Attitudes to 'Kaponya Mafumo': the terminators of pregnancy in urban Zambia

As part of a larger study of adolescent sexual and reproductive health in u rban Zambia, the issue of unwanted pregnancy and abortion was considered th rough the examination of the perceptions of both adolescents and adults. Yo ung people rank sexual health as their primary health issue, and sexual beh aviour is integrally linked into other aspects of their lives. Pregnancies were deemed to be a common occurrence amongst the adolescents, with an esti mated two-thirds of unwanted pregnancies ending in unsafe abortion. The dec ision to abort is primarily determined by the reaction of the boyfriend and his willingness to accept paternity and the associated financial implicati ons. Other crucial influences are the desire to stay in school and the stig ma attached to unwanted pregnancy. The decision-making process regarding th e abortion itself is related to the perceived advantages and disadvantages of various service providers. Around 40% of the respondents stated that in the event of an abortion being carried out, it would be performed either by the girl herself or with the assistance of other non-medical personnel. Le ss popular but still significant are traditional healers and private doctor s. Formal health services tend to be rejected due to their poor perception by young people, centred on the lack of privacy and confidentiality, and th e de facto illegal nature of abortion itself. The services of nurses are so ught, but outside of the clinic setting. The most popular method of self-in duced abortion is overdosing on chloroquine. Other methods involve the use of traditional medicines such as various types of roots, as well as more mo dern methods such as ingesting washing powder. Recommendations for policy-m akers concentrate on the improvement of formal, 'youth friendly' health ser vices and the development of appropriate outreach education methods which a ddress specific concerns widely held by young people.