In Zanzibar, a low-income and predominantly Muslim archipelago in Tanzania, east Africa, maternal mortality is high, contraceptive use is low, and currently almost no data exist about the consequences of unwanted pregnancy. Globally, more than 200 million women in developing countries have unmet need for contraception, leading to an estimated 76 million unintended pregnancies every year.
The Zanzibar Ministry of Health expressed a strong interest in research about unwanted pregnancy, so to inform evidence-based efforts to increase contraceptive use and reduce the region’s maternal mortality rate. Why are women in Zanzibar not using available, affordable, effective methods of contraception, and what are the consequences of unwanted pregnancy? To answer these questions, I initiated a year-long social science research study to address contraceptive decision-making and the impact of recent unplanned pregnancies in a population of poor Muslim women.
The study assessed community-held views on the barriers to contraceptive use (through semi-structured group interviews with men and women in the community and in-depth interviews with health care providers) and explored the particular circumstances of unmet need for contraception among women who have terminated pregnancies (through in-depth interviews with 50 women recruited through participant driven sampling). The final component of the research is a quantitative surveywith women who present to the main tertiary care facility in Zanzibar, Tanzania for post-abortion care. Post-abortion care (spontaneous abortions/miscarriages and induced abortions) is the leading cause for admission to the public hospital’s gynecological ward, and yet almost nothing is known about the women come for this care. These survey data on the use, perceptions, and barriers to contraception use and the experiences and consequences of unwanted pregnancy in Zanzibar build on the formative, qualitative research done by my group. My research team—trained Zanzibari interviewers—is using an empathic interview method to interview 200 women receiving post-abortion care. Each woman’s personal experiences with pregnancy, contraception, and pregnancy loss or termination is being examined in detail by asking her comprehensive reproductive life history.
Collaborations with the Zanzibar Ministry of Health and health care providers give these research findings unique leverage to improve programs for contraception and to provide policy-makers with information necessary to design interventions to reduce poor outcomes from unwanted pregnancy. In June and July 2011, together former members of my research team, we carried out several dissemination activities with stakeholders and partner organizations in Zanzibar and Dar es Salaam.
Norris A, Harrington B, Hemed M, Grossman D, Hindin M. Causes and consequences of induced abortion among a community-based snowball sample of Zanzibari women. Reproductive Health. February 2016.
Esber A*, Foraker R, Hemed M, Norris A. Partner approval and intention to use contraception among women presenting for post-abortion care at Mnazi Mmoja Hospital, Zanzibar. Contraception. Volume 90, Issue 1,2014.
Norris A, Hemed M, Casterline J. Fears of unwanted pregnancy versus fears of unsafe abortion: A qualitative community-based study with women who terminated pregnancies in Zanzibar, Tanzania. IUSSP working paper prepared for the seminar “Decision-making regarding abortion—determinants and consequences,” Nanyuki, Kenya, 3-5 June 2014.
- Maryam Hemed, MD, MMed, MIH, (co-Investigator) Medical services directorate, African Union Commission
- Michelle Hindin, PhD, (mentor) Johns Hopkins School of Public Health, USA
- Sarah Beckham, MA, doctoral student at Johns Hopkins School of Public Health, USA
- Bryna Harrington, doctoral student at University of North Carolina, USA
- Research team: Lillian Brown, Fatma Gharib, Giselle Hadley, Fatma Khamis, Shemsa Salahadin, Fatma Salum, Marielle Schweickart, Ghanima Shehe, Nila Uthayakumar.
We are grateful for funding from:
- Ellertson Postdoctoral Fellowship, Ibis Reproductive Health
- Society of Family Planning