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The individual level cost of pregnancy termination in Zambia: a comparison of safe and unsafe abortion

Author

Listed:
  • Leone, Tiziana
  • Coast, Ernestina
  • Parmar, Divya
  • Vwalika, Bellington
Abstract
Zambia has one of the most liberal abortion laws in sub-Saharan Africa. However, rates of unsafe abortion remain high with negative health and economic consequences. Little is known about the economic burden on women of abortion care-seeking in low income countries. The majority of studies focus on direct costs (e.g. hospital fees). This article estimates the individual-level economic burden of safe and unsafe abortion care-seeking in Zambia, incorporating all indirect and direct costs. It uses data collected in 2013 from a tertiary hospital in Lusaka, (n = 112) with women who had an abortion. Three treatment routes are identified: (1) safe abortion at the hospital, (2) unsafe clandestine medical abortion initiated elsewhere with post-abortion care at the hospital and (3) unsafe abortion initiated elsewhere with post-abortion care at the hospital. Based on these three typologies, we use descriptive analysis and linear regression to estimate the costs for women of seeking safe and unsafe abortion and to establish whether the burden of abortion care-seeking costs is equally distributed across the sample. Around 39% of women had an unsafe abortion, incurring substantial economic costs before seeking post-abortion care. Adolescents and poorer women are more likely to use unsafe abortion. Unsafe abortion requiring post-abortion care costs women 27% more than a safe abortion. When accounting for uncertainty this figure increases dramatically. For safe and unsafe abortions, unofficial provider payments represent a major cost to women. This study demonstrates that despite a liberal legislation, Zambia still needs better dissemination of the law to women and providers and resources to ensure abortion service access. The policy implications of this study include: the role of pharmacists and mid-level providers in the provision of medical abortion services; increased access to contraception, especially for adolescents; and elimination of demands for unofficial provider payments.

Suggested Citation

  • Leone, Tiziana & Coast, Ernestina & Parmar, Divya & Vwalika, Bellington, 2016. "The individual level cost of pregnancy termination in Zambia: a comparison of safe and unsafe abortion," LSE Research Online Documents on Economics 64716, London School of Economics and Political Science, LSE Library.
    • Handle: RePEc:ehl:lserod:64716
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    File URL: http://eprints.lse.ac.uk/64716/
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    References listed on IDEAS

    as
    1. Sue J Goldie & Steve Sweet & Natalie Carvalho & Uma Chandra Mouli Natchu & Delphine Hu, 2010. "Alternative Strategies to Reduce Maternal Mortality in India: A Cost-Effectiveness Analysis," PLOS Medicine, Public Library of Science, vol. 7(4), pages 1-1, April.
    2. Koster-Oyekan, Winny, 1998. "Why resort to illegal abortion in Zambia? Findings of a community-based study in Western Province," Social Science & Medicine, Elsevier, vol. 46(10), pages 1303-1312, March.
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    Citations

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    Cited by:

    1. Freeman, Emily & Coast, Ernestina, 2019. "Conscientious objection to abortion: Zambian healthcare practitioners' beliefs and practices," Social Science & Medicine, Elsevier, vol. 221(C), pages 106-114.
    2. Haaland, Marte E.S. & Haukanes, Haldis & Zulu, Joseph Mumba & Moland, Karen Marie & Blystad, Astrid, 2020. "Silent politics and unknown numbers: Rural health bureaucrats and Zambian abortion policy," Social Science & Medicine, Elsevier, vol. 251(C).
    3. Seydou Drabo, 2019. "A Pill in the Lifeworld of Women in Burkina Faso: Can Misoprostol Reframe the Meaning of Abortion," IJERPH, MDPI, vol. 16(22), pages 1-13, November.
    4. Banke-Thomas, Aduragbemi & Ayomoh, Francis & Aberjirinde, Ibukun-Oluwa & Banke-Thomas, Oluwasola & Eboreime, Ejemai Amaize & Ameh, Charles, 2021. "Cost of utilising maternal health services in low- and middle-income countries: a systematic review," LSE Research Online Documents on Economics 105081, London School of Economics and Political Science, LSE Library.
    5. Coast, Ernestina & Norris, Alison H. & Moore, Ann M. & Freeman, Emily, 2018. "Trajectories of women's abortion-related care: A conceptual framework," Social Science & Medicine, Elsevier, vol. 200(C), pages 199-210.
    6. Ernestina Coast & Samantha R Lattof & Yana van der Meulen Rodgers & Brittany Moore & Cheri Poss, 2021. "The microeconomics of abortion: A scoping review and analysis of the economic consequences for abortion care-seekers," PLOS ONE, Public Library of Science, vol. 16(6), pages 1-21, June.
    7. Haaland, Marte E.S. & Mumba Zulu, Joseph & Moland, Karen Marie & Haukanes, Haldis & Astrid Blystad,, 2020. "When abortion becomes public - Everyday politics of reproduction in rural Zambia," Social Science & Medicine, Elsevier, vol. 265(C).

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    More about this item

    Keywords

    abortion; Africa; direct costs; indirect costs; Zambia;
    All these keywords.

    JEL classification:

    • E6 - Macroeconomics and Monetary Economics - - Macroeconomic Policy, Macroeconomic Aspects of Public Finance, and General Outlook

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