Zambia abortion survey report : incidence and determinants of abortion in Zambia.

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Likwa, Rosemary Ndonyo
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Abortion remains the major risk factor to maternal morbidity and mortality in many parts of Africa and more so in the Zambian situation, even though the level of its incidence is still uncertain. Despite Zambia having the most favourable and liberal abortion law in Africa, morbidity and mortality that have accounted for unsafe abortion remain a major reproductive health challenge, demonstrating gaps in application of abortion law compounded by institutional and socio-cultural barriers, as social norms of Zambian societies. The purpose of a national abortion survey in Zambia was to estimate abortion incidence ratio rate and examine its determinants in order to better understand the magnitude of unsafe abortion and seek further approaches for improving safe abortion services and other related reproductive health services in the country. Specifically, it involved collecting annual abortion data, from June 2008 to May 2009 in major referral hospitals, alongside determining abortion complications by demographic characteristics in relation to age, education, occupation, marital status, religion, parity and method used for abortion over a period of six months. The other objective was to examine the mode of abortion practice and its occurrence by type of abortion complications, as whether legal, unsafe (illegal practice), or spontaneous abortion prevalent at the health facilities. Aretrospective cross sectional hospital-based survey was conducted to review 4174 abortion case records over a period of six months, January to June 2009, in four major hospitals of Kitwe Central, Ndola Central, University Teaching Hospital (UTH) and Kabwe General Hospital in three provinces of Lusaka, Copperbelt and Central. These study sites were selected purposively on the basis of population concentration and serving as major referral hospitals in the country. A ratio estimation of abortion incidence rate was applied to the annual abortion data for June 2008 to May 2009 estimated on the basis of annual expected pregnancies for 2009. Other measures included demographic characteristics and abortion status in relation to its classification as, legal termination of pregnancy (TOP), unsafe abortion (Illegally induced), or spontaneous, method used for abortion and parity as main variables. A record review checklist was used to collect all abortion data. Data were analyzed by SPSS statistical package for descriptive statistics and statistical tests for associations in the occurrence of abortion and its characteristics, method used and parity. The findings show the abortion incidence ratio rate of 12.3 percent per 100 live births of expected annual number of pregnancies for 2009 for the three provinces. There are greater significant associations in the prevalence of abortion with education, marital status, occupation, religion, parity, methods used for abortion and type of health facility (pvalue< 0.000- 0.001), which determines the extent to which abortion affects women in Zambia. Age was not found significantly statistical difference in its association with the prevalence of abortion (pvalue > 0.558). However, abortion affected all age-groups of women in the age range from 10 to 49 years, with a mean of 26.29 years, even though there were some variations in the distribution of abortion incidences according to their age-groups. Significant differences were also observed in the practice of legal abortions (2.5 percent) and those presenting with complications of unsafe abortion and spontaneous abortions as incomplete abortion accounting for 92.4 percent (pvalue < 0.000). Mortality is highest in Ndola Central (45.5 percent) followed by Kitwe Central (27.3 percent) than UTH and Kabwe General Hospital with limited figures, giving the overall percent of 0.3 percent of all abortion deaths. More women are surviving from the risk of abortion morbidity in Zambia. Use of MVA is found highly significant in reducing abortion mortality at health facilities. The findings suggest greater unmet needs for family planning and safe abortion services directing to improvement in family planning programme, policies and future innovation research approaches including the effective process of monitoring and evaluating abortion trend and strategies alongside strengthened health information system are imperative. Abortion is a highly risk factor to morbidity more than mortality which directs to better effective preventive measures of unwanted pregnancies than reliance on case management strategies of abortion care.
Unwanted pregnancy. , Birth control clinics. , Abortion--Cross-cultural studies. , Abortion, Induced. , Abortion services--Standards. , Safe abortion. , Abortion.