Beyond the Law - An Ethnography of Zambian Abortion Politics
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Every year, as many as 25 million women are estimated to resort to unsafe abortion worldwide. Many of these abortions lead to severe complications and death. Nevertheless, abortion remains a contentious issue that is commonly left out of discussion in global health. When addressed in international fora, abortion is often treated primarily as a legal question, and liberal abortion laws are taken as proxies for girls’ and women’s access to safe and legal abortion services. Zambia is internationally known to have a relatively permissive abortion law. Nonetheless safe abortions are difficult to access and unsafe abortion remains a considerable health and societal problem, contributing to the high maternal mortality statistics in the country. The inconsistency between Zambia’s abortion legislation and the lack of legal abortion services is not well understood, and is the starting point for this study that examines the complex relationship between abortion law, policy implementation and practice. The aim of this dissertation is to generate knowledge on how articulations between policy, legislation and sociocultural conditions shape women’s reproductive possibilities. The study draws on 11 months of multi-sited ethnographic fieldwork that took the Zambian abortion policy as its main object of study and followed its movements across different layers of the Zambian society and health system. The findings reveal that the restrictive elements of the abortion law - which were in focus when it was developed in the early 1970s - resonate strongly with current interpretations of the law, further strengthened by the declaration of Zambia as a Christian nation. Examining the processes involved in translating abortion policy from paperwork to practice, the study reveals unfolding discursive disputes and subtle power mechanisms. Centrally located policy actors in the health bureaucracy are key in these processes that shape and constrain girls’ and women’s access to safe abortion services. The dissertation argues that strategic use of knowledge and ‘ignorance’ are core mechanisms for the ways in which the politics of abortion is played out. The study further investigates the everyday reproductive politics of abortion as it unfolds at the local community level and reveals a tolerance of abortions that are kept out of the public domain, while abortions that become known to the public are made subject to loud condemnation. Informed by Fassin’s conceptualization of moral economy, the dissertation discusses how public opposition to abortion serves to preserve the moral self and to strengthen social ties in the community. Morgan and Roberts’ concept of ‘reproductive governance’ is located centrally in this inquiry of Zambian abortion politics. The concept facilitates an analysis of how abortion governance plays out across social and bureaucratic layers in subtle ways that shape or even impede the abortion policy’s on-the-ground implementation. As such, this study goes beyond the common focus on the legal status of abortion and contributes to the literature on how reproductive practices, such as abortion, are shaped by structures of power that operate through a set of visible and less visible tools.
Has partsPaper I: Haaland, M. E. S., Haukanes, H., Zulu, J. M., Moland, K. M., Michelo, C., Munakampe, M. N., & Blystad, A. 2019. Shaping the abortion policy – competing discourses on the Zambian termination of pregnancy act. International Journal for Equity in Health 18(1), 20. The article is available at: https://hdl.handle.net/1956/19835
Paper II: Haaland, M. E. S., Haukanes, H., Zulu, J. M., Moland, K. M., & Blystad, A. (2020). Silent politics and unknown numbers: Rural health bureaucrats and Zambian abortion policy. Social Science & Medicine, 251, 112909. The article is available at: https://hdl.handle.net/11250/2727320
Paper III: Haaland, M. E. S., Mumba Zulu, J., Moland, K. M., Haukanes, H., & Blystad, A. (2020). When abortion becomes public - Everyday politics of reproduction in rural Zambia. Social Science & Medicine, 265, 113502. The article is available at: https://hdl.handle.net/11250/2731584