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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. | 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 | 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 Zambia, 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 | There are various clinics and hospitals that one can visit in Zambia, though quality will vary. For women who cannot afford private providers, Marie Stopes 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. | ||
==Contraception (Birth Control)== | ==Contraception (Birth Control)== | ||
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In Zambia, you can purchase oral contraceptives (birth control pills) over-the-counter at pharmacies in urban areas. No prescription is needed.<ref>[http://ocsotc.org/wp-content/uploads/worldmap/worldmap.html Global Oral Contraception Availability]</ref> <ref>[http://freethepill.org/where-on-earth/ Free the Pill: Where on Earth]</ref> 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.<ref>[https://www.ippf.org/blogs/overcoming-family-planning-challenges-zambia Overcoming family planning challenges in Zambia]</ref> | In Zambia, you can purchase oral contraceptives (birth control pills) over-the-counter at pharmacies in urban areas. No prescription is needed.<ref>[http://ocsotc.org/wp-content/uploads/worldmap/worldmap.html Global Oral Contraception Availability]</ref> <ref>[http://freethepill.org/where-on-earth/ Free the Pill: Where on Earth]</ref> 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.<ref>[https://www.ippf.org/blogs/overcoming-family-planning-challenges-zambia Overcoming family planning challenges in Zambia]</ref> | ||
Zambia has a high fertility rate (nearly 6 children per woman), making it the country with the eighth highest fertility rate in the world.<ref>[https://www.cia.gov/library/publications/the-world-factbook/geos/za.html CIA World Factbook7]</ref> 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 | Zambia has a high fertility rate (nearly 6 children per woman), making it the country with the eighth highest fertility rate in the world.<ref>[https://www.cia.gov/library/publications/the-world-factbook/geos/za.html CIA World Factbook7]</ref> 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. 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%).<ref>[http://www.un.org/en/development/desa/population/publications/pdf/family/trendsContraceptiveUse2015Report.pdf Trends in Contraceptive Use Worldwide 2015]</ref> | ||
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.<ref>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5363807/ Why don’t urban youth in Zambia use condoms? The influence of gender and marriage on non-use of male condoms among young adults]</ref> 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).<ref>[https://www.unicef.org/zambia/children_5157.html UNICEF Zambia - Poverty]</ref> 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).<ref>[https://www.cia.gov/library/publications/the-world-factbook/geos/za.html CIA World Factbook 2017]</ref> 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.<ref>[https://www.genderindex.org/country/zambia/ Gender Index - Zambia]</ref> <ref>[https://www.daily-mail.co.zm/family-planning-the-grim-reality-in-rural-areas/ Family planning: The grim reality in rural areas]</ref> 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.<ref>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5363807/ Why don’t urban youth in Zambia use condoms? The influence of gender and marriage on non-use of male condoms among young adults]</ref> You can read an article from the Lusaka Times, which tried to dispel many of the myths surrounding condoms, [https://www.lusakatimes.com/2016/12/05/facts-about-condoms/ here]. | 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.<ref>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5363807/ Why don’t urban youth in Zambia use condoms? The influence of gender and marriage on non-use of male condoms among young adults]</ref> 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).<ref>[https://www.unicef.org/zambia/children_5157.html UNICEF Zambia - Poverty]</ref> 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).<ref>[https://www.cia.gov/library/publications/the-world-factbook/geos/za.html CIA World Factbook 2017]</ref> 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.<ref>[https://www.genderindex.org/country/zambia/ Gender Index - Zambia]</ref> <ref>[https://www.daily-mail.co.zm/family-planning-the-grim-reality-in-rural-areas/ Family planning: The grim reality in rural areas]</ref> This issue is compounded by the fact that there are widespread stigmas around contraceptives. For example, it is a common misconception among many women that contraceptives cause permanent infertility.<ref>[https://globalpressjournal.com/africa/zambia/myths-infertility-mean-many-young-zambian-women-dont-use-contraception-already-late/ Fertility Myths – Not Access – Stand Between Zambian Women and Contraception]</ref> Furthermore, surveys in 2009 showed that two-thirds of young adults in Zambia believed that condoms promoted promiscuity.<ref>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5363807/ Why don’t urban youth in Zambia use condoms? The influence of gender and marriage on non-use of male condoms among young adults]</ref> You can read an article from the Lusaka Times, which tried to dispel many of the myths surrounding condoms, [https://www.lusakatimes.com/2016/12/05/facts-about-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.<ref>[https://www.ippf.org/blogs/overcoming-family-planning-challenges-zambia Overcoming family planning challenges in Zambia]</ref> Rural women typically tend to marry young and give birth early, as children are seen as a sign of prestige.<ref>[https://www.cia.gov/library/publications/the-world-factbook/geos/za.html CIA World Factbook7]</ref> | 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.<ref>[https://www.ippf.org/blogs/overcoming-family-planning-challenges-zambia Overcoming family planning challenges in Zambia]</ref> Rural women typically tend to marry young and give birth early, as children are seen as a sign of prestige.<ref>[https://www.cia.gov/library/publications/the-world-factbook/geos/za.html CIA World Factbook7]</ref> | ||
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===What to Get & Where to Get It=== | ===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).<ref>[https://pdfs.semanticscholar.org/0f72/d2877020f78351558be8add36923cfdf491a.pdf Equity in access to condoms in urban Zambia]</ref> Some of the condom brands you can expect to find in pharmacies are | * 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).<ref>[https://pdfs.semanticscholar.org/0f72/d2877020f78351558be8add36923cfdf491a.pdf Equity in access to condoms in urban Zambia]</ref> Some of the condom brands you can expect to find in pharmacies are Carex, Contempo, Durex, Maximum, Moods, Manforce, and Rough Rider. | ||
* You can find '''female condoms''' sold in pharmacies 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 [https://www.daily-mail.co.zm/why-women-shun-their-condoms/ here]. | * You can find '''female condoms''' sold in pharmacies 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 [https://www.daily-mail.co.zm/why-women-shun-their-condoms/ here]. | ||
* You can find a variety of '''oral 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 Diane 35, Safe Plan, Microgynon, and Oraclon. | * You can find a variety of '''oral 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 Diane 35, Safe Plan, Microgynon, and Oraclon. | ||
** Note: If you obtain birth control pills with instructions that are only in non-English languages (such as Chinese), they may be in the country illegally, and the Zambian government warns against using them. You can read more about this issue [https://www.daily-mail.co.zm/chinese-contraceptive-pill-worries-state-medical-bodies/ here]. | |||
* If you want an '''intrauterine device (IUD)''', you can get it inserted it at various hospitals and clinics in Zambia. For example, at [http://victoriahospitals.org/ 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 '''intrauterine device (IUD)''', you can get it inserted it at various hospitals and clinics in Zambia. For example, at [http://victoriahospitals.org/ 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 [http://victoriahospitals.org/ 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 implant''', you can get it inserted at various hospitals and clinics in Zambia. For example, at [http://victoriahospitals.org/ 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). | ||
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===Costs=== | ===Costs=== | ||
* For a box of '''condoms,''' you can expect to pay between | * For a box of '''condoms,''' you can expect to pay between K1 to K35 at pharmacies (as of July 2018). For example, here are the prices for condoms provided by two Lusaka pharmacies, July 2018: Maximum - K1 to K2.5, Manforce - K5, Moods - K7.50 to K15, Carex - K15, Rough Rider - K18, Contempo - K22.00, Durex K39.00 However, you can probably find free condoms from certain clinics and social marketing programs. | ||
* For a month (or many months) supply of '''oral contraceptives (birth control pills)''', you can expect to pay between K15 to K200, if you're paying the full price at pharmacies (as of July 2018). For example, here are the prices for birth control pills at one Lusaka pharmacy in July 2018: Diane 35 - K170.00/28 tabs, Safe Plan - K15.00/3 months, Oralcon F - K45.00/3 months. However, you can probably find reduced cost control pills from certain clinics and social marketing programs. | * For a month (or many months) supply of '''oral contraceptives (birth control pills)''', you can expect to pay between K15 to K200, if you're paying the full price at pharmacies (as of July 2018). For example, here are the prices for birth control pills at one Lusaka pharmacy in July 2018: Diane 35 - K170.00/28 tabs, Safe Plan - K15.00/3 months, Oralcon F - K45.00/3 months. However, you can probably find reduced cost control pills from certain clinics and social marketing programs. | ||
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===What to Get & Where to Get It=== | ===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 '''pads/pantyliners''' for sale in stores and pharmacies in Zambia, particularly in larger cities like Lusaka. Some of the brands you can expect to see are Always, Stay Free, and Kotex. | ||
* You can find '''tampons''' for sale in stores in Zambia, particularly in larger cities like Lusaka. | * You can find '''tampons''' for sale in stores and pharmacies in Zambia, particularly in larger cities like Lusaka. Some of the brands you can expect to see are Kotex and Lilets. | ||
* 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 [http://umoyo.com/shop/product/menstrual-cup/ Umoyo]. You can check out [http://www.talulacup.com/ 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." | * 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 [http://umoyo.com/shop/product/menstrual-cup/ Umoyo]. You can check out [http://www.talulacup.com/ 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." | ||
===Costs=== | ===Costs=== | ||
* Here are the price quotes for '''pads/pantyliners''' at a pharmacy in Lusaka (July 2018): Always K19.50, Stay Free K10, Kotex K15 | |||
* Here are the price quotes for '''tampons''' at a pharmacy in Lusaka (July 2018): Kotex K22.50 and Lilets K25 | |||
==Gynecological Exams== | ==Gynecological Exams== | ||