By safe2choose

Like many countries in Southern and East Africa, abortion legality in the context of Zambia is quite stringent. Unlike many of its neighbouring countries, such as Zimbabwe and Angola, Zambia has a more liberal abortion legislation. It also has a a unique stipulation [1]  that allows for abortion upon request. As is evident in many countries where abortion upon request is allowed, access to the service is affected by much more than legislation. Lack of healthcare facilities that offer this service as well as stigma equally contribute to the inability to undergo safe abortions for many women. In this blog, we hope to highlight the legislative framework under which abortions in Zambia exist as well as shed light on the ways in which one can access the service.

Abortion laws date back to pre-colonial times

The Termination of Pregnancy Act of Zambia dates back to 1972 and allows abortion under specific conditions, namely; if the health of the pregnant person is at risk, both physical and mental, or the health of the fetus is at risk. Abortion is also allowed under socio-economic grounds. If the pregnant person can justify that the pregnancy would impact their socioeconomic situation, an abortion is allowed. Previously, this stipulation required the approval of three healthcare providers, but reports from the ground reflect that this requirement is no longer implemented religiously.

Despite this somewhat liberal abortion law, women in Zambia still struggle with accessing safe abortions. Proper estimates of how many women actually seek out the service are hard to quantify given the immense stigma and number of unsafe abortions that occur. This number is at around 39 abortions per 1000 women. In addition, the incidence of women admitted for abortion related complications (including induced abortions) was 10,000 in 2008, a sharp increase from the 5600 in 2003. [2]

Stigma is one of the greatest forces to inhibit abortion access

These numbers can largely be attributed to the stigma associated with abortions in the region: although the service is available, many women worry about the shame that comes with seeking the service. Furthermore, in Zambia, there are about 2 doctors per 10,000 people, which means there are even less opportunities for women to access the service.  [3]

Although these numbers paint a fraught image of the situation on the ground, they also highlight the high number of women who are making the decision to terminate a pregnancy. The fact of the matter is that abortions have been occuring and will continue to occur, for multiple reasons, each diverse but each equally justified. As such, it is imperative that we re-examine the stigma we have become so accustomed to in the region and more generally, across the globe. Navigating fertility for periods up to 20 years can be challenging, and women reserve the right to make decisions that honor their lived experience.

Despite the restrictions, great strides are being made to increase abortion access

In recent years, there have been many strides made to increase access to the service, whether intentional or not. Many teaching hospitals as well as the Marie Stopes in Zambia offer abortion services, and there are new methodologies for adminstering the service, such as Manual Vacuum Aspiration that have become available for women in Zambia [4]. A recent conversation I had with a Zambian woman also revealed that the stipulation that three doctors have to approve the service is largely not implemented, and you can walk into a clinic, state that you seek to have an abortion and in most cases, if the facilities are present, you will receive one.

There are two main types of abortion options

There are two routes you can take if you seek to end a pregnancy. Medical Abortion, which involves the administering of either one pill, misoprostol, or two pills, misoporostol and mifepristone. This method can be conducted at home and is viable up to 9 weeks of gestational age. The second option is Manual Vacuum or Electrical Vacuum Aspiration. This method is done in-clinic and takes about one hour in total, and you can resume normal activities once it is completed in the clinic. It involves a mild sedation around the cervix, followed by the use of an aspirator to remove the products of conception. This method is viable up to 12 weeks of gestation.

Both options are viable, the decision simply rests on what works best for you and your situation. Now, although I have provided some technical guidance on how to access an abortion, it would be thoughtless of me to not mention that stigma still stands in many of the institutions that ought to provide the service, and navigating that can be incredibly difficult. Our counselors at safe2choose.org can help in preparing you or talking you through what it would look like to seek the service, but what is always important to remember is that you yourself are the best advocate for your body, and the decision to terminate a pregnancy does not have to be approved by those around you, only yourself. Here, you can read more about the stories of the many women who have sought out the service, or watch a testimonial of a woman who made this brave choice in South Africa.

To find out more about what options are available to you, you can learn more about the legislation and context in which abortion exists in Zambia here. As I have already mentioned, our team of multilingual counsellors can also walk you through everything, or offer a helping hand. And for those simply reading this to learn more, I hope this has shed light on abortions in Zambia and perhaps in the future, this information can help you or someone who might need it.

About the author: Marie-Simone Kadurira is a Reproductive Health consultant in Southern Africa. She is also the founder of Vasikana Vedu. It is a not for profit organisation which combats period poverty in the region.

Works Cited

1. Termination of Pregnancy Act. National Assembly of Zambia. Accessed July 2021. https://www.parliament.gov.zm/node/1263
2. Unsafe Abortion In Zambia. The Guttmacher Institute. Accessed July 2021. https://www.guttmacher.org/sites/default/files/report_pdf/ib-unsafe-abortion-zambia.pdf
3. Moving from legality to reality: how medical abortion methods were introduced with implementation science in Zambia. Reproductive Health. Accessed July 2021. https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-017-0289-2