limited [9]. Regardless of their education, socioeconomic status or place of residence, most Zambian women have more children than they originally wanted [9]. Although weak in its implementation, Zambia has one of the most liberal abortion policies of any country in sub-Saharan Africa. The Termination of Pregnancy Act 1972 (TOP) permits abortion in Zambia in the following circumstances: the pregnancy endangers the life of the pregnant woman; risk of harm to the physical or mental health of the pregnant woman; higher risk of harm to the physical or mental health of the woman`s existing children than in the case of an abortion; or if there is a significant risk of fetal malformations.
In addition, the law stipulates that if the evolution of a pregnancy presents a great risk, the pregnant woman`s environment or age may be taken into account [22]. Other amendments to the penal code allowed abortion in cases of rape and incest. Our results show that Zambia`s abortion law is an ambiguous law that leaves a lot of room for interpretation. Although the 1972 law appears progressive and allows abortion for socio-economic reasons, records show that the restrictive elements of the law were at the heart of the debates that led to its adoption. The same elements were reinforced by Zambia`s declaration as a Christian nation, which had important consequences for the willingness of health workers to participate in legal abortion services.
