consortium for research on unsafe abortion in...

Zambia Household Survey: Abortion Knowledge, Attitudes, and Practices

Place of InterviewInterviewer: Please fill out the following prior to traveling to interview location.

Province (circle one): Copperbelt | Lusaka

District (circle one): Kafue | Lusaka | Mufulira | Kitwe

Community (circle one): Chilanga | Chipata | Kawama | Mufulira

Census supervisory area (CSA): ___________

Standard enumeration area (SEA): ___________

Locality: _______________________________

Sampling serial number of household: ___ ___ ___

Day of Interview: ___ ___ November

Primary language of Interview (circle one): English | Bemba | Nyanja | Tonga

Interviewer’s Name: _________________________________

Interviewer’s Sex (circle one): Male | Female

Field Reviewed/Edited by: ________________________________

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Respondent Information (for adult who answers door)

Good morning/afternoon. My name is __________________ and I’m conducting a survey on behalf of the Ministry of Health, University Teaching Hospital, and an NGO called Ipas. Would you or any other adult in your household be willing to answer a few questions? [If yes, thank them and continue. If no, thank them, stop the interview, and mark the box below.]Respondent who answered the door refused to participate in the survey.

List of Household MembersCould you please tell me the name of all the adults aged 18-49, including yourself, that live in this household and who slept here last night? [Where applicable, mention that this does not include servants.]

RESPONDENT NUMBER

NAME AGESEX

(M/F)

SELECTED FOR

INTERVIEW (Y/N)

RESULT*

01

02

03

04

05

06

07

08

09

10

Interviewer: Please randomly select two adults in the household for the interviews. If the household only has one or two adults please interview all adult household members.

* Code for result column: 1=Respondent refused to participate 2=Respondent agreed to participate3=Told to come back at another time 4=Not selected for interview5=Tonga speaker only 6=Made 3 unsuccessful attempts to contact

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Sampling serial number: ___ ___ ___ Household respondent number: ___ ___

Introduction [Read to randomly selected respondent]

Good morning/afternoon. My name is __________________ and I’m conducting a survey on behalf of the Ministry of Health, University Teaching Hospital, and an NGO called Ipas. Would you be willing to answer a few questions? [If yes, thank them and continue, marking their participation in the “results” column on the previous page. If no, thank them and record their refusal on the previous page.]

We are undertaking a survey among community members about an important reproductive health problem that affects many women and teenage girls. The survey is about unwanted pregnancy and means of preventing it. Unwanted pregnancy is a problem that affects women all over the world and can seriously impair their health, well-being, and future fertility. The purpose of this survey is to obtain information that can help improve our understanding of the problem and how to address it in Zambia. Your views on these issues are important to us. Information gathered from you and other volunteers will help us to get a better picture of the situation in Zambia and will form the basis for planning to provide better reproductive health services. We would be very grateful for your cooperation. We assure you that any information you provide will be kept strictly confidential and your name will not be captured or used in any reports. Any identifying information is captured only so that we can select the respondent for the questionnaire and to be sure that you understand what we are asking you to do. No identifying information about you or your household members will be used in any report or anaylsis of these data. Your participation is voluntary.

If you decide to participate in this interview, you will be among approximately 800 others interviewed. We will ask you a series of questions. This interview will take between 30 minutes to one hour to complete.

You will not benefit personally from your participation in this study. This research is designed to benefit society by obtaining new knowledge.

You may feel uncomfortable answering questions about topics related to sexual health and rights. If you do not want to answer a question, we can skip it.

We will protect your personal contact information and will not share it with anyone outside of the study team. You will not be personally identified in any report or manuscript resulting from this study.

There are no costs for participating in this study.

[GIVE THEM INFORMATION SHEET TO KEEP; HAVE THEM SIGN CONSENT FORM AT THIS POINT]

Do you have any questions before we begin?

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SignaturesIf you don’t have any/any more questions and agree to participate in the study, I ask you to sign this form stating that I, the interviewer, have informed you of your rights as a participant and that you have agreed to participate. We thank you for your time.

I have read the information in this consent form (or it has been read to me). All my questions about the study and my participation have been answered. I understand what my involvement in the study means. I understand my participation is voluntary and I can refuse to participate at any moment, for any reason, without penalty.

Participant Name (Please print) Participant Signature Date

_________________________ _________________________ _______________

Thumbprint of participant (if participant cannot sign):

Interviewer Name (Please print) Interviewer Signature Date

_________________________ _________________________ ___________________

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Section 1. Demographic and Household Information

101

Are you able to read and write?(select only one answer)

Read onlyWrite only Both read and write Cannot read nor write (neither)

102

What is the highest level of schooling you have completed?(select only one answer)

None Primary SecondaryTechnical schoolCollegeUniversity

103

What is your current marital status?(select only one answer)

MarriedSeparated/ DivorcedWidowedSingle/never married

104

What is the religion you follow?(select only one answer)

ProtestantCatholicMuslimTraditionalNoneOther (specify): __________________________________

105

What do you do for a living?(select only one answer)

FarmerAgricultural laborNon-agricultural wage laborBusinessSalariedNot working/studentSmall trade/vendorOther (specify): ___________________________________

106

What is the average monthly income of your household?(select only one answer)

Less than 100,000 Kwacha101,000-150,000 Kwacha151,000-500,000 Kwacha501,000-1,000,000 Kwacha1,000,000 Kwacha and aboveDoes not know/No answer

110Have you ever witnessed a street drama on a health topic?(select only one answer)

No Go to question 201YesDoes not know/No answer

111

If yes, on which topics?

(allow multiple answers, read responses aloud)

MalariaHIV/AIDSSTI preventionVaccinationsTuberculosisFamily PlanningAbortionOther (specify): ___________________________________Does not know/No answer

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Section 2. Legal Indications for Abortion in Zambia

201

Do you think abortion is legal in Zambia?(select only one answer)

NoYesDoes not know/ No answer Go to question 203

202

Where did you get this information on abortion?(allow multiple answers, but do not read responses)

The radioMedical staff at a health facilityNeighbors/family/friendsStreet drama/signs/posters/pamphletsChurchOther (specify): __________________________________

203To your knowledge, is abortion legal if the pregnancy is a result of rape?(select only one answer)

NoYesDoes not know/ No answer

204

To your knowledge, is abortion legal if the woman’s existing children would suffer from physical or mental harm if the pregnancy were continued?(select only one answer)


205To your knowledge, is abortion legal if the woman’s life is endangered by the pregnancy?(select only one answer)


206

To your knowledge, is abortion legal if the child has a strong chance of a serious physical or mental defect?(select only one answer)


207To your knowledge, is abortion legal if the woman does not want another child?(select only one answer)


208

To your knowledge, is abortion legal if the woman cannot financially afford to support another child?(select only one answer)


209To your knowledge, is abortion legal if the pregnancy is a result of incest?(select only one answer)


210To your knowledge, is abortion legal for any reason or whenever the woman decides?(select only one answer)


211

To your knowledge, is abortion legal if the young girl or woman wants to continue her studies?(select only one answer)


212

To your knowledge, is abortion legal if there is a risk to the woman’s physical or mental health?(select only one answer)


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Now, I’d like to know your personal opinion. Under which of the following situations do you personally feel that a woman should be allowed to have an abortion?

213

Do you think a woman should be allowed to have an abortion if the pregnancy is a result of rape?(select only one answer)


214

Do you think a woman should be allowed to have an abortion if the woman’s existing children would suffer from physical or mental harm if the pregnancy were continued?(select only one answer)


215

Do you think a woman should be allowed to have an abortion if the woman’s life is endangered by the pregnancy?(select only one answer)


216

Do you think a woman should be allowed to have an abortion if the child has a strong chance of a serious physical or mental defect ?(select only one answer)


217

Do you think a woman should be allowed to have an abortion if the woman does not want another child?(select only one answer)


218

Do you think a woman should be allowed to have an abortion if the woman cannot financially afford to support another child?(select only one answer)


219

Do you think a woman should be allowed to have an abortion if the pregnancy is a result of incest?(select only one answer)


220

Do you think a woman should be allowed to have an abortion for any reason or whenever the woman decides?(select only one answer)


221

Do you think a woman should be allowed to have an abortion if the young girl or woman wants to continue her studies?(select only one answer)


222

Do you think a woman should be allowed to have an abortion if there is a risk to the woman’s physical or mental health?(select only one answer)


Section 3. Attitudes and Beliefs301 In the past year, have you heard of safe

abortion services being provided at ______________________________________?

NoYesDoes not knowNo answer

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(INSERT NAME OF NEAREST STUDY FACILITY: RONALD ROSS, CHIPATA CLINIC, CHILANGA CLINIC, OR KAWAMA CLINIC)(select only one answer)

Other (specify): ___________________________________

302

Do you know any women from your community who became seriously ill from abortion related complications or who died from trying to terminate a pregnancy?(select only one answer)

NoYesDoes not knowNo answer

In the next few questions, I am going to ask your opinion. I will read out some statements. Please let me know whether you disagree with the statement, are neutral or unsure, or agree with the statement.

Disagree Neutral/Unsure Agree

303In your opinion, abortion services are normally only available at urban clinics.(select only one answer)

304In your opinion, abortions usually cost more than any other health treatment.(select only one answer)

305

In your opinion, in your community abortions among unmarried women are usually treated as bad or sinful.(select only one answer)

306In your opinion, in your community abortions among married women are usually treated as bad or sinful. (select only one answer)

307

In your opinion, in your community it is not acceptable to talk about any abortion-related issues.(select only one answer)

308

In your opinion, in your community people who want to terminate a pregnancy prefer to go to a traditional healer rather than a medical doctor, nurse, or midwife.(select only one answer)

309 In your opinion, abortion is immoral.(select only one answer)

310

In your opinion, a woman has the right to decide whether or not she wants to terminate a pregnancy.(select only one answer)

311In your opinion, women should have access to safe abortion services.(select only one answer)

312In your opinion, women dying from pregnancy-related causes are a large problem in Zambia.(select only one answer)

313

In your opinion, men and women should have access to contraceptives to plan and space births and prevent unplanned pregnancies.(select only one answer)

314

In your opinion, adolescents should have access to contraceptives to prevent unplanned pregnancies.(select only one answer)

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315

In your opinion, quacks are more trustworthy to keep your situation secret than doctors, nurses, or midwives.(select only one answer)


316

In your opinion, a woman who has an unsafe abortion can never become pregnant again afterwards.(select only one answer)

317

In your opinion, a woman who has a safe abortion can never become pregnant again afterwards.(select only one answer)

318In your opinion, a woman cannot work immediately after having an abortion. (select only one answer)

319In your opinion, a woman can die from a botched abortion done in unsafe conditions by quacks. (select only one answer)

320

[For female respondents: ]In your opinion, if you wanted to terminate a pregnancy, your partner would support you.(select only one answer)

[For male respondents: ]In your opinion, if your partner wanted to terminate a pregnancy, you would support her.(select only one answer)

321

[For female respondents: ]In your opinion, if you wanted to terminate a pregnancy, your family would support you.(select only one answer)

[For male respondents: ]In your opinion, if your partner and you wanted to have an abortion your family would support you.(select only one answer)

322

[For female respondents: ]In your opinion, if you wanted to have an abortion, you would have to do so without telling anyone.(select only one answer)

[For male respondents: ]In your opinion, if your partner and you wanted to have an abortion, you would have to do so without telling anyone. (select only one answer)

323 [For female respondents: ]In your opinion, if you wanted to have an abortion, your friends and relatives would isolate or reject you.

[For male respondents: ]

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In your opinion, if your partner and you wanted to have an abortion, your friends and relatives would isolate or reject you.(select only one answer)


324

[For female respondents: ]In your opinion, if you wanted to terminate a pregnancy, doctors and health care providers would treat you rudely.(select only one answer)

[For male respondents: ]In your opinion, if your partner and you wanted to terminate a pregnancy, doctors and health care providers would treat you rudely.(select only one answer)

325

In your opinion, you can confidently talk to a health care provider about issues related to abortion.(select only one answer)

326

In your opinion, you can easily talk about issues related to abortion with yourfriends or neighbors.(select only one answer)

327

In your opinion, you can confidently talk to your partner about any issues related to abortion.(select only one answer)

328In your opinion, a woman who has an abortion probably has sex with lots of different men.(select only one answer)

329

In your opinion, doctors and midwives who perform abortions in a clinic are committing a crime.(select only one answer)

330In your opinion, you would feel ashamed if a member of my family had an abortion.(select only one answer)

331In your opinion, a woman should keep her abortion a secret from other people.(select only one answer)

332In your opinion, traditional healers who help women abort a pregnancy are helping women.(select only one answer)

333

In your opinion, if a man wants to marry a woman who has had an abortion, you would advise against it.(select only one answer)

334In your opinion, a woman who has an abortion can make other people fall ill or get sick.(select only one answer)

335In your opinion, if a woman has an abortion, she should be reported to the police.(select only one answer)

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336

In your opinion, you would try to disgrace a woman in your community if you found out she’d had an abortion.(select only one answer)


337

In your opinion, the health of a woman who had an abortion is never as good as it was before the abortion.(select only one answer)

338

In your opinion, a woman who has had an abortion should be counseled by religious leaders so that she doesn’t do it again.(select only one answer)

339

In your opinion, it is a good idea for a woman who has an abortion to not talk about her experience.(select only one answer)

340

In your opinion, you would not allow your children to go near a woman who has had an abortion.(select only one answer)

341In your opinion, a woman who has an abortion is a bad mother.(select only one answer)

342In your opinion, a man who supports a woman in getting an abortion is committing a crime.(select only one answer)

343In your opinion, it is a good idea for the government to allow abortions to be legal.(select only one answer)

344

In your opinion, you would continue to be friends with someone if you found out that they had an abortion.(select only one answer)

345

In your opinion, a woman who has had an abortion might influence other women to get abortions.(select only one answer)

346In your opinion, it is okay for a woman to feel relieved after having an abortion.(select only one answer)

347

In your opinion, a man should not marry a woman who has had an abortion because she may not be able to bear children.(select only one answer)

348In your opinion, a woman who has an abortion should be treated the same as everyone else.(select only one answer)

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Section 4. Knowledge of Abortion Practices

401

Where do married women in this community go to have an abortion?

(allow multiple answers, but do not read responses)

Traditional healer (Ng’anga)Teaching/tertiary hospital (UTH)Public HospitalPublic Health CenterPrivate clinicNGO clinic (MSI)Friends/familyInduces by herselfTraditional birth attendantPharmacy/drug sellerOther (specify):____________________________________Does not know/No answer

402

Where do unmarried girls or women in this community go to have an abortion?


Traditional healer (Ng’anga)Teaching/tertiary hospital (UTH)Public HospitalPublic Health CenterPrivate clinicNGO clinic (MSI)Friends/familyInduces by herselfTraditional birth attendantPharmacy/drug sellerOther (specify): ___________________________________Does not know/No answer

403

If you, your partner, or someone you know needed to have an abortion, where would you go?


Traditional healer (Ng’anga)Teaching/tertiary hospital (UTH)Public HospitalPublic Health CenterPrivate clinicNGO clinic (MSI)Friends/familyInduces by herselfTraditional birth attendantPharmacy/drug sellerOther (specify): ___________________________________Does not know/No answer

404

Why would you choose this facility/provider?


CostDistanceFemale providerPrivacyPartner’s consent not requiredProvider skillEquipped facilityNot required to adopt family planning methodOther (specify):________________ ____________________Does not know/No answer

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405

To your knowledge, where is the nearest location where you or someone you know could access services or help in getting a safe abortion?

(select only one answer)

Traditional healer (Ng’anga)Teaching/tertiary hospital (UTH)Public HospitalPublic Health CenterPrivate clinicNGO clinic (MSI)Friends/familyInduces by herselfTraditional birth attendantPharmacy/drug sellerOther (specify):____________________________________Does not know/No answer

406

If safe abortion services were to become available at a clinic or hospital near your community/compound, would you or your partner go there?(select only one answer)

NoYesDoes not know/No answer

407

If a woman wants to have an abortion, do you know of any medication or substance she can take?(select only one answer)


408

What medication, method or substance do you know of for starting an abortion?

(allow multiple answers, but do not read responses. probe for answers on list.)

If respondent answers one of the following 4 choices, ask question 409:Misoprostol/CytotecMedabonChinese abortion pillOther tablets/ tablets inserted vaginally______________________________________If respondent answers one of the following choices, go to question 410:Chloroquine tabletsBoiled roots (Lunsonga, muzwezi, mubonobono, mululwe, mulozameno, munsokansoka, itembusha, mbulumbulu, matolisa, mkoswe)Ashes (mulota, ifisikisa, chidulo)Painkillers/antibiotics (Cafenol, Panadol, ampicillin, aspirin, Anadin)Beverages (soda, coke, etc.)Physical removal (sharp stick or sharp root)Crushed bottles (drink ground glass)Washing powder (Dynamo, Boom, etc.)Other (specify):____________________________________Does not know/No answer

409 (If respondent answered 1, 2, 3 or 4 to the previous question, ask:)

You mentioned pills or tablets. How did you first come to know about this method?

Friend/Family member/PartnerHealth care providerTraditional healer (Ng’anga)RadioPamphlet

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Street dramaSigns/postersOther (specify):____________________________________Does not know/No answer

Section 5. Health-Seeking Behaviors

501

In the last 12 months, have you received any information about contraceptives or family planning?(select only one answer)


502

From whom did you get this information?


Friend/Family member/PartnerHealth care providerTraditional healer (Ng’anga)RadioPamphletStreet dramaSigns/postersPharmacy/drug sellerOther (specify):___________________________________Does not know/No answer

503In the last 12 months, have you received any information about abortion?(select only one answer)


504

From whom did you get this information?


Friend/Family member/PartnerHealth care providerTraditional healer (Ng’anga)RadioPamphletStreet dramaSigns/postersPharmacy/drug sellerOther (specify):____________________________________Does not know/No answer

505

In the past year, have you heard about abortions being performed by tablets or pills at ______________________________________?(INSERT NAME OF NEAREST STUDY FACILITY: RONALD ROSS, CHIPATA CLINIC, CHILANGA CLINIC, OR KAWAMA CLINIC)


506

Where did you hear about this?


Friend/Family member/PartnerHealth care providerTraditional healer (Ng’anga)RadioPamphletStreet dramaSigns/postersPharmacy/drug sellerOther (specify):___________________________________Does not know/No answer

507 Where do you go to treat general ailments for your family?

Government health facilityPrivate health facilityNGO hospital/clinic

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Pharmacy/Drug sellerTraditional Healer (Ng’anga)Other (specify):___________________________________Does not know/No answer

508

Where do you mostly go to consult/treat for more personal health issues such as antenatal care?


Government health facilityPrivate health facilityNGO hospital/clinicPharmacy/DrugstoreTraditional Healer (Ng’anga)Other (specify):___________________________________Does not know/No answer

Interviewer: If respondent is male, thank the respondent and end the survey. Only continue to the rest of the survey questions if the respondent is female.

Section 6. Female Respondents Only

601Have you ever have had an unexpected delay in your period?(select only one answer)


602Did you do anything to bring on your period?(select only one answer)


603

From whom did you seek help in bringing on your period?


No one/selfFamilyFriendPharmacistHealth care providerTraditional healerOther (specify):___________________________________Does not know/No answer

604

What did you use or do to bring on your period?


Misoprostol/CytotecMedabonChinese abortion pillOther tablets/ tablets inserted vaginallyChloroquine tabletsBoiled roots (Lunsonga, muzwezi, mubonobono, mululwe, mulozameno, munsokansoka, itembusha, mbulumbulu, matolisa, mkoswe)Ashes (mulota, ifisikisa, chidulo)Painkillers/antibiotics (Cafenol, Panadol, ampicillin, aspirin, Anadin)Beverages (soda, coke, etc.)Physical removal (sharp stick or sharp root)Crushed bottles (drink ground glass)Washing powder (Dynamo, Boom, etc.)Other (specify):____________________________________Does not know/No answer

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605

Have you ever fallen pregnant when you were not hoping or expecting to become pregnant?(select only one answer)

No Thank the respondent and end surveyYesDoes not know/No answer

606

Did you do anything to terminate the pregnancy?(select only one answer)


Interviewer: If respondent answered “No” to the previous question, thank the respondent and end the survey. Only continue to the rest of the survey questions if the respondent reports a previous abortion experience.

607

From whom did you seek help in terminating the pregnancy?


No one/selfFamilyFriendPharmacistHealth care providerTraditional healerDoes not know/No answer

608

What did you use or do terminate the pregnancy?

(allow multiple answers, but do not read responses. probe for answers in list.)

Misoprostol/CytotecMedabonChinese abortion pillOther tablets/ tablets inserted vaginallyChloroquine tabletsBoiled roots (Lunsonga, muzwezi, mubonobono, mululwe, mulozameno, munsokansoka, itembusha, mbulumbulu, matolisa, mkoswe)Ashes (mulota, ifisikisa, chidulo)Painkillers/antibiotics (Cafenol, Panadol, ampicillin, aspirin, Anadin)Beverages (soda, coke, etc.)Physical removal (sharp stick or sharp root)Crushed bottles (drink ground glass)Washing powder (Dynamo, Boom, etc.)Other (specify):____________________________________Does not know/No answer

609

Did this action enable you to terminate the pregnancy completely?(select only one answer)

YesNo, it was incompleteNo, nothing happenedDoes not know/No answer

610Did you seek care at a health facility at any point after trying to terminate your pregnancy?(select only one answer)

NoYesDoes not know/No answer

611

Did you experience any health complications after trying to terminate this pregnancy?(select only one answer)


612 If yes, can you please tell us about your health complications?

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Interviewer: Thank the respondent and end the survey.

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consortium for research on unsafe abortion in...

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