Zambia Household Survey: Abortion Knowledge, Attitudes, and Practices Place of Interview Interviewer: 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: ________________________________ Page 1 of 16 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 Members Could 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 AGE SEX (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 3=Told to come back at another time 5=Tonga speaker only 2=Respondent agreed to participate 4=Not selected for interview 6=Made 3 unsuccessful attempts to contact Page 2 of 16 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? Page 3 of 16 Signatures If 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 _________________________ _________________________ ___________________ Page 4 of 16 Section 1. Demographic and Household Information 101 Are you able to read and write? (select only one answer) Read only Write 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 Secondary Technical school College University 103 What is your current marital status? (select only one answer) Married Separated/ Divorced Widowed Single/never married What is the religion you follow? (select only one answer) Protestant Catholic Muslim 104 Traditional None Other (specify): What do you do for a living? (select only one answer) 105 106 110 What is the average monthly income of your household? (select only one answer) Have you ever witnessed a street drama on a health topic? (select only one answer) If yes, on which topics? (allow multiple answers, read responses aloud) 111 Page 5 of 16 __________________________________ Farmer Agricultural labor Non-agricultural wage labor Business Salaried Not working/student Small trade/vendor Other (specify): ___________________________________ Less than 100,000 Kwacha 101,000-150,000 Kwacha 151,000-500,000 Kwacha 501,000-1,000,000 Kwacha 1,000,000 Kwacha and above Does not know/No answer No Go to question 201 Yes Does not know/No answer Malaria HIV/AIDS STI prevention Vaccinations Tuberculosis Family Planning Abortion Other (specify): ___________________________________ Does not know/No answer Section 2. Legal Indications for Abortion in Zambia 201 Do you think abortion is legal in Zambia? (select only one answer) 202 204 205 206 207 208 209 210 211 212 Yes Does not know/ No answer Go to Where did you get this information on abortion? (allow multiple answers, but do not read responses) 203 No To your knowledge, is abortion legal if the pregnancy is a result of rape? (select only one answer) 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) To your knowledge, is abortion legal if the woman’s life is endangered by the pregnancy? (select only one answer) To your knowledge, is abortion legal if the child has a strong chance of a serious physical or mental defect? (select only one answer) To your knowledge, is abortion legal if the woman does not want another child? (select only one answer) To your knowledge, is abortion legal if the woman cannot financially afford to support another child? (select only one answer) To your knowledge, is abortion legal if the pregnancy is a result of incest? (select only one answer) To your knowledge, is abortion legal for any reason or whenever the woman decides? (select only one answer) To your knowledge, is abortion legal if the young girl or woman wants to continue her studies? (select only one answer) To your knowledge, is abortion legal if there is a risk to the woman’s physical or mental health? (select only one answer) Page 6 of 16 question 203 The radio Medical staff at a health facility Neighbors/family/friends Street drama/signs/posters/pamphlets Church Other (specify): __________________________________ No Yes Does not know/ No answer No Yes Does not know/ No answer No Yes Does not know/ No answer No Yes Does not know/ No answer No Yes Does not know/ No answer No Yes Does not know/ No answer No Yes Does not know/ No answer No Yes Does not know/ No answer No Yes Does not know/ No answer No Yes Does not know/ No answer 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? 213 214 215 216 217 218 219 220 221 222 Do you think a woman should be allowed to have an abortion if the pregnancy is a result of rape? (select only one answer) 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) 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) 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) Do you think a woman should be allowed to have an abortion if the woman does not want another child? (select only one answer) 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) Do you think a woman should be allowed to have an abortion if the pregnancy is a result of incest? (select only one answer) Do you think a woman should be allowed to have an abortion for any reason or whenever the woman decides? (select only one answer) 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) 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) No Yes Does not know/ No answer No Yes Does not know/ No answer No Yes Does not know/ No answer No Yes Does not know/ No answer No Yes Does not know/ No answer No Yes Does not know/ No answer No Yes Does not know/ No answer No Yes Does not know/ No answer No Yes Does not know/ No answer No Yes Does not know/ No answer Section 3. Attitudes and Beliefs 301 In the past year, have you heard of safe abortion services being provided at ______________________________________? (INSERT NAME OF NEAREST STUDY FACILITY: RONALD ROSS, CHIPATA CLINIC, CHILANGA CLINIC, OR KAWAMA CLINIC) (select only one answer) Page 7 of 16 No Yes Does not know No 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) No Yes Does not know No 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 303 304 305 306 307 308 309 310 311 312 313 314 315 In your opinion, abortion services are normally only available at urban clinics. (select only one answer) In your opinion, abortions usually cost more than any other health treatment. (select only one answer) In your opinion, in your community abortions among unmarried women are usually treated as bad or sinful. (select only one answer) In your opinion, in your community abortions among married women are usually treated as bad or sinful. (select only one answer) In your opinion, in your community it is not acceptable to talk about any abortion-related issues. (select only one answer) 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) In your opinion, abortion is immoral. (select only one answer) In your opinion, a woman has the right to decide whether or not she wants to terminate a pregnancy. (select only one answer) In your opinion, women should have access to safe abortion services. (select only one answer) In your opinion, women dying from pregnancyrelated causes are a large problem in Zambia. (select only one answer) In your opinion, men and women should have access to contraceptives to plan and space births and prevent unplanned pregnancies. (select only one answer) In your opinion, adolescents should have access to contraceptives to prevent unplanned pregnancies. (select only one answer) In your opinion, quacks are more trustworthy to keep your situation secret than doctors, nurses, or midwives. (select only one answer) Page 8 of 16 Neutral/ Unsure Agree Disagree 316 317 318 319 In your opinion, a woman who has an unsafe abortion can never become pregnant again afterwards. (select only one answer) In your opinion, a woman who has a safe abortion can never become pregnant again afterwards. (select only one answer) In your opinion, a woman cannot work immediately after having an abortion. (select only one answer) In your opinion, a woman can die from a botched abortion done in unsafe conditions by quacks. (select only one answer) [For female respondents: ] In your opinion, if you wanted to terminate a pregnancy, your partner would support you. (select only one answer) 320 [For male respondents: ] In your opinion, if your partner wanted to terminate a pregnancy, you would support her. (select only one answer) [For female respondents: ] In your opinion, if you wanted to terminate a pregnancy, your family would support you. (select only one answer) 321 [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) [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) 322 [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) [For female respondents: ] In your opinion, if you wanted to have an abortion, your friends and relatives would isolate or reject you. 323 [For male respondents: ] 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) Page 9 of 16 Neutral/ Unsure Agree Disagree [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) 324 325 326 327 328 329 330 331 332 333 334 335 336 [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) In your opinion, you can confidently talk to a health care provider about issues related to abortion. (select only one answer) In your opinion, you can easily talk about issues related to abortion with yourfriends or neighbors. (select only one answer) In your opinion, you can confidently talk to your partner about any issues related to abortion. (select only one answer) In your opinion, a woman who has an abortion probably has sex with lots of different men. (select only one answer) In your opinion, doctors and midwives who perform abortions in a clinic are committing a crime. (select only one answer) In your opinion, you would feel ashamed if a member of my family had an abortion. (select only one answer) In your opinion, a woman should keep her abortion a secret from other people. (select only one answer) In your opinion, traditional healers who help women abort a pregnancy are helping women. (select only one answer) 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) In your opinion, a woman who has an abortion can make other people fall ill or get sick. (select only one answer) In your opinion, if a woman has an abortion, she should be reported to the police. (select only one answer) 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) Page 10 of 16 Neutral/ Unsure Agree Disagree 337 338 339 340 341 342 343 344 345 346 347 348 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) 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) 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) In your opinion, you would not allow your children to go near a woman who has had an abortion. (select only one answer) In your opinion, a woman who has an abortion is a bad mother. (select only one answer) In your opinion, a man who supports a woman in getting an abortion is committing a crime. (select only one answer) In your opinion, it is a good idea for the government to allow abortions to be legal. (select only one answer) In your opinion, you would continue to be friends with someone if you found out that they had an abortion. (select only one answer) In your opinion, a woman who has had an abortion might influence other women to get abortions. (select only one answer) In your opinion, it is okay for a woman to feel relieved after having an abortion. (select only one answer) 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) In your opinion, a woman who has an abortion should be treated the same as everyone else. (select only one answer) Page 11 of 16 Neutral/ Unsure Agree Section 4. Knowledge of Abortion Practices Where do married women in this community go to have an abortion? Traditional healer (Ng’anga) Teaching/tertiary hospital (UTH) Public Hospital (allow multiple answers, but do not read responses) Public Health Center Private clinic NGO clinic (MSI) 401 Friends/family Induces by herself Traditional birth attendant Pharmacy/drug seller Other (specify): Where do unmarried girls or women in this community go to have an abortion? (allow multiple answers, but do not read responses) 402 If you, your partner, or someone you know needed to have an abortion, where would you go? (allow multiple answers, but do not read responses) 403 Why would you choose this facility/provider? (allow multiple answers, but do not read responses) 404 Page 12 of 16 ____________________________________ Does not know/No answer Traditional healer (Ng’anga) Teaching/tertiary hospital (UTH) Public Hospital Public Health Center Private clinic NGO clinic (MSI) Friends/family Induces by herself Traditional birth attendant Pharmacy/drug seller Other (specify): ___________________________________ Does not know/No answer Traditional healer (Ng’anga) Teaching/tertiary hospital (UTH) Public Hospital Public Health Center Private clinic NGO clinic (MSI) Friends/family Induces by herself Traditional birth attendant Pharmacy/drug seller Other (specify): ___________________________________ Does not know/No answer Cost Distance Female provider Privacy Partner’s consent not required Provider skill Equipped facility Not required to adopt family planning method Other (specify): ________________ ____________________ Does not know/No answer To your knowledge, where is the nearest location where you or someone you know could access services or help in getting a safe abortion? Traditional healer (Ng’anga) Teaching/tertiary hospital (UTH) Public Hospital Public Health Center Private clinic (select only one answer) NGO clinic (MSI) 405 Friends/family Induces by herself Traditional birth attendant Pharmacy/drug seller Other (specify): 406 407 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) If a woman wants to have an abortion, do you know of any medication or substance she can take? (select only one answer) 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.) ____________________________________ Does not know/No answer No Yes Does not know/No answer No Go to question 410 Yes Does not know/No answer If respondent answers one of the following 4 choices, ask question 409: Misoprostol/Cytotec Medabon Chinese abortion pill Other tablets/ tablets inserted vaginally ______________________________________ If respondent answers one of the following choices, go to question 410: Chloroquine tablets Boiled roots (Lunsonga, muzwezi, 408 (If respondent answered 1, 2, 3 or 4 to the previous question, ask:) 409 You mentioned pills or tablets. How did you first come to know about this method? (allow multiple answers, but do not read responses) Page 13 of 16 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 Friend/Family member/Partner Health care provider Traditional healer (Ng’anga) Radio Pamphlet Street drama Signs/posters Other (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) From whom did you get this information? No Go to question 503 Yes Does not know/No answer Friend/Family member/Partner Health care provider (allow multiple answers, but do not read responses) Traditional healer (Ng’anga) Radio Pamphlet 502 Street drama Signs/posters Pharmacy/drug seller Other (specify): 503 In the last 12 months, have you received any information about abortion? (select only one answer) From whom did you get this information? (allow multiple answers, but do not read responses) 504 505 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) Where did you hear about this? ___________________________________ Does not know/No answer No Go to question 505 Yes Does not know/No answer Friend/Family member/Partner Health care provider Traditional healer (Ng’anga) Radio Pamphlet Street drama Signs/posters Pharmacy/drug seller Other (specify): ____________________________________ Does not know/No answer No Go to question 507 Yes Does not know/No answer Friend/Family member/Partner Health care provider (allow multiple answers, but do not read responses) Traditional healer (Ng’anga) Radio Pamphlet 506 Street drama Signs/posters Pharmacy/drug seller Other (specify): Where do you go to treat general ailments for your family? 507 (allow multiple answers, but do not read responses) Page 14 of 16 ___________________________________ Does not know/No answer Government health facility Private health facility NGO hospital/clinic Pharmacy/Drug seller Traditional Healer (Ng’anga) Other (specify): ___________________________________ Does not know/No answer Where do you mostly go to consult/treat for more personal health issues such as antenatal care? 508 Government health facility Private health facility NGO hospital/clinic Pharmacy/Drugstore (allow multiple answers, but do not read responses) Traditional 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 601 602 Have you ever have had an unexpected delay in your period? (select only one answer) Did you do anything to bring on your period? (select only one answer) No Go to question 605 Yes Does not know/No answer No Go to question 605 Yes Does not know/No answer From whom did you seek help in bringing on your period? No one/self Family Friend 603 (allow multiple answers, but do not read responses) Pharmacist Health care provider Traditional healer Other (specify): What did you use or do to bring on your period? (allow multiple answers, but do not read responses) 604 605 Have you ever fallen pregnant when you were not hoping or expecting to become pregnant? (select only one answer) Page 15 of 16 ___________________________________ Does not know/No answer Misoprostol/Cytotec Medabon Chinese abortion pill Other tablets/ tablets inserted vaginally Chloroquine tablets Boiled 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 No Thank the respondent and end survey Yes Does not know/No answer 606 Did you do anything to terminate the pregnancy? (select only one answer) No Thank the respondent and end survey Yes Does not know/No 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. From whom did you seek help in terminating the pregnancy? No one/self Family Friend 607 (allow multiple answers, but do not read responses) Pharmacist Health care provider Traditional healer Does not know/No answer What did you use or do terminate the pregnancy? Misoprostol/Cytotec Medabon Chinese abortion pill (allow multiple answers, but do not read responses. probe for answers in list.) Other tablets/ tablets inserted vaginally Chloroquine tablets Boiled roots (Lunsonga, muzwezi, 608 609 610 611 Did this action enable you to terminate the pregnancy completely? (select only one answer) Did you seek care at a health facility at any point after trying to terminate your pregnancy? (select only one answer) Did you experience any health complications after trying to terminate this pregnancy? (select only one answer) 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 Yes No, it was incomplete No, nothing happened Does not know/No answer No Yes Does not know/No answer No Thank the respondent and end survey Yes Does not know/No answer If yes, can you please tell us about your health complications? 612 Interviewer: Thank the respondent and end the survey. Page 16 of 16