A survey of lusaka district health management team and private health workers knowledge of the law, their attitudes towards aned practice on abortions

Abstract

BACKGROUND:Unsafe abortions contribute about one third to the maternal mortality in Zambia. The maternal mortality ratio in Zambia stands at 729/100000 live births. The millennium target for Zambia is 162/100000 live births. There are a high number of referrals to UTH for incomplete abortions which previously have been demonstrated to be mostly induced. Health workers in peripheral clinics were implicated as part of the barriers in part, due to their negative attitude and as providers of illegal and unsafe abortion services to these clients. This study assessed the knowledge of the law, the attitudes towards and the extent to which health workers in Lusaka provide abortion services.METHODS: A pre tested self administered questionnaire with both open and closed ended questions was used to collect data from a conveniently sampled group of health workers from Lusaka DHMT facilities and in five established private clinics.RESULTS: Of the 141 responses included for analysis, 4% were from doctors, 9% from clinical officers, 32% from midwives, 46% from general nurses, 2% from pharmacists and 5% from other heath staff such as laboratory technicians, radiographers and environmental health technicians. Fifty five percent demonstrated good knowledge of the Zambian abortion law while twenty nine percent had no knowledge of its existence. Fifty nine percent did not support laws that allowed abortions at all while 9% supported only in certain circumstances and 32% supported these laws in most circumstances. Religion was the basis for not supporting laws that allowed abortions in about 90% of those that were against abortions. 70% of respondents had had contact with a client seeking an abortion and only 3% admitted to have provided an abortion to such a client. 25% referred the client to a doctor, 4% referred her to another colleague but 70% turned the client away after some form of counseling. CONCLUSION: There are gaps in the knowledge and understanding of the Zambian abortion law among health workers in both Lusaka DHMT and private institutions. Provision of an elective abortion for reasons other than that of saving a woman’s life is generally not accepted. Fewer health workers provide abortion service than literature suggests.