PDF(Pubmed)
Abstract：
BACKGROUND: Despite attempts to increase Universal Health Coverage, availability, accessibility, acceptability, and quality-related challenges remain barriers to receiving essential services by women who need them. We aimed to explore the experiences and perceptions of women receiving post-abortal care services in Zambia, within a human-rights framework.
METHODS: A qualitative case study was conducted between August and September 2021 in Lusaka and Copperbelt provinces of Zambia. Fifteen (15) women seeking post-abortion care services were` interviewed using audio recorders; transcribed data was analyzed using thematic analysis. We report women\'s experiences and perceptions of the healthcare system, their experiences of abortion, and healthcare-seeking behaviour. We used the availability, accessibility, acceptability, and quality (AAAQ) framework to understand how women claimed their right to healthcare as they sought and utilized post-abortion care services.
RESULTS: Women who experienced spontaneous abortions delayed seeking health care by viewing symptoms as \'normal pregnancy symptoms\' and not dangerous. Women also delayed seeking care because they feared the negative attitudes from their communities and the health care providers towards abortion in general, despite it being legal in Zambia. Some services were considered costly, impeding their right to access quality care.
CONCLUSIONS: Women delayed seeking care compounded by fear of negative attitudes from the community and healthcare providers. To ensure the provision and utilization of quality all abortion-related healthcare services, there is a need to increase awareness of the availability and legality of safe abortion services, the importance of seeking healthcare early for any abortion-related discomfort, and the provision and availability of free services at all levels of care should be emphasized.
Unsafe abortions continue to be an avoidable public health concern both globally and locally. In Zambia, a fifth of maternal deaths are related to unsafe abortions. Unsafe abortions have been defined as any induced termination of pregnancy outside the health facility, performed by untrained health personnel. Several strides have been made including the provision of comprehensive abortion care in all facilities, and the training of health personnel to provide these services at different levels of healthcare. Despite the increased availability of comprehensive abortion care through liberalized abortion laws and regulations and the training of health personnel to provide these services at different levels of healthcare, the need for quality post-abortion care specifically persists. As such, we carried out in-depth interviews to explore the experiences of women who present at healthcare facilities in Lusaka and the Copperbelt provinces in Zambia seeking post-abortion services. It was found that delay in seeking care at a health facility was due to fear that the service is illegal; alongside judgment from health care providers and society for seeking such a service that is generally perceived as evil. The assumption that the cost of receiving such services is high and a general lack of awareness about the service being provided free was also expressed. The study highlighted the need for community awareness of the legal framework on abortions to ensure women access services at any time necessary without fear of being judged, which will consequently reduce the number of abortion-related disabilities and deaths.
METHODS: A qualitative case study was conducted between August and September 2021 in Lusaka and Copperbelt provinces of Zambia. Fifteen (15) women seeking post-abortion care services were` interviewed using audio recorders; transcribed data was analyzed using thematic analysis. We report women\'s experiences and perceptions of the healthcare system, their experiences of abortion, and healthcare-seeking behaviour. We used the availability, accessibility, acceptability, and quality (AAAQ) framework to understand how women claimed their right to healthcare as they sought and utilized post-abortion care services.
RESULTS: Women who experienced spontaneous abortions delayed seeking health care by viewing symptoms as \'normal pregnancy symptoms\' and not dangerous. Women also delayed seeking care because they feared the negative attitudes from their communities and the health care providers towards abortion in general, despite it being legal in Zambia. Some services were considered costly, impeding their right to access quality care.
CONCLUSIONS: Women delayed seeking care compounded by fear of negative attitudes from the community and healthcare providers. To ensure the provision and utilization of quality all abortion-related healthcare services, there is a need to increase awareness of the availability and legality of safe abortion services, the importance of seeking healthcare early for any abortion-related discomfort, and the provision and availability of free services at all levels of care should be emphasized.
Unsafe abortions continue to be an avoidable public health concern both globally and locally. In Zambia, a fifth of maternal deaths are related to unsafe abortions. Unsafe abortions have been defined as any induced termination of pregnancy outside the health facility, performed by untrained health personnel. Several strides have been made including the provision of comprehensive abortion care in all facilities, and the training of health personnel to provide these services at different levels of healthcare. Despite the increased availability of comprehensive abortion care through liberalized abortion laws and regulations and the training of health personnel to provide these services at different levels of healthcare, the need for quality post-abortion care specifically persists. As such, we carried out in-depth interviews to explore the experiences of women who present at healthcare facilities in Lusaka and the Copperbelt provinces in Zambia seeking post-abortion services. It was found that delay in seeking care at a health facility was due to fear that the service is illegal; alongside judgment from health care providers and society for seeking such a service that is generally perceived as evil. The assumption that the cost of receiving such services is high and a general lack of awareness about the service being provided free was also expressed. The study highlighted the need for community awareness of the legal framework on abortions to ensure women access services at any time necessary without fear of being judged, which will consequently reduce the number of abortion-related disabilities and deaths.
摘要：
背景：尽管尝试增加全民健康覆盖，可用性,可访问性,可接受性,与质量相关的挑战仍然是需要的妇女获得基本服务的障碍。我们旨在探索赞比亚妇女接受堕胎后护理服务的经验和看法，在人权框架内。
方法：2021年8月至9月在赞比亚的卢萨卡和铜带省进行了定性案例研究。使用录音机采访了十五（15）名寻求堕胎后护理服务的妇女；使用主题分析对转录数据进行了分析。我们报告了女性对医疗系统的经历和看法，他们的堕胎经历，和寻求医疗保健的行为。我们使用了可用性，可访问性,可接受性,和质量（AAAQ）框架，以了解妇女在寻求和利用堕胎后护理服务时如何主张其医疗保健权。
结果：经历了自然流产的妇女通过将症状视为“正常妊娠症状”而没有危险来延迟寻求医疗保健。妇女还推迟寻求护理，因为她们担心她们的社区和保健提供者对堕胎的消极态度。尽管这在赞比亚是合法的。一些服务被认为是昂贵的，阻碍他们获得优质护理的权利。
结论：由于担心社区和医疗服务提供者的消极态度，女性推迟了寻求护理的时间。确保提供和利用所有与堕胎有关的优质医疗服务，有必要提高对安全堕胎服务的可用性和合法性的认识，对于任何与堕胎有关的不适，尽早寻求医疗保健的重要性，应强调在各级护理中提供和提供免费服务。
不安全堕胎仍然是全球和当地可避免的公共卫生问题。在赞比亚，五分之一的孕产妇死亡与不安全堕胎有关。不安全堕胎被定义为在医疗机构以外的任何诱导终止妊娠，由未经培训的卫生人员执行。已经取得了一些进展，包括在所有设施中提供全面的堕胎护理，以及培训卫生人员以在不同级别的医疗保健中提供这些服务。尽管通过放宽堕胎法律和法规以及培训卫生人员以在不同级别的医疗保健中提供这些服务，但全面的堕胎护理越来越多，特别需要高质量的堕胎后护理。因此，我们进行了深入访谈,以探讨在卢萨卡和赞比亚铜带省医疗机构就诊的妇女寻求堕胎后服务的经验.人们发现，在医疗机构寻求护理的延迟是由于担心该服务是非法的；以及医疗保健提供者和社会对寻求这种通常被视为邪恶的服务的判断。有人还认为，接受此类服务的费用很高，而且普遍缺乏对免费提供服务的认识。该研究强调，需要提高社区对堕胎法律框架的认识，以确保妇女在必要的任何时候都能获得服务，而不必担心受到审判，这将减少堕胎相关的残疾和死亡人数。
方法：2021年8月至9月在赞比亚的卢萨卡和铜带省进行了定性案例研究。使用录音机采访了十五（15）名寻求堕胎后护理服务的妇女；使用主题分析对转录数据进行了分析。我们报告了女性对医疗系统的经历和看法，他们的堕胎经历，和寻求医疗保健的行为。我们使用了可用性，可访问性,可接受性,和质量（AAAQ）框架，以了解妇女在寻求和利用堕胎后护理服务时如何主张其医疗保健权。
结果：经历了自然流产的妇女通过将症状视为“正常妊娠症状”而没有危险来延迟寻求医疗保健。妇女还推迟寻求护理，因为她们担心她们的社区和保健提供者对堕胎的消极态度。尽管这在赞比亚是合法的。一些服务被认为是昂贵的，阻碍他们获得优质护理的权利。
结论：由于担心社区和医疗服务提供者的消极态度，女性推迟了寻求护理的时间。确保提供和利用所有与堕胎有关的优质医疗服务，有必要提高对安全堕胎服务的可用性和合法性的认识，对于任何与堕胎有关的不适，尽早寻求医疗保健的重要性，应强调在各级护理中提供和提供免费服务。
不安全堕胎仍然是全球和当地可避免的公共卫生问题。在赞比亚，五分之一的孕产妇死亡与不安全堕胎有关。不安全堕胎被定义为在医疗机构以外的任何诱导终止妊娠，由未经培训的卫生人员执行。已经取得了一些进展，包括在所有设施中提供全面的堕胎护理，以及培训卫生人员以在不同级别的医疗保健中提供这些服务。尽管通过放宽堕胎法律和法规以及培训卫生人员以在不同级别的医疗保健中提供这些服务，但全面的堕胎护理越来越多，特别需要高质量的堕胎后护理。因此，我们进行了深入访谈,以探讨在卢萨卡和赞比亚铜带省医疗机构就诊的妇女寻求堕胎后服务的经验.人们发现，在医疗机构寻求护理的延迟是由于担心该服务是非法的；以及医疗保健提供者和社会对寻求这种通常被视为邪恶的服务的判断。有人还认为，接受此类服务的费用很高，而且普遍缺乏对免费提供服务的认识。该研究强调，需要提高社区对堕胎法律框架的认识，以确保妇女在必要的任何时候都能获得服务，而不必担心受到审判，这将减少堕胎相关的残疾和死亡人数。
