Adolescent Pathways to Abortion Care in Lusaka, Zambia: Evidence from Routine Data

Abstract

Background: Adolescents in sub-Saharan Africa face significant barriers to accessing safe abortion services. In Zambia, empirical data on adolescents' interactions with abortion services within the health system are limited. This study aimed to describe the characteristics and service utilisation patterns of adolescents seeking abortion care in Lusaka Province. Methods: A retrospective, descriptive, observational study was conducted using routinely collected electronic medical records of adolescents aged 12 - 19 years who accessed abortion care between 2016 and 2020. A sample of 390 cases was selected by simple random sampling. Data were analysed using descriptive statistics to examine demographic characteristics, clinical management patterns, and post-abortion contraceptive uptake. Results: The mean age of adolescents was 17.8 years, and the mean gestational age at presentation was 9.0 weeks. Service utilisation was concentrated in Lusaka District (90.0%). Diagnoses were evenly split between incomplete abortion (50.8%) and induced abortion (49.2%). Clinical management varied by diagnosis and facility level. Post-abortion contraceptive uptake was moderate; 21.8% of adolescents did not receive a contraceptive method. Uptake was lower among adolescents presenting with incomplete abortion and those managed at tertiary facilities. Conclusion: Although adolescents who access formal services receive structured and guideline-aligned care, substantial gaps remain in equitable access and in the provision of post-abortion contraception. The high proportion of incomplete abortion cases may suggest continued reliance on informal abortion pathways. Strengthening the availability and readiness of adolescent-friendly services across different levels of care is critical to enhancing access to safe abortion. Keywords: Adolescent abortion; Abortion services; Post-abortion care; Contraceptive uptake; Health system utilisation; Zambia