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Abortion Incidence and Severity of Complications in Kenya 2022, Respondent-Driven Sampling survey (RDS)

Kenya, 2024
Health and Well-Being (HaW)
Kenneth Juma
Last modified June 10, 2025 Page views 38625 Metadata DDI/XML JSON

Identification

IDNO
DDI-KEN-APHRC-KAS-RDS-2022-v1.0
Title
Abortion Incidence and Severity of Complications in Kenya 2022, Respondent-Driven Sampling survey (RDS)
Subtitle
Respondent-Driven Sampling survey (RDS)
Country
Name Country code
Kenya KEN
Abstract
Background: Unsafe abortion remains a significant cause of maternal morbidity and mortality in many African countries, including Kenya. In Kenya, abortion is legally restricted except when the life or health of a pregnant woman is in danger and in cases of rape or incest. The restrictions around abortion, pervasive stigma and negative attitudes of healthcare providers often increase the risks of unsafe abortion. Ten years ago, a study by the Ministry of Health, the African Population and Health Research Center (APHRC), and the Guttmacher Institute reported close to 464,690 induced abortions in 2012. Given the time that has passed since that study, and changes in the landscape of abortion in Kenya (e.g., the availability of medication abortion drugs, enactment of the 2017 Health Act that defined “trained providers” to include nurses and midwives, and the 2019 High Court ruling that reinstated the withdrawn Standards and guidelines for reduction of maternal mortality from unsafe abortion), policymakers and advocates in Kenya have raised the need for another national abortion incidence study.
Objectives: To determine the incidence of induced abortions and the severity of abortion-related complications in Kenya.
Methods: The proposed study will employ a quantitative cross-sectional design. The study will have four separate surveys: i) a nationally representative Health Facility Survey (HFS) to estimate the number of women who receive post-abortion care (PAC) following abortion complications, ii) a Knowledgeable Informants Survey (KIS) to collect information on the proportion of all women having abortions who receive facility-based treatment for abortion-related complications, iii) a Respondent-Driven Sampling survey (RDS) of women who have had an abortion to understand abortion incidence and safety, and iv) a Prospective Morbidity Survey (PMS) to provide the data necessary to describe characteristics of women receiving treatment for abortion complications, the severity of complications, the type of treatment received, and the delays in access to PAC. The PMS will also include a limited component involving clinical data abstraction from the medical charts/records of PAC clients.
Utility of study: Evidence generated will contribute to a greater understanding of the incidence of induced abortions and the magnitude and severity of abortion-related complications. The evidence will support investment and decision-making toward addressing the contributors of unsafe abortions and unintended pregnancies, improving access to quality PAC services, and ultimately improving adolescent and maternal health in Kenya.

Version

Version Date
2024-06-04
Version Notes
NA

Scope

Keywords
Keyword
Abortion
Induced Abortion
Spontaneous Abortion
Safe abortion
Unsafe Abortion
Incidence of abortion

Coverage

Geographic Coverage
Urban areas in Kenya
Unit of Analysis
Women who had abortion in Kenya
Universe
Women between the ages of 15 and 49 in Kenya who had abortion

Producers and sponsors

Authoring entity/Primary investigators
Agency Name Affiliation
Kenneth Juma African Population and Heath Resource Center
Producers
Name Affiliation Role
Margaret Giorgio Guttmacher Institute Co-Investigator and a Senior Research Scientist
Yohannes Dibaba Wado African Population and Heath Resource Center Co-Investigator and a Senior Research Scientist
Jesse Philbin Guttmacher Institute Senior Research Associate
Sherine Athero African Population and Heath Resource Center Research Officer
Esther Mutuku African Population and Heath Resource Center Data analyst
Boniface Ushie African Population and Heath Resource Center Co-Investigator and an expert researcher
Hellen Akinyi African Population and Heath Resource Center Data Documenatarist
Isaiah Akuku African Population and Heath Resource Center Data management
Bonface Ingumba African Population and Heath Resource Center Data Governance Officer
Funding Agency/Sponsor
Name Abbreviation Role
Hewlett Foundation Funder
Norwegian Agency for Development Cooperation NORAD Funder
Other Identifications/Acknowledgments
Name Role
Ministry of Health,Kenya Ministerial partners

Sampling

Sampling Procedure
The RDS will target a purposive sample of 1600 women of reproductive age (15-49) who have had at least one induced abortion within the last five years (4 sites, 400 women per site). To be eligible to participate in the RDS survey, a number of criteria need to be met. First, women need to have had their most recent induced abortion in the last five years. This criterion will be confirmed in the initial introduction to the study during a short phone call and again at the beginning of the in-person survey. All recruitment channels will clearly stipulate that eligible respondents are women who have had an induced abortion in the last five years. Women who do not confirm at this point that they have had an induced abortion in the last five years will be excluded from the study but will be invited to recruit women who they know have had an induced abortion in the last five years to participate in the study. Because this component of the study is focused on women of reproductive age, minors (aged 15-17) will be included in the study. Understanding abortion incidence and outcomes among adolescents aged 15-19 is a key priority for the Kenya Ministry of Health and other advocates and service providers, which is why we proposed to include minors in this survey. All respondents must also provide consent to participate in the quantitative survey.
We will identify initial seed participants through several methods. Previous research has demonstrated that initial seeds do not need to represent the underlying population [52]. However, seeds must represent a diversity of the basic demographic characteristics that determine social relationships within the study population [53]. The previous RDS studies of women who have had abortions in Uganda and Ethiopia found that an important characteristic that defines social ties within this population is whether women accessed their abortions within or outside a health facility [39]. As such, we plan to recruit initial seeds through health facilities known to provide abortion services to women, pharmacies where women obtain medication abortion, and traditional providers that provide access to abortion services outside of the formal healthcare system.
After the initial seeds have been selected and participated in the survey, they will then recruit other people (peer-to-peer recruitment) into the study. After participation, the initial seeds will be given three study coupons to recruit peers who meet the study eligibility criteria. These coupons will not contain any information indicating that the study is about abortion. Instead, seed participants will be counseled to explain to their peers that the study is about abortion. If a woman is interested in participating in the research, she will call the number of a study staff listed on the coupon. Information about the study will be provided over the phone when potential participants call in to the study phone number provided on the coupons. This short phone call will last about 5 minutes, wherein the interviewer will briefly explain the study, answer any questions women may have, and ask the woman if she would like to schedule an interview. Before discussing the study, the interviewer will make sure that the woman is in a private location and not on speakerphone. Interviewers will follow the script (Appendix 12) during this initial phone call. All subsequent interviews will take place in a private location agreed upon by the respondent during the initial phone call (a private space either in her household or at a predetermined study location). This process of peer-to-peer recruitment will continue until equilibrium on key variables is reached or until we reach our desired sample size (whichever comes second.)
When potential participants call the study phone number to inquire about study participation, study staff will record the phone call into a logbook. They will record the date of the phone call and whether the caller is eligible to participate in the study. If eligible, study staff will also record the date of the scheduled interview and the participant's phone number. The logbook will be password protected, and the participant's phone number will be deleted (from the phone call log) as soon as they complete the interview. Given the widespread mobile telephone coverage in Kenya, we believe this approach would be the easiest to recruit women and girls. The coupons that seed participants will use to recruit other potential respondents will advise suitable participants to send a flash message or flash call to the study number. The study team will call all numbers from which a flash message or call is received. This approach will eliminate the possibility that potential participants may not have money in their phones to call, given that the flash messages do not have costs attached.
The APHRC and Guttmacher study teams will have weekly meetings to assess recruitment progress and the relative sample sizes from each study recruitment arm (see below), to ensure balanced recruitment from each study arm. During these weekly meetings, the team will decide whether to continue or stop recruiting through any arm, and whether or not some of the eligibility criteria should be adjusted to ensure a diverse sample (e.g. age, economic status, recent abortions, etc.). We will aim for equal quotas of respondents from each of the four study recruitment arms. Once the target sample has been met through one arm, the team will temporarily stop recruitment and put more effort into recruiting through the other study arms. We will aim for data collection to span 2-3 months, and for the emphasis to switch throughout between initial seed recruitment strategies and peer-to-peer recruitment strategies.
To minimize the potential for sampling women with overlapping social networks (in which case some women in those social networks may be discussed in multiple interviews), the portion of our recruitment done through peer referrals will follow established respondent-driven sampling guidelines [19]: 1) our referral chains will begin with diverse seeds (as described above), and 2) we limit the number of referrals any individual can make to five people.
To maintain participant confidentiality while also tracking the recruitment chains, we will assign unique identifiers to each participant that are not linked to their personal identifying information. Before the start of the study, we will print out 1,600 coupons (Appendix 13) and put unique QR codes on each one. The QR codes will be random and not linked to each other. When the initial seeds participate in the study, we will randomly assign each of them a unique identification (ID) code. After these initial seeds complete the survey, we will give each woman five coupons to use for recruiting their peers into the study. At the end of each respondent's survey form; there will be three blank fields where we can scan in the QR codes that were randomly assigned to the three coupons we gave her. When a new woman participates in the study, she will present her coupon to the interviewer, who will then scan the QR code on the coupon into an electronic survey; that number becomes her unique ID. This means that the QR codes for women who were recruited into the study from friends will show up twice in the dataset - once at the end of their recruiter's survey form and again as their unique ID. We will link them by matching codes in the analysis phase. This method removes human error when assigning unique IDs and ensures that we maintain the ability to track recruitment chains throughout the study.
Deviations from the Sample Design
N/A
Response Rate
The response rate caculated from both the coupon and recruitement value in the four counties in Kenya. The overall rate for Kenya was 41.5%, the counties were distributed as follows:
Nairobi with 42.7%, Mombasa with 42.4%, Nakuru with 38.6% and finally Kisumu with 42.1%.
Weighting
In RDS data on network size of the hard-to-reach population was captured. In this case the women were asked how many individuals they know have had abortion within the past 5 years, between the age of 15 and 49(women of reproductive age). This information was used to generate the RDS probability weights. We then obtained population margin data from the 2019 Kenya population and Housing Data for age and education, and employment status data from the 2022 KDHS data to generate postabortion weights and adjust the RDS probability weight to align with the general population.

Data Collection

Dates of Data Collection (YYYY/MM/DD)
Start date End date
2024-03-13 2024-05-10
Mode of data collection
Other [oth]
Supervision
The Interview was conducted by a team of field interviewers. Each team included 6 interviewers, in addition to 1 team lead.

The supervisor's role was to coordinate field data collection and manage teams. They also assigned tasks to interviewers, spot-checked work, maintained control documents, and sent completed questionnaires and progress reports to the central data portal.
Frequent Field visits were made after every two weeks for period of data collection by the KAS members
Type of Research Instrument
Respondent-Driven Sampling survey (RDS) was used to sample and recruit women who have had abortions in Kenya.
The questionnaire was written in English. It explored a number of questions that served to refine further an understanding of abortion incidence and safety in Kenya.These questions included whether the abortions resulted in complications, whether women sought treatment for the complications in health facilities, the circumstances under which the abortions occurred (methods used, providers, place of access, etc.), information on abortion stigma, and information on whom and why women disclose information about abortions within their social networks.

Data Processing

Cleaning Operations
the software used was survey CTO for data colllection, the data was later downloaded in STATA format.
Other Processing
N/A

Data Appraisal

Estimates of Sampling Error
N/A

Data access

Contact
Name Email
African Population and Heath Research Center datarequest@aphrc.org
Conditions
All non-APHRC staff seeking to use data generated at the Center must obtain written approval to use the data from the Director of Research. This form is developed to assess applications for data use and facilitate responsible sharing of data with external partners/collaborators/researchers. By entering into this agreement, the undersigned agrees to use these data only for the purpose for which they were obtained and to abide by the conditions outlined below:

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"This research uses livelihoods data collected under the longitudinal Nairobi Urban Health and Demographic Surveillance System (NUHDSS) since 2006. The NUHDSS is carried out by the African Population and Health Research Center in two slums settlements (Korogocho and Viwandani) in Nairobi City."

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- the Identification of the Primary Investigator
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Metadata production

Document ID
DDI-KEN-APHRC-KAS-RDS-2022-v1.0
Producers
Name Abbreviation Role
African Population and Health Research Center APHRC DDI Documentation
Date of Production
2024-06-04
Document version
Version 1.0(JUNE 2024)