Title: Pregnancy termination trajectories in Zambia: maximising research impact
Funder: Economic and Social Research Council

Abstract: Context Unsafe abortion, and its consequences, remains a major challenge in Zambia, despite an abortion law that is considered relatively favourable and a relatively liberal policy framework, relative to the rest of sub-Saharan Africa. Unsafe abortion is a significant, but preventable, cause of maternal mortality and morbidity and is both a cause and a consequence of poverty. Globally, there are an estimated 19.8 million unsafe abortions annually, of which it is estimated more than 5 million require hospital-based post-abortion care (PAC). Death is the most severe consequence of unsafe abortion, defined as a procedure for terminating unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking the minimal medical standards, or both. Unsafe abortion is the most easily prevented cause of maternal death. The current political climate in Zambia presents a key opportunity for our research findings to form part of the evidence that contributes to policymaking. Proposed Impact Maximisation project We proposed a series of activities, targeting specific audiences (e.g.: adolescents and women, health professionals, MPs), to increase the impact of the findings from our on-going research. Our research aims to establish how investment in abortion services impacts on the socio-economic conditions of women and their households. Research findings underpinning Impact Maximisation activities The project's data collection and analyses are on-going, and the current project is due to finish in May 2014. We can confidently suggest the likely direction of our findings from our multiple data sources: - Medical abortion methods offer a safe first trimester alternative to traditional unsafe methods but knowledge about how to obtain this is patchy - Unnecessary deaths are still occurring as a result of unsafe abortion - Health systems costs of dealing with the consequences of unsafe abortion are substantial and likely to increase as a result of population growth and urbanisation - There are currently very low levels of knowledge about the legality of pregnancy termination in Zambia even in the capital city - Insufficient sources of authoritative information on the service provision of safe abortion services - Multiple and complex attempts undertaken by adolescents and women to procure a termination - Lack of contraceptive knowledge and services amongst adolescents leading to unintended pregnancies - High levels of stigma and shame around pregnancy termination lead to unsafe abortion attempts Research impact team The team combines the research-specific expertise of members of the original research team (Coast, Vwalika, Murray) with Lusaka-based team members with expertise in particular research audiences (Sikateyo, Mwense) and knowledge exchange expertise by co-investigators from the African Institute of Development Policy [AFIDEP] (Zulu, Oronje, Mutheu), to deliver the planned impact activities. AFIDEP is a non-profit policy think-tank founded in 2009 to facilitate and build African capacity in synthesis, translation and utilization of health research evidence to improve policy-making and resource allocation in sub-Saharan Africa. AFIDEP's regional mandate for sub-Saharan Africa means that key lessons from this Zambia-based project will be shared with other African countries though AFIDEP's work with national and regional decision-makers in sexual and reproductive health nd rights. The research impact work involves - Training of team members in specialist knowledge exchange skills - Delivery of a set of targeted research impact activities, using these enhanced skills, to diverse audiences. - Describing "what works" for research impact on the subject of abortion.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH