Retrospective observational study of interventions to improve acceptance of long-acting reversible contraception following abortion at Lusaka Teaching Hospital, Zambia.

OBJECTIVE: To evaluate long-acting reversible contraceptive (LARC) uptake immediately after abortion at Lusaka University Teaching Hospital, Zambia in the period following an intervention to increase the acceptance of LARC. METHODS: The present retrospective, observational study reviewed the clinical records of all patients admitted to the Lusaka University Teaching Hospital for an incomplete abortion or for a legal induced abortion between January 1 and December 31, 2016. The primary outcome measure was the proportion of adult women (aged 20-44 years) and adolescents (aged 10-19 years) who were already using an available contraceptive method at the time of hospital discharge. Contraceptive use was compared with historical data from the same institution before the intervention to increase LARC acceptance was performed. RESULTS: Data from 3858 patients (587 adolescents and 3271 adults) were included. LARC use was recorded among 108 (18.4%) and 409 (12.5%) adolescents and adults, respectively. This compared with rates from 2011 of less than 1% and less than 4%, respectively. CONCLUSION: The rate of LARC use at discharge following incomplete or induced abortion had increased when compared with historical control data from before the intervention program was performed; however, there remains room for improvement.

Cultural humility and working with marginalized populations in developing countries.

Population health needs in developing countries are great and countries are scaling up health professional education to meet these needs. Marginalized populations, in particular, are vulnerable to poor health and health care. This paper presents a culturally appropriate diversity training program delivered to Global Health Fellows who are educators and leaders in health professions in Malawi and Zambia. The purpose of this interprofessional education experience was to promote culturally competent and humble care for marginalized populations.

Increasing access to legal termination of pregnancy and postabortion contraception at the University Teaching Hospital, Lusaka, Zambia.

The Zambian Association of Gynecology and Obstetrics is one of the International Federation of Gynecology and Obstetrics (FIGO) member societies participating in the FIGO Initiative for the Prevention of Unsafe Abortion and its Consequences from the East, Central, and Southern Africa region. The activities included in this country's plan of action were to provide access to safe abortion within the full extent of the law to women receiving care at the University Teaching Hospital in Lusaka, and to increase the proportion of women leaving the hospital with a contraceptive method. Zambian law regarding abortion is liberal, but in general it was not applied until very recently. The proportion of legal terminations of pregnancy among patients receiving abortion care at the hospital increased from 3.2% in 2009 to 7.7% in 2011, while the percentage of women leaving the hospital with a contraceptive method increased from 25.3% to 69.4% over the same period.