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Measuring Abortion Incidence, Cost, and Quality of Post-Abortion Care in Liberia, Knowledgeable Informant Survey - Liberia

Liberia, 2021 - 2022
Health and Well-Being (HaW)
Kenneth Juma, Boniface Ushie,
Last modified November 07, 2025 Page views 319 Documentation in PDF Metadata DDI/XML JSON

Identification

IDNO
DDI-LIB-APHRC-LAS-KIS-2021-v1.0
Title
Measuring Abortion Incidence, Cost, and Quality of Post-Abortion Care in Liberia, Knowledgeable Informant Survey - Liberia
Subtitle
Knowledgeable Informant 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
2025-01-02
Version Notes
N/A

Coverage

Geographic Coverage
National coverage
Unit of Analysis
professionals knowledgeable about the conditions of abortion and the provision of post-abortion care abortion around Liberia
Universe
The survey covered professionals knowledgeable about the conditions of abortion and the provision of post-abortion care abortion in Liberia, they included medical doctors and midwives in public and private practice, policymakers, advocates, researchers, NGO staff, community health workers, and community leaders

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
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 African Population and Health Research Center Co-Investigator
Esther Mutuku African Population and Health Research Center Co-Investigator
Stephanie Kung Guttmacher Institute Co-Investigator
Akin Bankole Guttmacher Institute Co-Investigator
Dr. Moses Massaquoi Clinton Health Access Initiative 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 KIS involved in-person structured interviews with a sample of purposively selected respondents with knowledge about the provision of abortion and PAC in the country (nationally or pertaining to specific regions). Informants were not restricted to clinicians providing direct CAC services to patients. Potential key informants were identified through purposeful and snowball sampling.
A total of 89 key informants were interviewed on topics ranging from their perception regarding the type of providers women seek abortion from, the likelihood women will experience complications that require
treatment in a facility according to the type of abortion provider used, to the likelihood that women who need treatment will receive it at a health facility. These questions were asked for four (4) major sub-groups of women within the population: rural poor, rural non-poor, urban poor, and urban non-poor. This information was used in the calculation of the multiplier. The multiplier is the number of women/girls who have induced abortion who either did not have complications, or had complications that were not treated in the formal health system, for everyone that received facility-based care. Other data sources used for calculating abortion incidence were the 2019/2020 Liberia Demographic and Health Survey (LDHS) (7), which provided information on fertility, contraceptive prevalence, unmet need for contraception, birth wantedness, and measures of access to health care. We also drew data from 2021 population projection for the number of women aged 15-49 in the different regions of Liberia. We used the Poverty & Equity Brief for Liberia 2021(15) and the Global Multidimensional Poverty Index (MPI) Country Briefing 2021: (16), to estimate the proportion of poor/non-poor in urban/rural settings in Liberia.
Deviations from the Sample Design
N/A
Response Rate
100%
Weighting
N/A

Data Collection

Dates of Data Collection (YYYY/MM/DD)
Start date End date
2021-11-05 2022-04-18
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
KIS was used to sample and recruit both health and non-health professionals (e.g., law, media, teachers, research, education, nursing, policymaking, advocacy, and family planning program implementation and management) who are nevertheless well-informed about the context of abortion (access, safety, care-seeking behavior) in their regions.
Interviews were carried out at the respondents' place of work or location of the respondents' choice
The questionnaire was written in English. It explored a number of questions that served to refine further an understanding and the opinion of abortion incidence and safety in Liberia.

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
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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
- 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-KIS-2021-v1.0
Producers
Name Abbreviation Role
African Population and Health Research Center APHRC Documentation of the DDI
Date of Production
2025-01-02
Document version
Version 1.0(JANUARY 2025)