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首页> 外文期刊>Reproductive Health >Moving from legality to reality: how medical abortion methods were introduced with implementation science in Zambia
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Moving from legality to reality: how medical abortion methods were introduced with implementation science in Zambia

机译：从合法走向现实：赞比亚如何通过实施科学引入医疗流产方法

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Background Although abortion is technically legal in Zambia, the reality is far more complicated. This study describes the process and results of galvanizing access to medical abortion where abortion has been legal for many years, but provision severely limited. It highlights the challenges and successes of scaling up abortion care using implementation science to document 2 years of implementation. Methods An intervention between the Ministry of Health, University Teaching Hospital and the international organization Ipas, was established to introduce medical abortion and to address the lack of understanding and implementation of the country’s abortion law. An implementation science model was used to evaluate effectiveness and glean lessons for other countries about bringing safe and legal abortion services to scale. The intervention involved the provision of Comprehensive Abortion Care services in 28 public health facilities in Zambia for a 2 year period, August 2009 to September 2011. The study focused on three main areas: building health worker capacity in public facilities and introducing medical abortion, working with pharmacists to provide improved information on medical abortion, and community engagement and mobilization to increase knowledge of abortion services and rights through stronger health system and community partnerships. Results After 2 years, 25 of 28 sites provided abortion services, caring for more than 13,000 women during the intervention. For the first time, abortion was decentralized, 19% of all abortion care was performed in health centers. At the end of the intervention, all providing facilities had managers supportive of continuing legal abortion services. When asked about the impact of medical abortion provision, a number of providers reported that medical abortion improved their ability to provide affordable safe abortion. In neighboring pharmacies only 19% of mystery clients visiting them were offered misoprostol for purchase at baseline, this increased to 47% after the intervention. Despite progress in attitudes towards abortion clients, such as empathy, and improved community engagement, the evaluation revealed continuing stigma on both provider and client sides. Conclusions These findings provide a case study of the medical abortion introduction in Zambia and offer important lessons for expanding safe and legal abortion access in similar settings across Africa.
机译：背景技术尽管在赞比亚堕胎在技术上是合法的，但现实要复杂得多。这项研究描述了刺激堕胎的过程和结果，因为堕胎已经合法多年，但堕胎的规定受到严格限制。它着重介绍了使用实施科学记录实施2年的经验来扩大流产护理的挑战和成功。方法卫生部，大学教学医院和国际组织伊帕斯（Ipas）之间建立了一项干预措施，以引入药物流产并解决对该国流产法律缺乏了解和执行的问题。实施科学模型用于评估有效性，并为其他国家提供规模安全和合法堕胎服务的经验教训。干预包括在2009年8月至2011年9月的两年期间在赞比亚的28个公共卫生设施中提供全面堕胎护理服务。该研究集中在三个主要领域：在公共设施中建设卫生工作者的能力，引入医疗堕胎，工作与药剂师合作，通过更完善的卫生系统和社区合作伙伴关系，提供有关药物流产，社区参与和动员的信息，以提高对堕胎服务和权利的了解。结果两年后，在28个地点中有25个提供了​​堕胎服务，在干预期间照顾了13,000多名妇女。人工流产是第一次分散化，所有流产护理的19％是在卫生中心进行的。干预结束时，所有提供设施的管理人员都支持继续进行合法堕胎服务。当被问及提供医疗堕胎的影响时，许多提供者报告说，医疗堕胎提高了他们提供负担得起的安全堕胎的能力。在邻近的药房，只有19％的神秘顾客在基线时被提供米索前列醇购买，干预后增加到47％。尽管在对待堕胎客户的态度（例如同情心）方面有所进步，并且社区参与度有所提高，但评估显示，提供者和客户双方的污名持续存在。结论这些发现为在赞比亚引进医疗堕胎提供了案例研究，并为在非洲类似地区扩大安全和合法堕胎途径提供了重要的教训。

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