Leone Tiziana, Coast Ernestina, Parmar Divya, Vwalika Bellington
Department of Social Policy, London School of Economics, London WC2A 2AE, UK,
Department of Social Policy, London School of Economics, London WC2A 2AE, UK.
Health Policy Plan. 2016 Sep;31(7):825-33. doi: 10.1093/heapol/czv138. Epub 2016 Feb 14.
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.
赞比亚拥有撒哈拉以南非洲地区最为宽松的堕胎法律之一。然而，不安全堕胎率依然居高不下，并带来了负面的健康和经济后果。在低收入国家，对于寻求堕胎护理的女性所承担的经济负担，人们了解甚少。大多数研究聚焦于直接成本（如医院费用）。本文估算了赞比亚寻求安全和不安全堕胎护理的个人层面经济负担，纳入了所有间接和直接成本。它使用了2013年从卢萨卡一家三级医院收集的数据（n = 112），这些数据来自接受堕胎的女性。确定了三种治疗途径：（1）在医院进行安全堕胎；（2）在其他地方开始的不安全秘密药物流产并在医院接受堕胎后护理；（3）在其他地方开始的不安全堕胎并在医院接受堕胎后护理。基于这三种类型，我们使用描述性分析和线性回归来估算女性寻求安全和不安全堕胎的成本，并确定寻求堕胎护理成本的负担在样本中是否平均分布。约39%的女性进行了不安全堕胎，在寻求堕胎后护理之前产生了大量经济成本。青少年和较贫困女性更有可能使用不安全堕胎。需要堕胎后护理的不安全堕胎比安全堕胎使女性花费多27%。考虑到不确定性，这个数字会大幅增加。对于安全和不安全堕胎，向非正规提供者支付的费用是女性的一项主要成本。这项研究表明，尽管有宽松的立法，赞比亚仍需要更好地向女性和提供者宣传法律，并提供资源以确保堕胎服务的可及性。本研究的政策影响包括：药剂师和中级提供者在提供药物流产服务中的作用；增加避孕措施的可及性，尤其是对青少年而言；以及消除对非正规提供者支付费用的需求。
