title: Women's knowledge and attitudes surrounding abortion in Zambia: a cross-sectional survey across three provinces.
abstract: OBJECTIVE
  In Zambia, despite a relatively liberal legal framework, there remains a substantial burden of unsafe abortion. Many women do not use skilled providers in a well-equipped setting, even where these are available. The aim of this study was to describe women's knowledge of the law relating to abortion and attitudes towards abortion in Zambia.
  
  
  METHODS
  Community-based survey in Central, Copperbelt and Lusaka provinces.
  
  
  METHODS
  1484 women of reproductive age (15-44 years).
  
  
  METHODS
  Correct knowledge of the legal grounds for abortion, attitudes towards abortion services and the previous abortions of friends, family or other confidants. Descriptive statistics and multivariable logistic regression were used to analyse how knowledge and attitudes varied according to sociodemographic characteristics.
  
  
  RESULTS
  Overall, just 16% (95% CI 11% to 21%) of women of reproductive age correctly identified the grounds for which abortion is legal. Only 40% (95% CI 32% to 45% of women of reproductive age knew that abortion was legally permitted in the extreme situation where the pregnancy threatens the life of the mother. Even in urban areas of Lusaka province, only 55% (95% CI 41% to 67%) of women knew that an abortion could legally take place to save the mother's life. Attitudes remain conservative. Women with correct knowledge of abortion law in Zambia tended to have more liberal attitudes towards abortion and access to safe abortion services. Neither correct knowledge of the law nor attitudes towards abortion were associated with knowing someone who previously had an induced abortion.
  
  
  CONCLUSIONS
  Poor knowledge and conservative attitudes are important obstacles to accessing safe abortion services. Changing knowledge and attitudes can be challenging for policymakers and public health practitioners alike. Zambia could draw on its previous experience in dealing with its large HIV epidemic to learn cross-cutting lessons in effective mass communication on what is a difficult and sensitive issue.
authors.affiliation: MARCH Centre for Maternal, Adolescent, Reproductive and Child Health, LSHTM, London, UK.
authors.forename: Jenny A
authors.initials: JA
authors.lastname: Cresswell
authors.affiliation: MARCH Centre for Maternal, Adolescent, Reproductive and Child Health, LSHTM, London, UK Bixby Center for Global Reproductive Health, University of California, San Francisco, California, USA.
authors.forename: Rosalyn
authors.initials: R
authors.lastname: Schroeder
authors.affiliation: Population Council, Lusaka, Zambia.
authors.forename: Mardieh
authors.initials: M
authors.lastname: Dennis
authors.affiliation: MARCH Centre for Maternal, Adolescent, Reproductive and Child Health, LSHTM, London, UK.
authors.forename: Onikepe
authors.initials: O
authors.lastname: Owolabi
authors.affiliation: Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia.
authors.forename: Bellington
authors.initials: B
authors.lastname: Vwalika
authors.affiliation: Population Council, Lusaka, Zambia.
authors.forename: Maurice
authors.initials: M
authors.lastname: Musheke
authors.affiliation: MARCH Centre for Maternal, Adolescent, Reproductive and Child Health, LSHTM, London, UK.
authors.forename: Oona
authors.initials: O
authors.lastname: Campbell
authors.affiliation: MARCH Centre for Maternal, Adolescent, Reproductive and Child Health, LSHTM, London, UK.
authors.forename: Veronique
authors.initials: V
authors.lastname: Filippi
mesh_terms: D000028:Abortion, Induced / Q000523:psychology / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005193:Family Planning Services; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D011247:Pregnancy; D012928:Social Desirability; D011795:Surveys and Questionnaires; D016387:Women's Health; D015024:Zambia / Q000453:epidemiology
keywords: Induced abortion; Maternal health; Unsafe abortion