No woman should be left behind: A decomposition analysis of socioeconomic inequalities in unsafe abortion among women presenting for abortion care services in Lusaka and Copperbelt provinces of Zambia

This study measured socioeconomic-related unsafe abortion inequality among women presenting for abortion care services in Lusaka and the Copperbelt provinces of Zambia and decompose its causes. We conducted a cross-sectional study between August and September 2021. Unsafe abortion inequalities were assessed using corrected concentration index and Erreygers-type decomposition analysis was conducted to assess causes of unsafe abortion inequalities. Out of 362 women, the magnitude of unsafe abortion was 77(21.3%, [95% CI: 17.8, 24.9]). The corrected concentration index was -0.231 (95% CI: -0.309, -0.154), implying pro-poor inequality in unsafe abortion among women. Decomposition analysis showed that the major contributors of the unsafe abortion inequality were socioeconomic status (66.6%), marital status (6.3%), education (10.2%) and employment (3.7%). Also, history of unwanted pregnancy (5.1%), awareness of whether abortion is legal in Zambia (8.9%) and awareness that hospitals offered free abortion services (11.3%). The findings suggest that the unsafe abortion is a problem in Zambia and substantial inequality mainly due to socioeconomic factors. Stakeholders and policymakers should consider socioeconomic strategies to reduce unsafe abortion inequality promoting advocacy to increased access to legal safe abortion and use of modern contraceptives so that no woman is left behind in the prevention of unsafe abortion.