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 paper
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: i) safe abortion at the hospital ii) unsafe clandestine medical abortion
initiated elsewhere with post-abortion care at the hospital and iii) 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.