Post-abortion care services in Zambian health facilities: a qualitative study of users' experiences and perceptions

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) individual interviews with women seeking post-abortion care services were` conducted using audio recorders; transcribed data was analyzed using thematic analysis. Results: We report women's experiences and perceptions of the healthcare system, their experiences of abortion, and healthcare-seeking behavior. We used the availability, accessibility, acceptability, and quality (AAAQ) framework to understand how women claimed their right to healthcare as they sought and utilized abortion care services. 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 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.