In Zambia, abortion is legal if the pregnancy would threaten the mother's life or physical or mental health or those of existing children, or if it would cause a birth defect.
The Termination of Pregnancy (TOP) Act, passed in 1972, legalizes abortion if approved by medical professionals.
Amendments to the bill and medical guidelines clarify that the law allows the consideration of situations such as pregnancy from rape, as well as socioeconomic factors.
Some critics of Zambia's abortion law believe that the TOP Act's restrictions are barriers to access for most Zambians.
Public health providers legally do not charge money for abortions, but unofficial fees are common.
Zambia's state religion is Christianity, and churches are influential in opposing abortion on religious grounds.
[4] The TOP Act does not specify a gestational limit, but the MOH has regulated that abortion is banned after fetal viability, at 28 weeks.
Uncertainty about the law and the option of conscientious objection may lead to medical professionals refusing to provide abortions.
It was passed eight years into the presidency of Kenneth Kaunda, whose Zambian Humanism ideology involved conservative Christian, patriarchal views on female sexuality.
The Minister of Health presented it to the parliament, saying, "the purpose of this Bill is to amend and clarify the law relating to termination of pregnancy by registered medical practitioners".
The Catholic Church in Zambia wrote to the Secretary General to the Cabinet to protest the bill, claiming that it had been passed too quickly, without public debate, and was based on a British law.
[1] Dilation and curettage was the standard method of abortion until the 2000s, despite the World Health Organization's recommendation of manual vacuum aspiration (MVA).
This reform occurred during the peak of the Zambian AIDS epidemic, which weakened the healthcare system too much for other initiatives.
Beginning in August 2009, the MOH collaborated with Ipas and UTH on a pilot project to introduce medical abortions to hospitals.
It planned to implement comprehensive abortion care in 7 hospitals and 21 primary health facilities across Lusaka and Copperbelt Province.
In early 2012, the Ministry of Health approved Medabon, a combination pack of mifepristone and misoprostol, for abortions, and an NGO procured the first shipment of it.
[12][13] Article 12 of the Constitution of Zambia protects fetal rights, saying "A person shall not deprive an unborn child of life by termination of pregnancy except in accordance with the conditions laid down by an Act of Parliament for that purpose".
[13] Some employees of public-sector facilities provide abortion care there under private arrangements at higher prices.
[20] Fees within the official healthcare system are low and sometimes waived, but stigma and lack of knowledge prevent access.
[8] Women who receive abortions often borrow money from friends and relatives or sell belongings to afford the procedure.
Abortions are difficult due to a lack of information, societal stigma, objections from health workers, and insufficient services.
[3] A 2011 report by the Center for Reproductive Rights and the U.N. Committee on the Elimination of Discrimination against Women estimated that 30% of maternal deaths in the country were caused by unsafe abortions.
Unofficial payments in medical facilities are widely known to occur illegally but continue because the stigma prevents women from reporting them.
[25] Among secondary school students, a girl's decision to terminate a pregnancy is often influenced by fear of her fathers' reaction, concerns about her personal and financial relationships their partners, and wanting to continue education.
[19] The national guidelines support abortions that are "the best interest of the minor", but healthcare workers may misunderstand the law to limit implementation.
[27] Rural residents often keep silent about the topic, tolerating abortions that are kept private and reproaching cases that become public to defend their own morals.
Some men are not involved in their partners' pregnancies because the man denies paternity or the woman fears his response.
According to a 2008 report by the Guttmacher Institute, many healthcare providers are unaware of the legal requirements for abortion.
"[1] Zambia's Comprehensive Sexuality Education (CSE) framework does not include the topic of abortion due to cultural and religious concerns.
[3] In Zambia and other African countries, abortion-rights activists frame the issue in terms of public health.