Pregnancy
Maternal health services are free in public facilities, and skilled attendance at birth has risen substantially. Zambia has invested in maternity waiting homes attached to health facilities, allowing women from remote areas to stay nearby in the final weeks. Maternity leave is fourteen weeks.
Maternal care is free in public facilities in Zambia, and the distinctive response to the country's distances is the maternity waiting home: accommodation beside a health centre where a woman from a distant village stays in the final weeks so that she is nearby when labour starts. Hundreds have been built. Maternity leave is fourteen weeks, with additional provision for multiple births.
Key points
| Cost | Free in public facilities |
|---|---|
| Maternity leave | Fourteen weeks, with paternity leave of five days |
| Waiting homes | Attached to many facilities for women living far away |
| HIV | Testing and treatment integrated into antenatal care, with high coverage |
| Skilled attendance | Has risen substantially over the past decade |
In practice
- Ask about the maternity waiting home at your referral facility if you live more than an hour away.
- Accept HIV testing: it directly protects the baby.
- Prepare the items you will be asked to bring for the delivery.
Cost and coverage
Public maternal care is free; supplies and transport remain the family's cost.
Recent changes
The Employment Code consolidated leave entitlements and extended maternity leave, and the maternity waiting home programme has been scaled up with donor support across rural districts.
Where to go
- Health posts, health centres and district hospitals.
- Maternity waiting homes.
- Community health workers and safe motherhood action groups.
Worth knowing
Maternity waiting homes remove the single biggest cause of death in rural areas: the time taken to reach a facility once labour has started.
Frequently asked questions
What is a maternity waiting home?
Simple accommodation next to a health facility where women from remote areas stay in the last weeks of pregnancy so they can deliver with a skilled attendant. Families usually bring food and a carer. It is the main answer to the distances that drive maternal deaths in rural Zambia.
How long is maternity leave?
Fourteen weeks of paid leave under the Employment Code, with additional weeks for multiple births, and five days of paternity leave. A qualifying period of service applies, and the entitlement covers formal employees only.
The general article: Pregnancy · Compare with another country
Periods and period products
Zambia is one of the very few countries with statutory menstrual leave: since 2015, kept in the Employment Code Act of 2019, every female employee may take one day off a month, known as Mother's Day, without notice or medical certificate and without loss of pay. The government has supplied free sanitary pads to girls in rural and peri-urban public schools since 2017, to reduce absenteeism; distribution is uneven and depends on the budget.
Tax policy has favoured local production and school supply rather than a blanket exemption; prices in shops remain high for most households, and NGOs promote reusable pads.
Endometriosis is treated in the gynaecology departments of the University Teaching Hospital in Lusaka and the provincial hospitals, with limited laparoscopy; private clinics in Lusaka and the Copperbelt serve those who can pay. Awareness is low.
Employers sometimes contest Mother's Day; the law is clear that it is a right, and the labour office handles complaints.
Key points
| Menstrual leave | One day a month (“Mother's Day”), Employment Code Act 2019, no notice or certificate required |
|---|---|
| Schools | Free pads for girls in rural and peri-urban public schools since 2017 |
| Tax | No blanket exemption; support to local production |
| Endometriosis | University Teaching Hospital and provincial hospitals; private clinics |
In practice
- Mother's Day needs no justification: tell the employer you are taking it; refusal can be reported to the labour office.
- Ask the school whether government pads are supplied and when.
- For pelvic pain, the provincial hospital gynaecology clinic is the public route.
What it costs
A cycle costs roughly 30 to 80 kwacha in disposables. Free pads in eligible schools; one paid day a month off work by law.
What has changed recently
Mother's Day survived the 2019 recodification of labour law; the school programme has continued with fluctuating budgets.
Where to find help
- Ministry of Labour: Employment Code Act and complaints.
- Ministry of Education: school sanitary pad programme.
- University Teaching Hospital gynaecology department.
- NGOs promoting reusable pads.
Worth knowing
Mother's Day is a right, but some employers still demand proof or refuse it; keep a written record and use the labour office.
Frequently asked questions
Is there menstrual leave in Zambia?
Yes: one day a month, Mother's Day, without notice or certificate, under the Employment Code Act.
Are pads free in schools?
For girls in rural and peri-urban public schools since 2017, subject to supply.
Are pads tax-free?
No blanket exemption; policy has favoured local production and school supply.
Sources
- Ministry of Labour and Social Security — Employment Code Act, Mother's Day
The general article: Periods and period products · Compare with another country
Mental health
Zambia's 2019 law on mental health is framed around patients' rights, and yet the treatment gap is among the widest worldwide.
The Mental Disorders Act inherited from colonial times was swapped in 2019 for legislation built on patients' rights.
The general article: Mental health · Compare with another country
Dental care
Dental benefits under national health insurance are limited, so public care centres on pain relief and extraction and restorative work is largely private.
Dental care is organised around public facilities and the National Health Insurance Scheme, whose dental benefits are limited.
The general article: Dental care · Compare with another country
HIV and AIDS
Zambia has a generalised epidemic with high prevalence and has invested heavily in treatment: antiretrovirals are free, treatment is started on diagnosis, and self-testing has been distributed at scale. Coverage indicators have improved markedly over the past decade, with the main remaining gaps among men and young people.
Zambia provides free antiretroviral treatment through public facilities and has achieved high treatment coverage, with PrEP available at many sites. Self-testing and community-based distribution have been used extensively to raise the proportion of people who know their status, and the country reports strong progress against international targets.
Key points
| Prevalence | High, with a generalised epidemic |
|---|---|
| Treatment | Free, started on diagnosis regardless of CD4 count |
| Self-testing | Distributed widely, including through community channels |
| Testing | Free at public facilities and through outreach |
| PMTCT | Well-established programme |
| PrEP | Available through the national programme |
| Remaining gaps | Men and young people are less likely to be diagnosed and retained |
In practice
- Self-test kits are free and available through community distribution.
- Ask for multi-month dispensing and community collection points if you are stable on treatment.
- PrEP is part of the national programme: ask for it by name.
- Peer support groups are effective at maintaining adherence.
Where to go
- Public health facilities and antiretroviral therapy sites.
- National AIDS Council and community organisations.
Worth knowing
Men are diagnosed later and die more often as a result. Self-testing exists partly to solve that: it requires no appointment and no conversation.
Frequently asked questions
How good is treatment coverage in Zambia?
High by regional standards: a large majority of people living with HIV know their status, are on treatment and have a suppressed viral load. Treatment and monitoring are free at public facilities, and community distribution of medication reduces the need for frequent clinic visits.
Hepatitis B
Routine infant vaccination, high co-infection with HIV, and treatment often delivered through HIV services.
Hepatitis B is common in Zambia and frequently coexists with HIV. Infant vaccination is part of routine immunisation from six weeks, without a universal birth dose. Because several antiretroviral regimens also suppress hepatitis B, much of the treatment in practice is delivered through HIV services, which makes co-infection status important to establish.
Zambia includes hepatitis B in the pentavalent vaccine from six weeks and does not routinely give a birth dose. Screening is most developed within HIV services, where hepatitis B testing is part of assessment before starting treatment, because the drugs used against HIV also act on hepatitis B and the choice of regimen depends on it.
Key points
| Prevalence | High, with frequent HIV co-infection |
|---|---|
| HIV co-infection | Common; several antiretroviral regimens also treat hepatitis B |
| Testing | Available at public facilities; ask for it |
| Treatment | Often delivered through HIV services |
| Antenatal screening | Not universal |
In practice
- If you are living with HIV, ask whether you have been tested for hepatitis B: it changes which regimen is appropriate.
- Never stop an antiretroviral regimen that is also treating hepatitis B without specialist advice.
Cost and coverage
Vaccination and testing are free in the public sector; treatment is often provided through HIV services.
Where to go
- Public health facilities and HIV clinics.
- University Teaching Hospital in Lusaka.
Worth knowing
Stopping a regimen that also suppresses hepatitis B can cause a severe flare. If you have both infections, any change to treatment must be made with that in mind.
Frequently asked questions
Why does HIV treatment affect hepatitis B?
Because several antiretroviral drugs are also active against hepatitis B. Anyone starting HIV treatment should be tested for hepatitis B, since the regimen must be chosen accordingly — and stopping such a drug abruptly can cause a dangerous flare of hepatitis.
HPV
A long-established national screening programme built on visual inspection, and vaccination since 2019.
Zambia built one of the earliest large cervical cancer prevention programmes in Africa, using visual inspection with digital imaging and same-visit treatment, delivered through public clinics. HPV vaccination entered routine immunisation in 2019 for girls aged 9 to 14. The burden remains among the highest in the world, driven in part by high HIV prevalence.
Zambia runs one of the longest-established cervical cancer prevention programmes in Africa, built around screening integrated into HIV services with visual inspection and same-visit treatment, and has introduced HPV vaccination for girls into routine immunisation. The integration with HIV care is the distinctive feature and has been widely studied.
Key points
| Screening programme | A long-established national programme using visual inspection with same-visit treatment |
|---|---|
| Vaccination | In routine immunisation since 2019 for girls aged 9 to 14 |
| Women living with HIV | Screened more frequently; HIV substantially raises risk |
| Same-visit treatment | Cryotherapy or thermal ablation during the screening visit |
| Burden | Among the highest incidence rates in the world |
| Integration | Screening is integrated with HIV care in many facilities |
In practice
- Ask for screening at a public clinic: the programme is established and treatment can follow in the same visit.
- If you are living with HIV, screening is more urgent and more frequent for you.
- Have daughters aged 9 to 14 vaccinated free of charge.
Where to go
- Public clinics with cervical cancer prevention services.
- Cancer Diseases Hospital in Lusaka.
- HIV clinics, which integrate screening.
Worth knowing
Same-visit screening and treatment is the core of the Zambian model: you can arrive, be screened and be treated in one visit, which removes the loss of women between diagnosis and care.
Frequently asked questions
Why is screening linked to HIV services in Zambia?
Because women living with HIV are at much higher risk of persistent HPV infection and of progression to cancer, and because HIV clinics already see them regularly. Integrating screening into that visit reaches the highest-risk group without requiring a separate appointment.