TITLE:
Self-Inflicted “Cesarean Section” in a 14-Year-Old Primigravida: A Case Report on the Consequences of Barriers to Safe Abortion Services
AUTHORS:
Aubrey Shanzi, Reward Sibanda, David Kadisha, Chifuka Phiri, Chanda Nkaka, Mabvuto Zulu
KEYWORDS:
Unsafe Abortion, Teenage Pregnancy, Self-Harm, Case Report, Health Systems, Informal Payments
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.16 No.6,
June
30,
2026
ABSTRACT: Introduction: Unsafe abortion remains a major challenge in Zambia despite a legal framework that permits termination of pregnancy. With a maternal mortality ratio (MMR) of 187 per 100,000 live births, it is estimated that up to 10% of these deaths are a result of unsafe abortion. Teenagers face unique financial, emotional, and physical barriers compared to adults, often leading to desperate attempts at unsafe abortion. Patient and Observation: This is a case of a 14-year-old Zambian primigravida at 15 weeks of gestation who presented to the emergency gynecology unit with a self-inflicted transverse abdominal incision. The patient had previously attempted to access termination services at a local clinic but was denied due to her age and inability to pay an unofficial fee. In a desperate attempt to extract the fetus, she used a razor blade to incise her abdomen down to the level of the rectus abdominis aponeurosis. The procedure was halted due to excessive blood loss. The wound was surgically repaired, and a medical termination of pregnancy was subsequently conducted. Conclusion: This case demonstrates how a lack of comprehensive abortion services can endanger lives. It emphasizes that a liberal abortion law does not necessarily translate to safe access, particularly for adolescents who face financial and consent-related issues.