Abstract
Background:It is estimated that one in every five pregnancies globally ends up as abortion, with about 40% being unsafe. Abortions account for approximately 5.9% of all maternal mortalities and 50% of gynaecological admissions in Zambia. Despite implementing Comprehensive Abortion Care (CAC), which aims to provide high quality, safe and affordable services to women, unsafe abortions rates remain high. In this study, we explored the barriers and facilitators to CAC provision in selected health facilities of Lusaka and Copperbelt provinces in Zambia.Materials and methods: A qualitative case study using in-depth interviews with health care providers was conducted between July – August, 2021 in nine selected public health facilities of Zambia. A total of 17 interviews were conducted with participants purposively sampled. The interviews were digitally recorded and transcribed verbatim. Data analysis was done using content analysis. Results: The study revealed a number of barriers and facilitators most of which are health system related. The health system related barriers included inadequate CAC providers, healthcare provider perception that provision of CAC was optional, lack of CAC dedicated space and privacy, frequent shortages of medical supplies and lack of incentives, while individual related barriers included stigma surrounding CAC provision, religious and moral dilemmas. Facilitators to CAC provision included having providers trained and mentored in CAC, availability of a liberal legal framework, accessible services, task shifting and external financial support. Conclusions: The findings of this study on the several barriers of CAC reinforces the idea that despite having appropriate legal provisions to CAC provision in Zambia, challenges in the implementation of the law and related service provision continue to persist. The identified barrriers suggests to consider incorporating CAC services into the pre-service training to ensure more trained and skilled providers are available in the public facilities.