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Unsafe abortions costing Zambia millions of dollars a year, says study

Research is first to provide financial estimates of abortion care in Zambia

by George Wigmore (Senior Communications Officer)

The Zambian health system could save $0.4 million dollars a year by removing administrative burdens and ensuring that all women received safe abortions, according to research published by an academic at City University London.

The study, which is published in the journal Global Public Health, is the first to provide financial estimates of abortion care in Zambia and shows that treating complications of unsafely induced abortions can cost two and a half times as much as providing safe abortion care. Academics from the London School of Economics, King’s College London and the University of Zambia also contributed to the research.

Speaking about the study, lead author Dr Divya Parmar, Lecturer in Public Health at City University London, said:

“Preventing unwanted pregnancies and providing safe abortion services are cost-effective and life-saving. Although Zambia has a well-established and relatively liberal abortion law our study has shown that unsafely induced abortions are still common. If provision of safe abortion services were to become more accessible, it could significantly increase women’s access to safe abortion and reduce not only the health system costs of unsafe abortion, but also the costs to women’s health and lives.”

Unsafe abortion is a significant but preventable cause of maternal mortality with the World Health Organisation estimating that 21.6 million women experience an unsafe abortion worldwide each year with 47,000 women dying from complications. 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.

Using a set of scenarios based on a range of estimates, as well as information from key information interviews, hospital logbooks and medical records, the researchers estimated that safe abortion costs on average US$14 per case less than post abortion care following an unsafe induced abortion.

As a result the Zambian health system could save around US $0.4 million per year if all these women were able to access safe abortion, a procedure they are legally entitled to under a wide range of circumstances.

Another issue was that in Zambia signatures from three medical practitioners, of which one must be a specialist, is required for a non-emergency abortion. With fewer than 1,000 registered doctors and less than 60 specialists, this results in safe abortions becoming costly and less accessible for a population of 14.5 million.

With Zambia’s population demographics to change by 2030, the authors estimate that the burden of treating unsafe abortions on Zambia’s health expenditure budget will increase from 0.2 % of Zambia’s current health budget of US$1.24 billion to 0.9% by 2030. This increase could take up potentially a large chunk of the overall budget dedicated to reproductive health. Investing in safe abortion services would considerably decrease the overall economic burden of treating unsafe abortions, as well as prevent avoidable morbidity and mortality.

Dr Parmar said: “Due to lack of trained staff and required drugs in most health facilities in Zambia, safe abortion services are costly and inaccessible in spite of the legal provision. Costs could be reduced further if unwanted pregnancies were reduced through the uptake of contraception as Zambia has one of the highest levels of unmet need for contraception in sub-Saharan Africa. Policy change in this area could make a huge difference to women’s lives and set a trend in sub-Saharan Africa.”

Read the full paper

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