Cost of abortions in Zambia: A comparison of safe abortion and post abortion care

ABSTRACT

Unsafe abortion is a significant but preventable cause of maternal mortality. Although induced abortion has been legal in Zambia since 1972, many women still face logistical, financial, social, and legal obstacles to access safe abortion services, and undergo unsafe abortion instead. This study provides the first estimates of costs of post abortion care (PAC) after an unsafe abortion and the cost of safe abortion in Zambia. In the absence of routinely collected data on abortions, we used multiple data sources: key informant interviews, medical records and hospital logbooks. We estimated the costs of providing safe abortion and PAC services at the University Teaching Hospital, Lusaka and then projected these costs to generate indicative cost estimates for Zambia. Due to unavailability of data on the actual number of safe abortions and PAC cases in Zambia, we used estimates from previous studies and from other similar countries, and checked the robustness of our estimates with sensitivity analyses. We found that PAC following an unsafe abortion can cost 2.5 times more than safe abortion care. The Zambian health system could save as much as US$0.4 million annually if those women currently treated for an unsafe abortion instead had a safe abortion.

KEYWORDS:

• Abortion
• termination of pregnancy
• Zambia
• cost
• health system

Acknowledgements

We would like to thank Dr Bornwell Sikateyo, Doreen Mwanza, and the staff of the University Teaching Hospital, Lusaka for their support in data collection. Dr Emily Freeman and Dr Giulia Greco for commenting on an earlier version of this paper.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethical approval

Ethical approval for the project was obtained in Zambia from the Biomedical Research Ethics Committee, University of Zambia [018-07-12] and in the UK from the Research Ethics Committee, London School of Economics and Political Science [23-07-12]

ORCID

Divya Parmar http://orcid.org/0000-0002-7979-3140

Notes

1 US$1.36–US$10.87.

2 http://www.who.int/choice/en/ (accessed on 29.03.2014).

3 Key informants reported that less than 2% women at UTH require treatment for perforations or lacerations. We therefore decided to drop these two categories and provide costs for five services: MA, MVA, incomplete abortion, sepsis and shock.

4 Exchange rate as on 29.03.2013 (www.xe.com).

Additional information

Funding

This work was supported by the Economic & Social Research Council and DFID [RES-167-25-0626]. The funders were not involved in the research and preparation of the article, including study design; collection, analysis and interpretation of data; writing of the article; nor in the decision to submit it for publication.