| Title |
Moving from legality to reality: how medical abortion methods were introduced with implementation science in Zambia
|
|---|---|
| Published in |
Reproductive Health, February 2017
|
| DOI | 10.1186/s12978-017-0289-2 |
| Pubmed ID | |
| Authors |
Tamara Fetters, Ghazaleh Samandari, Patrick Djemo, Bellington Vwallika, Stephen Mupeta |
| Abstract |
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. |
X Demographics
The data shown below were collected from the profiles of 5 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 4 | 80% |
| South Africa | 1 | 20% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 5 | 100% |
Mendeley readers
The data shown below were compiled from readership statistics for 183 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Brazil | 1 | <1% |
| Unknown | 182 | 99% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Master | 40 | 22% |
| Researcher | 35 | 19% |
| Student > Ph. D. Student | 14 | 8% |
| Student > Bachelor | 14 | 8% |
| Other | 9 | 5% |
| Other | 27 | 15% |
| Unknown | 44 | 24% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 41 | 22% |
| Social Sciences | 30 | 16% |
| Nursing and Health Professions | 29 | 16% |
| Pharmacology, Toxicology and Pharmaceutical Science | 7 | 4% |
| Engineering | 6 | 3% |
| Other | 22 | 12% |
| Unknown | 48 | 26% |
Attention Score in Context
This research output has an Altmetric Attention Score of 5. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 02 March 2017.
All research outputs
#7,441,281
of 25,754,670 outputs
Outputs from Reproductive Health
#879
of 1,595 outputs
Outputs of similar age
#110,381
of 320,422 outputs
Outputs of similar age from Reproductive Health
#22
of 40 outputs
Altmetric has tracked 25,754,670 research outputs across all sources so far. This one has received more attention than most of these and is in the 70th percentile.
So far Altmetric has tracked 1,595 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 13.0. This one is in the 44th percentile – i.e., 44% of its peers scored the same or lower than it.
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We're also able to compare this research output to 40 others from the same source and published within six weeks on either side of this one. This one is in the 42nd percentile – i.e., 42% of its contemporaries scored the same or lower than it.