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Measuring Abortion Incidence, Cost, and Quality of Post-Abortion Care in Liberia, Health facility Survey - Liberia

Liberia, 2021
Health and Well-Being (HaW)
Kenneth Juma, Boniface Ushie,
Last modified November 07, 2025 Page views 1649 Documentation in PDF Metadata DDI/XML JSON

Identification

IDNO
DDI-LIB-APHRC-LAS-HFS-2021-v1.0
Title
Measuring Abortion Incidence, Cost, and Quality of Post-Abortion Care in Liberia, Health facility Survey - Liberia
Subtitle
Health facility Survey - Liberia
Country
Name Country code
Liberia Lib
Abstract
Unsafe abortion was one of the major causes of complications, leading to Liberia's high maternal mortality ratio (1,072 deaths per 100,000 live births). The Ministry of Health highly prioritized reducing the high rates of maternal and neonatal deaths in the country. Among national efforts to improve access to and quality of reproductive, maternal, neonatal, child, and adolescent health (RMNCAH) services was the prevention of unsafe abortion and morbidity and mortality from unsafe abortions because nearly 6 out of 10 girls were mothers before age 19. In addition, adolescent pregnancy contributed to high maternal mortality and high neonatal mortality. Nevertheless, there was little information available on abortion incidence, burden and costs of managing complications from unsafe abortions, and the quality of post-abortion care. Data were critical for government and civil society stakeholders to design effective policies and guidance to reduce maternal morbidity and mortality from unsafe abortions and to advocate for increased access to comprehensive abortion care (inclusive of safe abortion for legal indications and post-abortion care) in Liberia.

Objectives: The overall aim of the study was to determine the incidence of induced abortions, severity and magnitude of abortion-related complications, quality of PAC, and cost burden of unsafe abortion on the health systems in Liberia.

Methodology: A mixed-method cross-sectional design was applied to determine the incidence of abortion in Liberia. This research design was employed using the Abortion Incidence Complication Method (AICM). This widely applied indirect method had produced robust estimates of abortion incidence in a range of contexts. The study comprised five (5) different surveys, namely: 1) Health Facility Survey (HFS), 2) Prospective Morbidity Survey, 3) Knowledgeable Informant Survey, 4) Quality of PAC survey, and 5) Post Abortion Care (PAC) Costing Survey. The Health Facility Survey was implemented at sampled public facilities using a nationally representative, stratified, random sampling approach to determine the incidence of induced abortion and abortion complications in Liberia. The Health Facility Survey also included a quality survey to assess the quality of post-abortion care. The Prospective Morbidity Survey was about women seeking PAC in health facilities and providers, including a patient chart review to assess the severity of complications. It also collected data on decision-making, care-seeking pathways, and awareness of the country's abortion law. For the Knowledgeable Informant Survey, a sample of health sector stakeholders who were knowledgeable about abortion/PAC in Liberia were interviewed. Data from this component generated the multiplier to inform the incidence of abortion. The PAC costing study targeted health facility administrators to estimate the costs of PAC at facilities and the national level.

Version

Version Date
2025-01-03
Version Notes
N/A

Coverage

Geographic Coverage
National coverage
Unit of Analysis
knowledgeable healthcare providers
Universe
senior health providers, who are knowledgeable about the provision of PAC

Producers and sponsors

Authoring entity/Primary investigators
Agency Name Affiliation
Kenneth Juma African Population and Health Research Center – Kenya
Boniface Ushie African Population and Health Research Center – Kenya
Producers
Name Affiliation Role
Bentoe Z. Tehoungue Ministry of Health - Liberia Director of Family Health Division
Margaret Giorgio Guttmacher Institute Co-Investigator and a Senior Research Scientist
Jesse Philbin Guttmacher Institute Senior Research Associate
Hellen Akinyi APHRC Data Documentarist
Dr. Moses Massaquoi Clinton Health Access Initiative Co-Investigator
Nelson K. Dunbar Ministry of Health, Liberia Co-Investigator
Vekeh Donzo Clinton Health Access Initiative Co-Investigator
Lily Lu, Clinton Health Access Initiative Co-Investigator
Matthew Nviiri Clinton Health Access Initiative Co-Investigator
Ramatou Ouedraogo APHRC Co-Investigator
Esther Mutuku APHRC Co-Investigator
Stephanie Kung Guttmacher Institute Co-Investigator
Akin Bankole Guttmacher Institute Co-Investigator
Funding Agency/Sponsor
Name Abbreviation
Swedish International Development Cooperation Agency Sida
Other Identifications/Acknowledgments
Name Affiliation
Clinton Health Access Initiative CHAI

Sampling

Sampling Procedure
The sample frame for the health facility survey included all public clinics, health centers, and hospitals based on the assumption that all public facilities can provide some level of PAC as per the current Liberia National Guidelines for Comprehensive Abortion Care (2019). The sample size for public facilities was drawn from the MOH Master Facility Listing (updated October 8, 2020). According to the most updated Master Facility Listing, there are 467 functional public facilities. After eliminating specialized facilities (e.g., specific infectious disease facilities, rehabilitation centers, etc.) and military/paramilitary facilities (barrack, prisons, etc.), a sample frame of 436 functional public facilities across the 15 counties in Liberia was generated. These 436 facilities include 21 hospitals (5%), 37 health centers (8%), and 378 clinics (87%). All of the public hospitals (i.e., 100%) were included in the survey because of the high PAC patient load and service volume, 70% of health centers, and 10% of clinics were also randomly sampled for the HFS (considerations being PAC service volume and staffing of clinicians at those levels).

The study sample was distributed amongst the 15 counties by determining what proportion of the total eligible facilities in the country was situated in a county disaggregated by levels. We multiplied the percentage of facilities at each level in the county by the sample size to determine county allocation of the sample size. To select the actual facility for inclusion in the sample and study, we isolated the facilities by region and level. For each level and region, we ordered the list of facilities in alphabetical order and following that order, attach serial numbers to the facilities. Using the Stata program, we generated random numbers of the ordered facilities. Any facility so randomly selected was included in the sample and study.

As for private facilities, there were no standard formula for estimating the sample to include in the HFS. Facilities were purposely selected based on consideration of the level of care, the number of facilities available in each level of care, facility catchment population, number of PAC cases (reported in DHIS-2 for 2020), and logistical considerations. Twenty private facilities (11 hospitals, 3 health centers, 6 clinics) were purposively selected because of the volume of PAC consultations at those facilities.
Deviations from the Sample Design
Health facility survey (HFS): One hundred and thirty-two (132) health facilities were sampled, but only 128 health facilities responded.
Response Rate
97.0%
Weighting
Sample weights were calculated for each of the Study Region focusing on the level of facility per region

Data Collection

Dates of Data Collection (YYYY/MM/DD)
Start date End date
2021-09-03 2021-11-28
Mode of data collection
Face-to-face [f2f]
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 Study members
Type of Research Instrument
The questionnaire was written in english with a primary purpose of the HFS is to estimate the number of women who receive treatment in facilities for abortion-related complications.
The HFS will be a statistically representative survey of all health facilities in Kenya classified as having the capacity to provide PAC services. In each selected health facility, a senior health provider, who is knowledgeable about the provision of PAC, is interviewed.

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 Affiliation Email
African Population and Heath Research Center APHRC datarequest@aphrc.org
Conditions
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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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Citation requirement
Use of the dataset must be acknowledged using a citation which would include:
- the Identification of the Primary Investigator
- the title of the survey (including country, acronym and year of implementation)
- the survey reference number
- the source and date of download

Metadata production

Document ID
DDI-LIB-APHRC-LAS-HFS-2021-v1.0
Producers
Name Abbreviation Role
African Population and Health Research Center APHRC Documentation of the DDI
Date of Production
2025-01-03
Document version
Version 1.0(JANUARY 2025)