Zambia

OVERVIEW

The story of reproductive and sexual health care in Zambia is a complex one. On the one hand, women in urban areas can find condoms sold in a variety of markets, and birth control pills can be purchased over-the-counter. You can also find longer lasting contraceptive methods, such as IUDs, implants, or injectables, available at clinics and hospitals. Emergency contraceptive pills are available and no prescription is required. On the other hand, Zambia is a generally conservative society, where homosexuality is illegal and many topics related to sexuality are considered taboo. The majority of women in Zambia live in poverty and, in many communities, contraceptives are a stigmatized topic. Rural women may live a day's trek away from the nearest contraceptive distributor, and they are typically expected to marry young and start families at an early age. As of 2018, Zambian women have one of the highest fertility rates in the world.

For many years, Zambia has struggled with an HIV epidemic, though the rate of HIV infection has decreased considerably in recent years. In 2016, a little under 15% of women in Zambia were living with HIV. If you are a foreigner who is visiting HIV, there are no travel or residency restrictions related to your HIV status. There are also many programs and initiatives related to HIV prevention, treatment, and care in Zambia.

There are various clinics and hospitals that one visit in Zambia, though quality will vary. For women who cannot afford private providers, Marie Stope International may be a good place to visit for sexual and reproductive health care. In Zambia, maternity leave is granted to women, but we do not know how widely this policy is enforced (if you do, please update the page). Abortion is also legally permitted, but only in certain circumstances. In Zambia, maternity leave is granted to women, but we do not know how widely this policy is enforced (if you do, please update the page). Abortion is also legally permitted, but only in certain circumstances.

Contraception (Birth Control)

General Note: There are many types of contraceptives, also known as "birth control," including IUDs, oral contraceptives, patches, shots, and condoms, etc. If you would like to view a full list, click here.

Laws & Social Stigmas

In Zambia, you can purchase oral contraceptives (birth control pills) over-the-counter at pharmacies in urban areas. No prescription is needed. You can also find other contraceptive methods, such as implants and intrauterine devices (IUDs), available at clinics and hospitals. For rural women, certain contraceptive methods can be accessed from Community Based Distributors (CBDs), though the trek to CBD centers may be arduous, and they may be discouraged from seeking out contraceptives from their husbands or communities.

Zambia has a high fertility rate (nearly 6 children per woman), making it the country with the eighth highest fertility rate in the world. According to a 2015 United Nations report, it was found that about 52% of Zambian women (who were of reproductive age and married/in unions) used any form of contraception, including traditional methods. This rate was notably higher than the Eastern African regional average for contraceptive use among women in 2015 (40%). The most common contraceptive methods for Zambian women were found to be contraceptive injectables (20%), birth control pills (12%), and contraceptive implants (6%). Male condoms were used by some couples (about 4%). While some couples opted for sterilization, the rates were rather low (2% for women and 0% for men). There were especially low rates of usage for IUDs (1%) and practically no users of the vaginal barrier method (0%). Traditional methods were also used at a very low rate, such as the rhythm method (less than 1%) and withdrawal (less than 1%).

Generally speaking, Zambian women experience vastly different lives, depending on their economic and social status, whether they live in rural or urban areas, and the agency that they are granted in their families and communities. Women who are more wealthy, educated, urbanized, and independent tend to have greater access to family planning options, particularly if they live in bigger cities like Lusaka or Kitwe, and may be able afford higher quality care at private clinics and hospitals. However, this is not the case for most women in Zambia, where 64% of people live in poverty (and, in rural areas, 80% of people live in poverty). The lack of educational, economic, and social opportunities hit women particularly hard. In 2015, it was estimated that women had a 56% literacy rate (compared to 70.9% literacy rate for men). Patriarchal social structures and norms also grant many women limited agency over their property, land, sex lives, and contraceptive decisions. As a result, women may not seek out contraception because their husbands or communities do not approve. This issue is compounded by the fact that there are widespread stigmas around contraceptives. For example, surveys in 2009 showed that two-thirds of young adults in Zambia believed that condoms promoted promiscuity. You can read an article from the Lusaka Times, which tried to dispel many of the myths surrounding condoms, here.

While Zambia has a large urban population (43.5% of total population in 2018), there are still many women who live in remote and rural areas. For these women, it is particularly difficult to access family planning services. They may need to travel long distances, often by foot, to access family planning services from Community Based Distributors (CBDs). The CBDs typically have condoms available, but as of 2016, they were not trained or authorized to offer longer-lasting contraceptive methods, such as IUDs or implants. Rural women typically tend to marry young and give birth early, as children are seen as a sign of prestige.

What to Get & Where to Get It

• You can find male condoms sold at a variety of markets, including kiosks, grocery stores, and pharmacies. There are also initiatives, like social marketing programs and donor subsidized programs, which allow people to access condoms at reduced rates (for example, these programs may allow people to purchase condoms at one tenth of the typical price).
• You can find female condoms in Zambia. However, they do not appear to be widely used and there are reports of women rejecting them as an option. You can read a story about rural women rejecting female condoms here.
• You can find a variety of contraceptive pills (birth control pills) available at pharmacies, clinics, hospitals, and NGOs that provide health services. Some of the birth control pill brands you can expect to see are Microgynon and Diane.
• If you want an intrauterine device (IUD), you can get it inserted it at various hospitals and clinics in Zambia. For example, at Victoria Hospital, you can get a copper IUD inserted for k1600 (as of June 2018). For women who are low-income, there may be free or low-cost options available at NGOs and public sector facilities, such as Marie Stopes International (see below for more information on MSI).
• If you want an contraceptive implant, you can get it inserted at various hospitals and clinics in Zambia. For example, at Victoria Hospital, you can get the Jadelle implant inserted for k1000 (as of June 2018). For women who are low-income, there may be free or low-cost options available at NGOs and public sector facilities, such as Marie Stopes International (see below for more information on MSI).
• If you want an contraceptive shot/injectable, you can receive the injection at various hospitals and clinics in Zambia. For example, at Victoria Hospital, you can get the Depo-Provera or Noristerat injection for k70 (as of June 2018). For women who are low-income, there may be free or low-cost options available at NGOs and public sector facilities, such as Marie Stopes International (see below for more information on MSI).
• Marie Stopes International - Zambia: "We offer a full range of family planning services, and comprehensive abortion care in the country. Despite recent improvements in the modern contraceptive prevalence rate in Zambia, there is still a discrepancy in meeting the needs of the population with a current unmet need for family planning services at 21%. Our outreach teams based in urban centres enhance the capacity of the Ministry of Health and offer more choice, by supplementing the short-term methods of contraception often offered by the public health system, with long-acting and permanent methods. Our rural outreach teams meanwhile travel the length and breadth of the country to take our services to clients who have the greatest need for family planning but often cannot access services." Phone number to talk to advisors: 5600 (toll-free on MTN or Airtel networks) Email: info@mariestopes.org.zm You can also find them on Facebook

Emergency Contraception (Morning After Pill)

Important Notes: Emergency contraception may prevent pregnancy for three days (72 hours) and sometimes five days (120 hours) after unprotected sex. Take EC as soon as possible after unprotected sex. If you don't have access to dedicated EC, oral contraceptives can be used as replacement EC, but remember the following: 1) Only some contraceptives work as EC 2) Different contraceptives require different dosages and time schedules to work as EC 3) You must only use the first 21 pills in 28-day packs and 4) They may be less effective than dedicated EC. For general information on emergency contraceptives, click here and here.

Laws & Social Stigmas

In Zambia, it appears that you can only access emergency contraceptive pills (morning after pills) with a prescription. However, the usage of ECPs is extremely low. In 2007, it was reported that only 0.5% of women had ever used ECPs and 9.3% had knowledge of them. However, in the years since this data was collected, the rate of usage and knowledge may have increased.

What to Get & Where to Get It

• In Zambia, you can find emergency contraceptive pills (morning after pills) at public sector clinics, hospitals (such as Victoria Hospital), pharmacies, and NGOS/programs affiliated with the International Planned Parenthood Foundation (IPPF) or Marie Stopes International - Zambia. You don't need a prescription to obtain emergency contraceptive pills, as of July 2018. Some of the brands you can expect to find are Lenor 72, Pregnon, and Revoke 72. These brands are produced by Indian pharmaceutical companies and are imported into Zambia.
• If you cannot access dedicated emergency contraceptive pills, you can use regular birth control pills as replacement ECPS. To do this, you can take progestin-only pills, like Microlut or Microval (for these pills, you take 50 pills within 120 hours after unprotected sex), or you can take combined progestin-estrogen pills, like Eugynon, Neogynon or Ovral (for these pills, take 2 pills within 120 hours after unprotected sex and take 2 more pills 12 hours later), or Lo-Femenal, Microgynon-30 or Nordette (for these pills, take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later). For combined pills, remember that in in 28-day packs, only the first 21 pills can be used.

Sexually Transmitted Infections (STIs/STDs)

Important Notes - Learn about PEP and PrEP: If you think that you've been recently exposed to HIV (i.e. within 72 hours), seek out PEP (Post-Exposure Prophylaxis). It's a month-long treatment to prevent HIV infection after exposure, and it may be available in your city. Take PEP as soon as possible. For more information, click here. If you are at risk of HIV exposure, seek out PrEP (Pre-Exposure Prophylaxis). It's a daily oral pill that can prevent HIV infection before exposure. To learn more about PrEP, click here.

Laws & Social Stigmas

In Zambia, there are no travel or residency restrictions related to HIV status. This means that, if you're a foreigner who is visiting Zambia, you will not need to present a medical certificate related to your HIV status or reveal your HIV status in order to enter the country. Furthermore, if you plan to attain a work or residency visa in Zambia, you will not be required to take an HIV test. If you are in the country and choose to have an HIV test, and if you are found to be HIV-positive, you will not be deported or expelled from the country. You are also legally allowed to import antiretroviral medication, but a prescription must be carried.

Generally speaking, Zambia has a rather large population living with HIV. However, the country has taken major steps to reduce the rate of transmission and improve treatment options for those living by HIV. In fact, between 2010 and 2016, the HIV infection rate decreased by 27% and the rate of AIDS-related deaths decreased by 11%. In 2016, it was estimated that 12.4% of all adults (ages 15-49) were living with HIV in 2016. The HIV rates were higher among women (14.5% infection rate) than with men (10.3% infection rate), and it was estimated that 66% of people living with HIV in Zambia knew their status. The populations most affected by HIV were sex workers (56.4% infection rate) and prisoners (27.4% infection rate). Currently, Zambia provides comprehensive sexuality education in its public schools, and there are strategies to reach out to adolescents regarding safe sex practices.

Testing Facilities

• Marie Stopes International - Zambia: This international NGO provides STI tests. Phone number to talk to advisors: 5600 (toll-free on MTN or Airtel networks) Email: info@mariestopes.org.zm You can also find them on Facebook
• Kara Counselling & Training Trust: They have been offering voluntary HIV testing and counseling services since 1992. Address: Hope House, Counselling & HIV Testing, P.O. Box 37559, Lusaka. Phone: +260 1 227 085/87, 229 847. Fax: +260 1 228 948. Email: trainingcentre@zamnet.zm
• Victoria Hospital: This private health care facility provides a range of STI tests for k250, as of June 2018. Lusaka: +260 95 5255798. +260 21 1290985. Email: victoriahospitalszambia@gmail.com

Support

• "Medical treatment for people with HIV/AIDS is offered in most public hospitals. However, the financial means of these hospitals are very limited. The government’s efforts in this field are supported by some NGOs." - HIVTravel, 2018
• The Zambia Prevention Care and Treatment Partnership, Bridge project (ZPCT IIB): This organization, funded by the United States Agency for International Development (USAID) and managed by FHI 360, has helped strengthen 197 health care facilities in Zambia that provide HIV services.
• UNAIDS - Zambia: Contact: Medhin TSEHAIU, UNAIDS Country Director. Phone: 260211252645. Email: TsehaiuM@unaids.org
• Kara Counselling & Training Trust: They offer HIV counseling and support. Address: Hope House, Counselling & HIV Testing, P.O. Box 37559, Lusaka. Phone: +260 1 227 085/87, 229 847. Fax: +260 1 228 948
• Family Life Movement of Zambia (FLMZ): Address: Design House, P.0. Box 37644, Lusaka / Zambia. Phone: +260 1 221 898 /224 669
• Medical Women Association of Zambia (MWAZ): Address: P.O. Box 317 Y, Lusaka / Zambia, Phone +260 1 254 71 0. Fax: +260 1 250 753. Contact Person Dr. A. Mwiinga
• Society for Women and AIDS in Zambia (SWAAZ): Address: P.0. BOX 501 1 0, Lusaka, University Teaching Hospital, Zambia. Phone: +260 1 252 904.
• NGO Coordinating Committee Zambia: Address: P.0. Box 37879, Lusaka / Zambia. Phone: +260 1 223 834. Fax.: +260 1 224 241. E-mail: ngocc@Zamnet.Zm. Attention of: Grace Kanyanga; Executive Director

Medications & Vaccines

What to Get & Where to Get It

• If you have a yeast infection, you can get medication to treat it at pharmacies, clinics, or hospitals. For example, at Victoria Hospital, a private health care facility, "we have a wide range of medications from Ciprofloxacin Norfloxacin Levofloxacin and combinations with Ornidazole as treatment for UTIs and Fluconazoles Nystatin Itraconzaoles etc., used for yeast infections. They are prescription-only medication."
• If you want to get Pre-Exposure Prophylaxis (PrEP) or Post-Exposure Prophylaxis (PEP), you can get it at Victoria Hospital, a private health care facility. They say: "We are an accredited ARV center. PrEP, PEP, or refills are available 24hrs directly from our pharmacy. Patient has to register see a GP conduct a lab test and obtain meds and be counseled." Lusaka: +260 95 5255798. +260 21 1290985. Email: victoriahospitalszambia@gmail.com

Menstruation

Note: In addition to pads and tampons, you can also use menstrual cups and menstrual underwear for your period. To learn more about menstrual cups, click here. To learn more about menstrual underwear, click here.

Laws & Social Stigmas

In Zambia, social attitudes toward menstruation vary. While women in more urbanized areas, and particularly women from wealthier and more educated families, may have access to various menstrual products, young girls in rural areas often experience stigma, embarrassment, and shame related to their periods. Some girls skip school for the duration of their periods, and there is a lack of education related to menstrual hygiene. Furthermore, menstrual products may be inaccessible or expensive to some girls. However, there are local initiatives to educate rural girls regarding menstrual hygiene, as well as workshops to teach them how to make eco-friendly pads with local products. Furthermore, the 2017 budget for the Zambian government included free sanitary napkins for 14,000 rural girls in 16 districts. To learn more about one of these initiatives, click here and here.

What to Get & Where to Get It

• You can find pads/pantyliners for sale in stores in Zambia, particularly in larger cities like Lusaka.
• You can find tampons for sale in stores in Zambia, particularly in larger cities like Lusaka.
• If you are interested in menstrual cups, there may be online vendors of menstrual cups that can deliver to your local address in Zambia, such as Umoyo. You can check out Talula Cup, a Zambia-based menstrual cup (contact: Alice Fircks - Druadan Estate, Mkushi, Zambia; Email: alice@talulacup.com). About Talula Cup: "The Talula Cup is a medical grade silicone cup, shaped like a bell and is flexible. It's a clean and convenient solution for local African women in Zambia. Menstruation products aren't always accessible, so we're working to bring Talula cups to them."

Gynecological Exams

What to Get & Where to Get It

• Marie Stopes International - Zambia: This international NGO is known to provide free and/or low-cost services to women around the world. They offer cervical screenings at their facilities in Zambia. Prices typically tend to be much lower for locals than for foreigners, travelers, or expats. Phone number to talk to advisors: 5600 (toll-free on MTN or Airtel networks) Email: info@mariestopes.org.zm You can also find them on Facebook
• Victoria Hospital: This hospital, recommended by multiple locals, provides gynecological and obstetric services. From the website: "Victoria Hospital offers the public access to quality and affordable healthcare. We offer a diverse portfolio of Doctors & Specialists." Address: 5498 Lunsenfwa Rd, Lusaka 10101, Zambia. Hours: Open 24 hours. Phone: +260 21 1290985. Email: victoriahospitalszambia@gmail.com
• SES Zambia: "SES has an established network of contacts within Zambia and neighbouring territories. In addition to our headquarters in Lusaka, we have offices in Kitwe, Livingstone and partners in Johannesburg and Lubumbashi. From our central base in Zambia we are able to provide rapid emergency response services across the Sub Saharan Africa region."
  • Recommended Doctor: Dr Bastian
• Consultation for Dr. Nargis Ashurova is 300 K and scan is at 300 K. Phone: ‭+260 97 9777166‬
• Fairview Hospital: You can expect to pay K450 for a consultation and you're then entitled to a free follow-up check within 7 days of your consultation, as of June 2018.
  • Recommended doctor: Dr. Gangat
  • Recommended doctor: Dr. Souhail Nasreddine
• Dr. Saida Mukhitdinova at Medcross: She comes highly recommended by a local. You can expect to pay around K200 to K250, as of June 2018 for a consultation, and then additional services will be extra fees. Address: Med Cross Hospital, Plot 555, 65 Independence Ave, Lusaka, Zambia, PO Box 33410, Lusaka, Zambia. Email: medcross@mail.ru. Phone: 0211 25 6148
• Wellspring Hospital: Recommended gynecologists - Dr. Sasa and Dr Nangis. From a local: "The best ever. Personal care. And best prices."

Pregnancy

Laws & Social Stigmas

In Zambia, all non-unionized workers (such as soldiers, domestic workers, public service workers, police, and teachers) are technically entitled to 120 days of unpaid maternity leave. If workers are in unions, they are entitled to 90 days of paid maternity leave. However, in practice, there may be many workers, such as rural laborers, who are not granted the ability to take off many days of work, and we do not yet have data on how and if these laws are enforced. To learn more about maternity leave law in Zambia, click here. To learn about paternity leave in Zambia, click here. To read the full text of the Employment Act of the Republic of Zambia, click here.

What to Get & Where to Get It

• For a list of recommended ob/gyns, you can consult the "Gynecological Exams" section above.

Abortion

Important Note: There are two main types of abortions: medical (also known as the "abortion pill") and surgical (also known as "in-clinic"). For medical abortions, you take a pill to induce abortion. For surgical abortions, a procedure is performed to induce abortion. For general information about medical and surgical abortions, click here.

Laws & Social Stigmas

In Zambia, abortion is legal in certain cases, but it is not generally available upon request. It is legally permitted when the pregnancy endangers the life of the pregnant person, when the pregnancy threatens the physical or mental health of the pregnant person, when the pregnancy is the result of rape or incest, when there is risk of fetal impairment, or if the pregnant person has social or economic reasons for requesting the abortion.

What to Get & Where to Get It

• Marie Stopes International - Zambia: This international NGO has provided comprehensive abortion care to patients. You should contact them to learn the current status of what they offer. Phone number to talk to advisors: 5600 (toll-free on MTN or Airtel networks) Email: info@mariestopes.org.zm Facebook: https://m.facebook.com/MarieStopesZambia

Advocacy & Counseling

What to Get & Where to Get It

• Kara Counseling & Training Trust: "Kara counseling and Training Trust ltd (KCTT) was founded in 1989 as a centre for People Living With HIV/AIDS, and is now one of the leading NGO’s in Zambia working in the field of counseling and HIV/AIDS." Address: Plot No. 174, Villa Elizabeth, Along Luanshya Road. Telephone: +260 21 1227086; Fax: +260 21 1227087.
• PsycHealth Zambia: They offer a General Consultation (55 minutes, k400), Relationship and Marriage Counseling (1 hour, k400; follow-up for k250), Sexual Abuse & Violence Counseling (1 hour and 30 minutes, K400 Consultation; K250 Follow-up), etc. Prices posted as of July 2018. Address: 11 Buchi Road, Northmead, Lusaka, Zambia. Call +260 95 5264975.
• Alcoholics Anonymous Zambia: "Alcoholics Anonymous is an international mutual aid fellowship founded in 1935. In Zambia, this fellowship of men and women gather and share their experience, strength and hope with each other in order to solve their common problem and recover from alcoholism. The only requirement for membership is a desire to stop drinking. The primary purpose for Alcoholics Anonymous is to stay sober and help other alcoholics achieve sobriety. The meetings takes place three times a week at the Cathedral of the Holy Cross."

List of Additional Resources

• Equaldex - Zambia: This webpage provides information on LGBTQ rights and laws in Zambia. It is important to note that homosexuality is illegal in Zambia, as of June 2018.
• Ministry of Gender - Zambia: This is the official government department devoted to gender-related issues. From the website: "The Government of the Republic of Zambia, through the Ministry of Gender is committed to protecting and promoting women's rights, curbing gender-based violence and reducing gender inequalities by making progressive changes to legislation to strengthen the protective environment."
• Zambia National Women's Lobby: "The Zambia National Women’s Lobby (ZNWL) is a non-partisan, non-profit making and membership driven non-governmental organization committed to the equal representation and participation of women in decision making at all levels. ZNWL was formed in 1991 to respond to the persistent exclusion of women from decision making processes and the increasing gender imbalances in the representation of women in government departments, political parties, the public and private sectors." Phone: +260 211 294319. Email: znwl@zamnet.zm
• Zambia Alliance of Women (ZAW) Zambia Alliance of Women (ZAW): "Zambia Alliance of Women (ZAW) is a Non Governmental Organization which was founded in 1978 to promote the themes of equality, development and peace, in recognition that without true gender equality peace would remain an illusion in a state of poverty. One of the key objectives of ZAW is to build capacity of rural people in sustainable income generating ventures such as sustainable small scale agriculture, by promoting food security at household level."
• Womanking - Zambia: This is the Zambia chapter of Womankind, an international NGO. Womankind focuses on empowering women and girls through initiatives related to education, economic empowerment, political participation, health care access, etc. In Zambia, the organization has developed leadership training and clubs for rural school girls, trained men and women on sexual and reproductive health care, educated girls about violence, and helped women-lead community groups attain better access to land, crops, and livestock. They can be reached at their head office in London for enquiries. General enquiries: +44 (0) 2035 675930. Fundraising enquiries: +44 (0) 2037 355558.
• Women for Change: "Women for Change (WFC) is a Zambian NGO working with communities, especially women and children, in rural areas to contribute towards sustainable human development." Address: Plot 1801 Nchenja Road Northmead, Lusaka, Zambia. Call +260 95 3529951. Email: info@wfc.org.zm
• UNDP - Gender & Women's Empowerment - Zambia: "The UN Joint Programme on GBV (2012-2016) in Zambia is supported by the United Nations System. The goal of the Joint programme is to contribute to the reduction of GBV in Zambia."
• Forum for African Women Educationalists: This organization has offices throughout Africa, including in Zambia. "The Forum for African Women Educationalists (FAWE) is a pan-African Non-Government Organisation founded in 1992 by five women ministers of education to promote girls’ and women’s education in sub-Saharan Africa in line with Education for All. The organisation’s members include female ministers of education, university vice-chancellors, education policy-makers, researchers, gender specialists and human rights activists." Address: FAWE Zambia Chapter, House No. 6680, Chiwalamabwe Rd, Olympia Park, P O Box 37695, LUSAKA, Zambia. Phone: (260) 211-295482; (260) 211-292753. Email: faweza@iconnect.zm
• Association of Zambian Women in Mining: Phone: 097 9 529655. Lusaka, Lusaka, Lusaka, Zambia
• Breastfeeding Association of Zambia: "Area of interest: Enhancement of child survival and safe motherhood through promotion and protection of breastfeeding." Address: C/o National AIDS Council, P.O. Box 32669, LUSAKA. Contact person: 097 7 335482. Email: bazibfan@yahoo.com.
• Empowerment of Prisoner Wives & Their Children: Phone: 0977-772379. Address: Mberere Road, Olympia Park, Lusaka, Zambia, P.O. Box 36370, LUSAKA, Zambia, Lusaka, Lusaka, Zambia