Abstract:
Universal Health Coverage (UHC) forces governments to consider not only how services will be
provided – but which services – and to whom, when, where, how and at what cost. This paper considers the
implications for achieving UHC through the lens of abortion-related care for adolescents. Our comparative
study design includes three countries purposively selected to represent varying levels of restriction on access to
abortion: Ethiopia (abortion is legal and services implemented); Zambia (legal, complex services with
numerous barriers to implementations and provision of information); Malawi (legally highly restricted). Our
policy and legal analyses are supplemented by comparative vignettes based on interviews (n = 330) in 2018/
2019 with adolescents aged 10–19 who have sought abortion-related care in each country. We focus on an
under-considered but critical legal framing for adolescents – the age of consent. We compare legal and
political commitments to advancing adolescent sexual and reproductive health and rights, including
abortion-related care. Ethiopia appears to approach UHC for safe abortion care, and the legal provision for
under 18-year-olds appears to be critical. In Malawi, the most restrictive legal environment for abortion, little
progress appears to have been made towards UHC for adolescents. In Zambia, despite longstanding legal
provision for safe abortion on a wide range of grounds, the limited services combined with low levels of
knowledge of the law mean that the combined rights and technical agendas of UHC have not yet been
realised. Our comparative analyses showing how policies and laws are framed have critical implications for
equity and justice.
