| 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. |
