Post-abortion contraception, by country.

Lack of access to safe abortions continues to be a major sexual and reproductive health concern. Adolescents can face barriers to safe abortions due to the unique implications of their age. Understanding adolescent abortion experiences and care trajectories is critical. Qualitative and quantitative evidence is analysed from interviews with 313 adolescents aged 10–19 years who sought abortion-related care in public health facilities in Addis Ababa (Ethiopia), Lilongwe (Malawi), and Lusaka (Zambia) between April 2018 and September 2019. The trajectories framework is used to understand how adolescent abortion-related care-seeking differs across a range of socio-legal national contexts. A comparative study design incorporates varying levels of restriction on access to abortion: Ethiopia (legal on broad social or economic grounds, services implemented); Zambia (legal on broad social or economic grounds, complex services with barriers to implementation and information provision); and Malawi (legally highly restricted). Most adolescents (n = 97, 98%) in Ethiopia obtained a medically safe abortion, and most adolescents (n = 70, 64%) in Zambia and almost all adolescents (n = 94, 94%) in Malawi obtained a less medically safe abortion. There is a significant association between country and whether an adolescent tried to end a pregnancy before coming to the facility, X²(2, N = 313) = 135.93, p