A Comparative Study of Health Systems Costs of Safe Abortion And Post Abortion Care In Zambia

Aim: Under the Millennium Development Goal of improving maternal health (MDG 5), the global community aims to reduce maternal mortality ratio (MMR) by three quarters. Unsafe abortion is a significant, but preventable cause of maternal mortality. In Eastern Africa for every 100,000 live births it is estimated that 160 women die from causes related to unsafe abortion –accounting for almost 30% of all maternal mortality. Zambia’s MMR is 440, of which a significant proportion is likely to be due to unsafe abortions, although there are no nationally representative data available. In spite of the existence of a Termination of Pregnancy Act (1972), women face logistical, financial, social, and legal obstacles to access safe abortion services in Zambia. Therefore more attention towards implementation of interventions that direct resources to the prevention of unsafe abortions is needed. In this paper we present an economic argument for policy makers to consider. We compare the cost of safe abortion and post abortion care for the Zambian health system. Our evidence shows that post abortion care can be at least 3 to 5 times more expensive compared to safe abortions. Objective: To estimate the per-case and annual costs of termination of pregnancy (TOP) and post abortion care (PAC) for the Zambian health system. Methods: We collected data on cost of drugs, materials and personnel time from the University Teaching Hospital (UTH) in Lusaka. We estimated the per-case and annual costs of providing TOP and PAC services at UTH and projected these costs to provide estimates for Zambia. Due to unavailability of the actual number of PAC and TOP cases in Zambia, we used estimates from previous studies and from other similar countries, and complemented it with sensitivity analysis to provide a range of costs. Key findings: We found that per-case and annual costs of PAC can be at least 3 to 5 times more expensive compared to TOP. Costs of medications and supplies accounted for the bulk of these costs.