COMPREHENSIVE ABORTION CARE IN CHIBOMBO DISTRICT JOMBO NAMUSHI ZAMBIA 49th International Course in Health Development September 19, 2012 – September 6, 2013 KIT (Royal Tropical Institute) Development Policy & Practice/ Vrije University of Amsterdam TITLE Analysing implementation of Comprehensive Abortion Care in Chibombo District: Barriers hindering women from accessing services A thesis submitted in partial fulfillment of the requirement for the degree of Master of Public Health By Name: Jombo Namushi Country: Zambia Declaration: Where other people’s work has been used (either from a print source, internet or any other source) this has been carefully acknowledged and referenced in accordance with departmental requirements. The thesis analysing challenges in implementing Comprehensive Abortion Care in Chibombo District is my own work. Signature: ………………………………………………………. 49th International Course in Health Development (ICHD) September 19, 2012 – September 6, 2013 KIT (Royal Tropical Institute)/ Vrije Universiteit Amsterdam September 2013 Organised by: KIT (Royal Tropical Institute), Development Policy & Practice Amsterdam, The Netherlands In co-operation with: Vrije Universiteit Amsterdam/ Free University of Amsterdam (VU) Amsterdam, The Netherlands Contents List of Tables page ................................... iv List of figures Page .................................... v Acknowledgements ............................................................................................................................... vi List of abbreviations ............................................................................................................................ vii Preface ....................................................................................................................................................... ix Abstract ...................................................................................................................................................... x Introduction .......................................................................................................................................... x Method .................................................................................................................................................... x Results .................................................................................................................................................... x Conclusion: ............................................................................................................................................ x Key words .............................................................................................................................................. x Word count ........................................................................................................................................... x 1. INTRODUCTION ................................................................................................................................. 1 1.1. Comprehensive Abortion Care (CAC) ................................................................................ 2 1.2. Background ................................................................................................................................. 3 1.2.1. Zambia ..................................................................................................................................... 4 1.2.2. Chibombo ................................................................................................................................ 7 2. Problem Statement, Justification, Objectives & Methodology ....................................... 10 2.1. Problem Statement ................................................................................................................ 10 2.2. Justification ............................................................................................................................... 11 2.3. Objectives .................................................................................................................................. 12 2.3.1. General Objective .............................................................................................................. 12 2.3.2. Specific Objectives............................................................................................................. 12 2.4. Methodology .............................................................................................................................. 12 2.4.1. Study area ............................................................................................................................ 12 2.4.2. Study design ........................................................................................................................ 12 2.4.3. Data collection method .................................................................................................... 13 2.4.4. Search engines and terms .............................................................................................. 13 2.4.5. Inclusion criteria ................................................................................................................. 13 i 2.4.6. Data analysis ....................................................................................................................... 13 2.4.8. Limitations ............................................................................................................................ 14 2.4.9. Dissemination and use of results ................................................................................. 14 3. RESULTS ............................................................................................................................................. 15 3.1. Global statistics/perspective of abortion........................................................................ 15 3.2. Abortion Laws ........................................................................................................................... 17 3.2.1. Global perspective of abortion laws ............................................................................ 17 3.2.2. Zambian abortion laws .................................................................................................... 19 3.3. Comprehensive Abortion Care (CAC) .............................................................................. 20 3.3.1. Family planning (FP) ......................................................................................................... 20 3.3.2. Safe abortion (or Legal TOP) ......................................................................................... 21 3.3.3. Post Abortion Care (PAC) ................................................................................................ 21 3.4.1. Reasons why Women may want an abortion .......................................................... 22 3.4.2 Providers and methods for unsafe abortion. ............................................................ 23 3.5. Sexual and reproductive health services in Chibombo District (all facilities) . 23 3.5.1. Family planning ................................................................................................................... 25 3.5.2. Abortion ................................................................................................................................. 26 3.5.3. Post Abortion Care (PAC) ................................................................................................ 27 3.6. Trends in uptake of CAC services during the rollout ................................................. 27 3.7. Analysing barriers to accessing CAC services .............................................................. 31 3.7.1. Supply/Health care related barriers ........................................................................... 32 3.7.2. Demand/Patient related barriers ................................................................................. 36 4. DISCUSSION ..................................................................................................................................... 40 4.1. Supply barriers ........................................................................................................................ 40 4.1.1. Availability ............................................................................................................................ 40 4.1.2. Acceptability ......................................................................................................................... 41 4.2. Demand barriers ..................................................................................................................... 41 4.2.1. Geographical accessibility ............................................................................................... 41 4.2.2. Affordability .......................................................................................................................... 42 4.2.3. Acceptability ......................................................................................................................... 42 5. CONCLUSION .................................................................................................................................... 43 ii 6. RECOMMENDATIONS ....................................................................................................................