Ipas Zambia 2018-2021

Outcome 1: Health systems strengthened to increase the provision of quality Comprehensive Abortion Care (CAC) services, including post-abortion family planning (PAFP), in Luapula Muchinga Southern and Eastern provinces. Ipas Zambia brought on board a total of 76 (30 Eastern and 46 Southern) new intervention facilities, bringing the cumulative total of supported facilities under the project to 269. In addition, Ipas Zambia trained 74 new CAC providers bringing the cumulative number of providers trained on the project to 289. The intervention facilities served a total of 10,064 women and girls with abortion care. Of the 10,064 clients, 21% accessed post abortion care (PAC) and 79% accessed induced abortion care. To date, the project has served a total of 31,215 women and girls, representing an 82% achievement against the project total. The project has also continued to record lower proportions of clients accessing PAC in comparison to past years. This entails that, more clients are accessing safer methods of abortion care. Further, 92% of all clients accessed a contraceptive method, which is a good indication for reduction of future unplanned pregnancies. In terms of age category, 28% of clients who access CAC services were 19years and below, while 30% were aged between 20 to 24 and 42% were 25years and above. A total of 10 CAC providers were trained as CAC TOT. The trainees consisted of three doctors, four nurses and three clinical officers. It is anticipated that the TOTs will be a great local resource for skills building in CAC in the two regions. Outcome 2: Community awareness and mobilization to increase knowledge, awareness, access, and social support for CAC services among community members in Luapula, Muchinga, Eastern and Southern provinces. Ipas Zambia partnered with the MoH and other stakeholders, namely; Marie Stopes Zambia and Catholic Relief Services to engage traditional leaders. They have also continued to engage with traditional and religious leaders,the print and electronic media and trained all the categories on various apsects of comprehensive abortion care. Ipas Zambia also conducted media trainings in SRHR including safe abortion and contraception for media houses and personnel from Southern and Eastern Provinces. A total of 57 Journalists were engaged, 26 from Southern and 31 from Eastern Province. The main objective of these trainings was to illustrate the impact of poor SRHR on women and girls hence build capacity of journalists and media houses, to enhance SRHR reporting and contribute to the reduction of maternal mortality through information dissemination. A total of 10, 212 community members were reached with information on contraceptives, Safe abortion Care, Stigma and general SRHR through trained community volunteers. Onsite CAC orientations in Muchinga Resulting from Community TOT trainings that were conducted in Muchinga province in the previous reporting period, the core facilitators have since trained 8 community groups in Mpika, Nakonde, Chinsali, Isoka, Chama, Kanchibiya, Lavushimanda, Shiwangandu and Mafinga districts.

This three-year project includes the foundational steps to establish the necessary guidelines and health system infrastructure to make comprehensive abortion and contraceptive services accessible to women and especially to girls in Zambia over the long term. Ipas have the opportunity to provide technical assistance and support to the MOH in its RMNCAHN work to prevent injuries and deaths of women especially adolescents from unsafe abortion and, more broadly, to advance the sexual and reproductive health and rights of especially poor women and adlescent girls in two very poor provinces of Zambia. 1.Health systems will be strengthened to increase the provision of quality comprehensive abortion care (CAC) services, including postabortion family planning (PAFP), in Luapula and Muchinga provinces.2. Ipas will raise ommunity awareness and mobilization to increase knowledge, awareness, access, and social support for CAC services among community members in the two provinces. The intervention intends to minimise the high rate of maternal death due to the problem of unsafe abortion,especially amongst adolescent women,which remains a major problem in Zambia and in particular the two poverty stricken provinces of Luapula and Muchinga. The Zambian MOH has estimated that as many as 30% of pregnancy-related deaths could be attributable to unsafe abortion, while hospital-based studies show that 30% to 50% of acute gynecological admissions are currently caused by abortion complications, a sizable proportion from unsafe abortion. The MOH also estimated that about 23% of incomplete abortions were among women younger than 20 years and that 25% of maternal deaths due to induced abortions were among adolescent girls younger than 18 years. While modern contraceptive uptake is generally low in Zambia, with a national average of 45%, the situation is worse in both Muchinga and Luapula where contraceptive uptake is only 34% and 33% respectively. Muchinga and Luapula provinces have the highest total fertility rate of Zambia’s provinces except Northern Province. No safe abortion services exist in the two provinces for women who need them. PAC is offered only in hospitals that represent 4% of all public health facilities in these provinces, making the service largely inaccessible by vulnerable women and adolescent girls. Increasing contraceptive use and availing CAC services will reduce both unwanted pregnancies and decrease maternal mortality especially amongst young poor women. Success of the intervention will depend on the interplay of acceptance of the programme,quality service provision by the health facilities and working within the legal framework.