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Introduction
Abortion law in Zambia allows a woman to seek the termination of pregnancy. Even so,
many illegal abortions are performed each year. The majority of women seeking to
terminate pregnancies seek help from friends, go to traditional healers or "wise women".
These approaches either succeed or result in major complications, including death because
they are unsafe. Unsafe abortion is a major cause of maternal mortality in Zambia.
Abortion among adolescents and youth is a major public health issue, especially in
developing countries. Estimates indicate that Six out of 10 of all unintended pregnancies
end in an induced abortion. Around 45% of all abortions are unsafe, of which 97% take
place in developing countries (WHO, 2021). Unsafe abortion is a leading but preventable
cause of maternal deaths and morbidities. Lack of access to safe, timely, affordable and
respectful abortion care is a critical public health and human rights issue. This chapter
covers the background, statement of the research problem, the significance of the study,
purpose of the research, research objectives, research questions, limitations, delimitation
and operational definition of the terms.

Background
According to the Zambia Association of Gynecologists and Obstetricians study seven
percent of all maternal deaths in Zambia were due to unsafe abortions (Chansa, 2021). It
was noted that unsafe abortions remained a major challenge in Zambia despite existing
abortion laws. The study revealed that unsafe abortions remain a major challenge in
Zambia, hence recognized as a problem of significant public health ranked among the top
five causes of maternal deaths in Zambia. Pre-marital and adolescent pregnancies remain
exponentially high as according to ZAGO (2021).

Women’s reasons for terminating a pregnancy vary widely, but small-scale studies of
patients seeking post-abortion care reveal certain patterns. Adolescents’ primary
motivations include feeling ashamed because of the stigma attached to unmarried
motherhood, wanting to continue with school, having been abandoned by their partner,
feeling too young to be a mother and being unable to afford having a baby. Others want to
avoid being expelled from school, avoid revealing a secret relationship, protect the health

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of their existing children and avoid revealing that they had violated cultural norms, such as
postpartum sexual abstinence Dahlback et al., (2007). However, privacy, secrecy and
economic concerns drive many women’s decisions about what type of provider and
method to use when it comes to abortion, and thus determine the risks they face. A study of
unsafe abortion in Zambia by Likwa and Biddlecom (2009) found that one form of
medication abortion, misoprostol, was widely available in pharmacies and prescribed by
some doctors, but there were also reports of use without proper instruction, Ministry of
Health (2008). The same study noted that traditional healers may charge as little as ZK5
for an unsafe abortion, whereas a safe abortion typically costs ZK10–20, plus ZK50 if the
woman does not have a referral at a public facility and even more at a private facility. It is
this difference that lead people to going for unsafe abortions owing to the fact safe abortion
services are costly and are difficult to follow instructions thereof.

Generally, unsafe abortion risks are immense to the reproductive health. They can impact
on future chances of pregnancies resulting from complications associated with having them
done unskillfully. In addition, some research suggests a possible link between such
abortions and an increased risk of vaginal bleeding during early pregnancy, preterm birth,
low birth weight, placenta problems and many more.

Statement of the Research Problem

There are escalating numbers of young women who are making decisions to terminate
pregnancies. Hospital based studies show that 30 to 50% of acute gynecological
admissions are currently as a result of abortion complications, a big proportion being from
unsafe abortion” (Zulu, N. M. and Irene de Vries, 2018). The Gynecology Department of
Chipata Central Hospital has been recording increased number of unsafe abortion cases as
tabulated in the table below recorded 80 abortions in 2020 and 86 in 2021. Though it was
not possible to make a conclusion based only on the two complete years’ records, first
quarter of 2022 had already recorded 8 cases. The question of why women opt for unsafe
abortions remained a reason for research in the field. As such, it was imperative that we
investigated factors contributing to unsafe abortions among the youths between the ages 15
and 30 years at Chipata Central Hospital.

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S/N Year and Months Number of Unsafe Abortion Cases
1 2020 – January to December 80
2 2021 – January to December 86
3 2022 – January to March 8
Table 1.0. Unsafe Abortion Cases Statistics, (Chipata Central Hospital, 2022)

Significance of the Research Study

Findings gathered from the conducted study will be important for the design of public
health interventions focusing on good reproductive health at Chipata Central Hospital and
the Ministry of Health as a whole.

Purpose of the Study

The purpose of this study was to investigate the contributing factors to unsafe abortions
among youths aged 15 to 30 years.

Objectives of the Study

The objectives of this research were:-

i. To find out what the causes of unsafe abortions among youths aged between 15 and
30 years
ii. To investigate whether the youths aged between 15 and 30 years know the effects of
unsafe abortion
iii. To suggest solutions to unsafe abortions among the youths aged between 15 and
30years

Questions of the Study

i. What are causes of unsafe abortions among young adults?
ii. What mostly are the effects of unsafe abortions on young adults?
iii. What could be the possible solutions to avoid unsafe abortions among young
adults?

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Limitations
The limitations in the conducted study were obvious. Among them included financial
resources for questionnaire and research guides print outs. This needed the researcher let
the sponsors increase the funding to carter for the conducted study. The second limitation
was time resource. To cover a bigger sample size, more time was required. The researcher
had to adjust the daily schedule and worked under pressure for a short time in order to
balance between the academic research work.

Delimitation
The researcher did the research at Chipata Central Hospital within the departments
responsible for reproductive health, and abortions in particular. Chipata Central Hospital is
found within Chipata City some few meters from Town Centre.

Definition of terms
Abortion: Termination of pregnancy prior to 20 weeks' gestation or a fetus born weighing
less than 500g, Shazia (2017).
Unsafe Abortion: A procedure for termination of a pregnancy done by an individual who
does not have the necessary training and/or in an environment not conforming to minimal
medical standards WHO (2011).

Safe Abortion: A procedure for termination of a pregnancy done performed by trained

health personnel using rightful equipment or drugs, WHO (2011).

Youth: The United Nations defines youth as persons between the ages of 15 and 24,
however, in Zambia, a youth is any person between the age of 15 and 35 years, Emily
(2021)

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 CHAPTER TWO
Literature Review

Introduction

This chapter builds a theoretical part of the study. It provides a review of the literature
available on the topic of study. All the reviewed literature focuses on discussing factors
contributing to unsafe abortions in different communities.

According to WHO (2015), “An estimated 21.6 million unsafe abortions took place
worldwide in 2008 — almost all of which were in developing countries,” and, “One in ten
pregnancies ends with an unsafe abortion worldwide,” (WHO, 2011). In developing
countries, unsafe abortions occur at an incidence of two in five women under 25 years of
age and about one in seven women under 20 years of age. An unsafe abortion involves the
termination of a pregnancy either by persons lacking the necessary skills or in an
environment lacking the minimal medical standards, or both. Unsafe methods of abortion
include: insertion of a sharp instrument into the uterus, use of high-dose medicine such as
antimalarials and birth control pills, flushing the vagina with liquids such as bleach,
physical abuse such as jumping from high places, severely prolonged sexual intercourse,
and hard and prolonged massage to manipulate the uterus.

The main causes behind unsafe abortions are numerous. Among the few are unwanted or
unplanned pregnancies which are the most common, forced abortions, rape, inadequate
counseling from guides such as medical professionals, NGOs and others and pregnancy-
related abuse and violence. According to Shah et al., (2011) it has been estimated that 37%
of all pregnancies are unwanted. There are a number of social, physical and biological
issues which lead to unsafe abortions and associated complications. The social issues may
include cultural beliefs and practices, lack of hospital resources, lack of transport systems
and a low socioeconomic status due to which most people refer unskilled birth attendants.
They mostly use manual methods and unsterilized instruments in an unhygienic
environment, hence leading to complications such as sepsis, infertility and hemorrhage
among others.

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Some women who cannot afford a proper abortion may try to terminate the pregnancy
themselves, possibly by using sharp instruments, physical violence and drugs. They often
lack awareness about the consequences of an unsafe abortion. Sometimes lack of social
resources due to corrupt leadership and government which does not provide resources
according to the needs of the population has been said to be one of the causes of most
women choosing to go for unsafe abortion.  

Among the biological issues, age is an important factor leading to abortion Shazia (2017).
Adolescents are vulnerable to sexual abuse, violence, rape and unwanted pregnancy due to
their sexual desires peaking at this young age and their immaturity. As a result of lack of
sexual knowledge and awareness, they usually engage in unprotected and unsafe sex in
their unmarried lives, which leads to unwanted pregnancies, Masthoff (2019). Such
pregnancies are usually terminated by traditional means with unhygienic methods, leading
to complications such as septicemia, uterine perforation, bowel perforation, and bladder
perforation.

An unsafe abortion can potentially create life-threatening complications. According to

WHO (2011), 25% of women who have such complications need emergency medical care.
These complications include incomplete abortion, heavy bleeding, infection and uterine
perforation in some cases.

Looking at the adverse effects of unwanted abortion in the world and Zambia in particular,
preventing and overcoming unsafe abortions entails changes at levels of government,
community and individuals, Shazia (2017). The governments should introduce strict laws
to prohibit unsafe abortions and anyone disobeying these rules should be duly punished.
The government should also provide basic facilities of transport, medical healthcare
through skilled birth attendants. At a community level, awareness sessions should be
conducted and unskilled workers should be trained. At individual level, nurses and
midwives should provide information to the youths and married couples regarding
preventive measures abortions which would in the end lead to abortion. They can educate
young girls about unsafe practices, their prevention and safety precautions and encourage

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them to further educate the community about dangers of unsafe abortions. All people
should be made aware of healthy practices.

An unsafe abortion can also be prevented by providing sexual awareness and education,
access to safe and legal abortion, and use of contraceptives and other family-planning
methods (WHO, 2022). In conclusion, unsafe abortions are one of the main reasons for
maternal morbidity and mortality. A woman can encounter social, physical and biological
problems which collectively lead to intricate complications. To overcome these
complications, strategies such as awareness of good sexuality and effective practices
should be put into use.

Problem Analysis
Factors contributing to the unsafe abortion among women was summarized as in the figure
below.

Cost of safe
abortion
services

Need for privacy availability

where women can CAUSES OF
be attended to of unsafe
UNSAFE
without leaving
details of their ABORTION
means of
identity abortion

lack of awareness
of the dangers of
unsafe abortion

Figure 1.0. Factors contributing to unsafe abortion among women, Likwa and Biddlecom
(2009)

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 CHAPTER THREE

RESEARCH METHODOLOGY
Introduction
Research methodology describes the way of gathering important data to answer the
research questions. It focuses on research design, research setting, study population,
sample selection, sample size, data collection tool, validity, reliability, pre-testing of
instruments and ethical considerations.

Research Design
A research design is the comprehensive plan for addressing a research question, including
requirement for enhancing the truthfulness of the study. This study was conducted under
the title, “Investigating the contributing factors to abortions among youths aged 15 to 30
years at Chipata Central Hospital.” This was a facility based study interviewing from the
health personnel concerned with abortions at the facility. They were interviewed
concerning cases they received relating to unsafe abortion among youths aged between 15
and 30 years.

Study Population
The study population is the total number of individuals to be studied on. The study
population was health staff in at Gynecology department. It was from this that the study
sample was selected.

Sample Size
A sample size is a portion of the population selected as respondents in a research study. In
the conducted study the researcher deliberately targeted to interview 7 health staff
understanding that they are a reliable group for the study.

Sample Selection
A sample selection which is also called sampling is the process of selecting a portion of the
population to represent the whole population in the study. In the sampling of the
participants a purposeful selection was used.

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Sampling Procedure
Sampling procedure the selection of a group of people, events, behaviors or other elements
with which to conduct a study, was be done randomly. By random sampling procedure
health staffs working at the gynecology department were selected randomly. Here the
researcher intentionally selected 7 staff to take part in the investigation of contributing
factors to abortions among youths aged 15 to 30 years.

Instrument for Data Collection

Data collection tools are instruments used to gather data needed to address a research
problem. The instruments used in the conducted study were interview schedule and focus
group discussions with the selected.

Validity and Reliability

Validity is a measure of truth or accuracy of a claim; it is an important concern throughout
the research process. Validity also refers to the degree to which an instrument measures
what it is intended to measure. In the conducted study validity was ensured by pre-testing
the structured interview questions in a pilot study done in a different study setting. The pre-
test helped the researcher to make adjustments to the questions in order to collect relevant
data in the actual research.

Reliability, this is the consistency of a measurement, or the degree to which an instrument

measures the same way each time it is used under the same condition with the same
subjects. In the conducted study, instrument reliability was ensured by standardizing the
data collection instruments.

Data collection procedure

Data collection procedure is the method used to collect information needed to address a
research question or problem. Data collection technique is described as objective and
systematic. Here, ‘objective’ means that the data must not be influenced by anyone who
collects it. ‘Systematic’ means that the data must be collected in the same way by anyone
who is involved in the collection even if they were not involved in organizing the study. In
the conducted study, the researcher collected data through interviews and focus group

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discussions with the selected health staff. The only respondents who were interviewed
were those willing to take part in the study.

Data Analysis
Data analysis deals with the interpretation and conclusions that are drawn from the study,
reports how the data will be classified scientifically, placing items that have similar
attributes together in one class and orders, manipulated and summarized in order to answer
the question under study. The analysis was done using a data master sheet on which all
respondents were tallied, with data presentation done in tables, pie charts, radial diagrams
and bar graphs for easy analysis.

Ethical Consideration
Given the nature of this project, there are certain ethical considerations that need to be
taken note of. In the first instance, all respondents were treated with respect and politeness,
adopting a strategy of ‘informed consent’ with the aim and methods of the research being
made clear to all of them. Confidentiality and anonymity of individual respondents was
assured and consent was sought in the case where interviews may need to be audio-
recorded. Finally, a report detailing certain results of the research were provided to health
facility.

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CHAPTER FOUR
DATA PRESENTATION AND DATA ANALYSIS

This part of the report presents the findings from the field and provides the detailed
discussion thereof. The findings will be provided in diagrams for easy analysis.

The figure below shows the leading causes unsafe abortion.

Lack of
knowledge of
safe abortion
services

Avoiding
Socio- CAUSES OF parental
economic UNSAFE disappointm
conditions ABORTION ent and
anger

Stigma of
pregnancy
outside
marriage

Figure 4.1: Causes of unsafe abortion (Field data,2022)

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 Bleeding

EFFECTS OF Purforation
Infertility UNSAFE
ABORTIONS of uterus

Loss of
womb

Figure 4.2: Effects of unsafe abortions (Field data, 2022)

ANALYSIS

This study assessed contributing factors to unsafe abortion practices among women at
Chipata Central Hospital. These factors are discussed in line with the four (4) thematic
categories that were extracted from field data.

Socio-economic conditions
Two (02) out of seven (07) participants in the study disclosed that they received clients
seeking safe abortion services. The clients after being told that some medical supplies were
still out of stock as they were waiting for the arrival of the ordered; the clients were given
option of buying for themselves or wait for the supplies to arrive. The clients said that they
could not afford buying and waiting would put them at risk of being known because a
pregnancy grows.

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Since their socio-economic conditions such as financial difficulties, unemployment and
inadequate economic support this make them indulge in unsafe abortion practices.

Lack of knowledge of safe abortion services

Two (02) participants indicated that case of the women between the age of 15 and 30 years
they attended, the victims did not know of the safe abortion services. Lack of knowledge
on safe abortion services according to them led to unsafe abortion practices by women who
had unplanned pregnancies. Although almost all victims the participants attended to could
identify complications of unsafe abortion practices such as bleeding, death, uterine
damage, infertility, gastric damage, and infections, many said they indulged in unsafe
abortion practices because they did not know of the safe abortion option. What the health
staff who was also a participant could remember some victims saying was that the only
thing they knew was that they could use drugs not allowed to be taken by pregnant women
and take them in over dosage resulting into abortion.

The other according to the two (02) participants all she knew as an effective way of
abortion were some herbal mixtures which for some time she as well recommended to
some other pregnant women. She confessed that the method worked all the times. What
took her to the hospital was continued abdominal pains. She continued to say that in the
area she came from she never heard that there were abortion services offered in hospitals
where people could go and terminate pregnancies safely.  

In the other case, a research participant, a third participant said some victims explained to
her that they were not very sure that abortion would be acceptable by law in Zambia. They
used to hear others saying it was legally accepted and yet some saying it was not legally
accepted to have abortion in hospitals, because Zambia being a Christian nation abortion is
murder. This made a number of the victims of unsafe abortion hold on to what they were
sure of from before that there are no legal abortions done in hospitals and clinics taking it
that by no means could the government allow murder. Going to the hospital and open up
seeking abortion service was like surrendering oneself as a murderer to the government
because the hospitals sometimes work in collaboration with police in dealing with health
related criminal cases. Since they were not clearly informed that hospitals offer safe

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abortion services in any part of Zambia, all they used were locally sought means of
abortion.  

Avoiding parental disappointment and anger

From this same participant, some young women said they sought unsafe abortion not
wanting parents to know they were pregnant. Such victims knew safe abortion services
were available in hospitals and clinics. Findings show that young women do have
unplanned pregnancies and terminate them without going to the health facilities because
they fear the disappointment and anger of their parents or guardians. According to the third
participant,

“There were about two big girls she attended to, one was in her twelfth grade and the
other a college student. These when they came to the hospital with some complications of
incomplete abortion, they confessed that they were deemed as morally upright. They were
never known to be misbehaving with men around. Being assured of the trust, they are
expected to remain as such until they are married. The time they became pregnant they
preferred secret ways of aborting to going seeking the service from the facility where they
can have their details recorded and someone related could come across later disclose to
parents.”

To avoid this, using unsafe means become a choice for them. 

Stigma of pregnancy outside Marriage

The forth respondents were two (2) again. These respondents said that from the victims
they have attended to, some did unsafe abortion because of being seen as committed
Christians. To be seen pregnant while not married according to them was going to be a big
source of stigma because they cannot hide pregnancy as did sexual activities. This is
because sex is only allowed between couples and outside marriage it is sin before God.
Therefore, women who become pregnant before marriage are most often stigmatized in
their churches. All the churches expect women to get engaged and properly married before
getting pregnant. 

For this reason the respondents said,

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“Women who become pregnant outside marriage avoid embarrassment by aborting their
pregnancies through unsafe means, untraceable means. Some people sing in praise teams
of the church, others are ushers. Yet still, some are church leaders in various positions.
What they consider most to be sin was to be known of being pregnant and be disciplined in
the presence of the congregation. This is why the society respects those without babies
outside marriage even without knowing how many pregnancies they terminated secretly. At
the end they get married and struggle to have children because unsafe abortions left them
infertile. Those carrying children outside marriage are taken as prostitutes. Now since
there are relationships between some community members and health workers, such
women find it easy to use sticks, herbs or any other means to initiate abortion without
going for safe means in health facilities. This for them avoids stigma of becoming pregnant
outside marriage.” 

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CHAPTER FIVE
RECOMMENDATIONS AND CONCLUSION

This part covers health players are expected to do to help in finding the solution to ending
unsafe abortion and gives the conclusion of the findings. The recommendation part
provides suggestions for improved safe abortion practice at Chipata Central Hospital and
the Ministry of Health at large.

The following recommendations are suggested based on findings the conducted research.

1. Chipata Central Hospital and Ministry of Health (MOH) should adopt evidence-
based public health approaches in educating women and the general public on the
safe abortion policy. This approach should concentrate on reducing maternal
mortality and morbidity and harm reduction.
2. Young people should be educated about sex and relationships by parents and
schools concerning unsafe sex.
3. The program for medical abortion should be publicized to replace the ineffective
and dangerous unsafe abortion methods practiced by young women.
4. Safe abortion information hotlines can be utilized in Zambia in providing quick and
adequate information on abortion to young women who may be considering that
option.

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Conclusion

Several factors are responsible for unsafe abortion practices in Chipata and Zambia as a
whole. In this study, women cited lack of knowledge on the abortion law and safe abortion
services, socio-economic conditions, religious beliefs, stigma of pregnancy outside
marriage and avoidance of parental disappointment and resentment. Education on the
Zambian safe abortion policy is a necessary step if the goal of avoiding preventable death
from unsafe abortions is to be achieved. Teachers in schools, colleges and universities
should also be involved in the education on safe abortion services in Zambia. The regimen
for medical abortion needs to be publicized to replace the ineffective and dangerous
concoctions that are resorted to by women. Results of this study should be interpreted with
care to populations not represented in this study. Further qualitative and quantitative
studies covering all other communities are recommended to explore the topic further. The
views and perceptions of parents and other community groups could also be studied in a
bid to provide a more complete view of contributing factors to unsafe abortion practices at
Chipata Central Hospital.

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 REFERENCES

Chipata Central Hospital (2022). Abortion Statistics; Gynecology Department: Chipata

Central.

Dahlback E et al., (2007). Unsafe induced abortions among adolescent girls in Lusaka,
HealthCare Women International, 28(7):654–676.

Emily (2021). Who is a Youth in Zambia. https://flairng.com/african-countries/who-is-a-

youth-in-zambia.html

Likwa R. N. and Biddlecom, A (2009). Unsafe abortion in Zambia.

https://www.researchgate.net/publication/45284051

Masthoff, K (2019). Abortions in Teenagers – Reasons And Effects??

https://newsessentials.wordpress.com/

Shah, N., Hossain, N., Noonari, M., & Khan, N. H. (2011). Maternal mortality and
morbidity of unsafe abortion in a university teaching hospital of Karachi, Pakistan. Journal
of the Pakistan Medical Association, 61(6), 582-586.

World Health Organization. (2011). Unsafe abortion: global and regional estimates of
incidence of unsafe abortion and associated mortality in 2008.

WHO (2015). WHO | Preventing unsafe abortion.

http://www.who.int/mediacentre/factsheets/fs388/en/

WHO (2022). Sexual and reproductive health: Preventing Unsafe Abortion.

https://www.who.int/reproductivehealth/en/

WHO (2021). Abortion. https://www.who.int/news-room/fact-sheets/detail/abortion.

Zulu, N. M. and Irene de Vries (2018). Zambia country report needs assessment on safe
abortion advocacy for the Zambia Association of Gynecologists and Obstetricians
(ZAGO). http://www.kit.nl/health

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 APPENDICES
APPENDIX I: WORK PLAN
The projected work plan from the month of March and August, 2022.
SN TASK DATE PERSONNEL

Preparation and Approval of the research Researcher/the

topic Research
1 Week 1 to 2
Supervisor
2 Finalize research proposal Week 3 to 7 The researcher

3 Seeking permission from the relevant Week 8 The researcher

authorities
5 Printing out of semi-structured Week 7 The researcher
questionnaires and interview schedules

6 Pre-testing the data collection tools Week 8 to 9 The researcher

7 Making adjustments to data collection Week 10 The researcher

tools were necessary

Data collection Week 10 to12 The researcher

8 Data analysis Week 13 to 14 The researcher

9 Report writing Week 15-21 The researcher

10 Submission of the report Week 22 The researcher

11 Distribution of the results Week 23 to 24 The researcher

APPENDIX II: RESEARCH QUESTIONS

a. What abortion?

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 b. Abortion is categorized into which types?
c. How can you describe the categories of abortion?
d. What causes unsafe abortion among young people aged between 15 and 30 years?
What mostly are the effects of unsafe abortions on young adults?
e. What could be the possible solutions for the young people to avoid opting for
unsafe abortion?

APPENDIX III: CONSENT FORM

Dear Participant,

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I am a third year Student Nurse from Rockview School of Nursing in Chipata. I am
carrying out a study on the contributing factors to abortions among youths aged 15 to 30
years. This study is being conducted in partial fulfillment of the Diploma in Registered
Nursing. However, the information resulting from this study will help in designing
appropriate information, education and communication strategies for better health service
delivery to expecting mother especially when it comes to giving birth from health facilities.
There are no direct benefits for the participant. The study is not sponsored by any
organization.
You are among the seven (07) health staff who will be interviewed. You will be asked
personal questions, some of which may be sensitive and private. Your selection to
participate in this study was randomly selected.

Please be informed that:

1. Participation is on voluntary basis

2. You are free to withdraw at any stage during the interview

3. Your withdrawal will not in any way affect your care

4. All information obtained from you will be kept confidential

Should you have need for further information, questions, comments, complaints or queries,
please do not hesitate to contact the following persons on the cell/addresses below:

The Principal Tutor

Rockview School of Nursing

P.O. Box ………..

Chipata

Cell: +260-……………

I accept participation

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Signature or thumbprint (Participant) ______________________

Date_______________

Signature of data collector_______________________________

Date_______________

APPENDIX IV: BUDGET

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SN ITEMS AMOUNT (ZMK)

1 Transport 100

2 Stationary 300

3 Communication Bill 100

Total 500

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