Fetters Tamara, Samandari Ghazaleh, Djemo Patrick, Vwallika Bellington, Mupeta Stephen
Ipas, 300 Market St., Suite 200, Chapel Hill, NC, USA.
Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Reprod Health. 2017 Feb 16;14(1):26. doi: 10.1186/s12978-017-0289-2.
Although abortion is technically legal in Zambia, the reality is far more complicated. This study describes the process and results of galvanizing access to medical abortion where abortion has been legal for many years, but provision severely limited. It highlights the challenges and successes of scaling up abortion care using implementation science to document 2 years of implementation.
An intervention between the Ministry of Health, University Teaching Hospital and the international organization Ipas, was established to introduce medical abortion and to address the lack of understanding and implementation of the country's abortion law. An implementation science model was used to evaluate effectiveness and glean lessons for other countries about bringing safe and legal abortion services to scale. The intervention involved the provision of Comprehensive Abortion Care services in 28 public health facilities in Zambia for a 2 year period, August 2009 to September 2011. The study focused on three main areas: building health worker capacity in public facilities and introducing medical abortion, working with pharmacists to provide improved information on medical abortion, and community engagement and mobilization to increase knowledge of abortion services and rights through stronger health system and community partnerships.
After 2 years, 25 of 28 sites provided abortion services, caring for more than 13,000 women during the intervention. For the first time, abortion was decentralized, 19% of all abortion care was performed in health centers. At the end of the intervention, all providing facilities had managers supportive of continuing legal abortion services. When asked about the impact of medical abortion provision, a number of providers reported that medical abortion improved their ability to provide affordable safe abortion. In neighboring pharmacies only 19% of mystery clients visiting them were offered misoprostol for purchase at baseline, this increased to 47% after the intervention. Despite progress in attitudes towards abortion clients, such as empathy, and improved community engagement, the evaluation revealed continuing stigma on both provider and client sides.
These findings provide a case study of the medical abortion introduction in Zambia and offer important lessons for expanding safe and legal abortion access in similar settings across Africa.
尽管在赞比亚堕胎在技术层面上是合法的，但实际情况要复杂得多。本研究描述了在堕胎合法多年但服务提供严重受限的情况下，推动获得药物流产服务的过程和结果。它突出了运用实施科学扩大堕胎护理服务规模的两年实施过程中的挑战与成功经验。
卫生部、大学教学医院与国际组织国际人口服务组织（Ipas）之间开展了一项干预措施，以引入药物流产并解决该国对堕胎法缺乏理解和实施的问题。采用实施科学模型来评估效果，并为其他国家提供关于扩大安全合法堕胎服务规模的经验教训。该干预措施包括在赞比亚的28个公共卫生机构提供为期两年（2009年8月至2011年9月）的全面堕胎护理服务。该研究聚焦于三个主要领域：提升公共机构卫生工作者的能力并引入药物流产、与药剂师合作以提供关于药物流产的更多信息，以及通过加强卫生系统和社区伙伴关系进行社区参与和动员，以增加对堕胎服务和权利的了解。
两年后，28个地点中有25个提供堕胎服务，在干预期间为超过13000名妇女提供了护理。堕胎服务首次实现了分散化，所有堕胎护理中有19%在卫生中心进行。在干预结束时，所有提供服务的机构都有支持继续提供合法堕胎服务的管理人员。当被问及提供药物流产的影响时，一些提供者报告称药物流产提高了他们提供负担得起的安全堕胎服务的能力。在邻近的药店，基线时只有19%的暗访顾客被提供米索前列醇购买，干预后这一比例增至4
