Healthcare Providers’ Ethical Navigation of Adolescent Abortion Care in Lusaka, Zambia

Background: Adolescent abortion care often poses ethical and practical challenges for healthcare providers. Debates commonly focus on adolescents’ decision-making capacity, the role of parental involvement, and how to balance respect for autonomy with the implementation of policies and guidelines. This study investigated the ethical debates surrounding adolescent abortion care in Lusaka, Zambia, from healthcare providers’ perspectives. Using an interpretive phenomenological approach, the study explored how providers understand adolescents’ autonomy, parental involvement, and their ethical responsibilities in abortion care. Methods: This qualitative study used an interpretive phenomenological design and Interpretative Phenomenological Analysis to explore healthcare providers’ experiences supporting adolescents seeking abortion services in Lusaka, Zambia. The study was conducted in the Lusaka and Chongwe districts and involved mid-level providers engaged in abortion care. Semi-structured, face-to-face interviews were conducted with twelve healthcare providers. Data were analysed manually through iterative reading of transcripts, identification of exploratory comments, and development of subordinate and superordinate themes. Microsoft Word and Excel were used to organise analytic tables and emerging themes. Results: Three interconnected themes emerged. First, providers viewed adolescents’ abortion decisions as shaped by wider social factors, including educational goals, financial difficulties, stigma, and relationship instability. Second, providers described assessing adolescents’ decision-making capacity through relational interactions, considering knowledge, communication, and educational background rather than age alone. Third, providers emphasised the balancing act between adolescent autonomy and parental involvement, often acting as mediators to reconcile legal obligations, parental authority, and adolescents’ views. Conclusion: Providers viewed adolescent abortion decision-making as a socially embedded, relational process rather than a purely individual choice. Policies and clinical guidance should better support providers in assessing adolescents’ evolving capacities and in managing parental involvement while safeguarding adolescents’ autonomy and access to care.