Pregnancy termination trajectories in Zambia: The socio-economic costs

Coast, Ernestina and Freeman, Emily and Murray, Susan and Leone, Tiziana and Parmar, Divya and Vwalika, Bellington and Sikateyo, Bornwell (2018). Pregnancy termination trajectories in Zambia: The socio-economic costs. [Data Collection]. Colchester, Essex: UK Data Archive. 10.5255/UKDA-SN-851652

Unsafe abortion is a significant, preventable, cause of maternal mortality and morbidity and is both a cause and a consequence of poverty. Unsafe abortion is the most easily prevented cause of maternal death. Post-abortion care (PAC) is a strategy to address the problem of the outcomes of unsafe abortion.This research aims to establish how investment in safe abortion services impacts on the socio-economic conditions of women and their households, and the implications for policy-making and service provision in Zambia. The microeconomic impact of out-of-pocket health expenditure for  reproductive health and abortion care, have received little attention.The data available for sub-Saharan Africa are particularly scanty and poor quality. The approach is multi-disciplinary, with primary data collection of both qualitative and quantitative data, including a quantitative survey and in-depth qualitative interviews with women who have sought PAC, and policymaker interviews. Zambia's relatively liberal legal context, and the existence of PAC provision facilitates research on issues related to abortion which can have broader lessons for developments elsewhere in the region.The majority of women seeking abortion-related care in Zambia do so for PAC following an unsafe abortion, and have not accessed safe abortion services.This demands better understanding and analysis.

Data description (abstract)

Hospital-based recruitment of females seeking termination of pregnancy or post-abortion care at a Zambian government health facility. The research used an innovative mixed methods interview which combined quantitative and qualitative techniques in one interview. Each participant was interviewed by two research assistants (RAs). One RA led the interview, using a conventional interview schedule in the manner of a qualitative semi-structured interview, while the second RA listened and, where possible, completed the quantitative ‘data sheet’. When the first RA has completed the qualitative part of the interview, interviewer two took over and asked the participant any remaining questions not yet answered on the data sheet. This technique allowed us to capture both the individual fine-grained narratives, which are not easily captured in a questionnaire-type survey, especially on such a sensitive area, as well as survey data. Rather than conducting an in-depth qualitative interview and a survey, our method reduced the burden on the respondent, avoiding repetition of questions and reducing the time taken. The quantitative data was used to establish the distribution of out-of-pocket expenses, for women and their households, incurred using hospital-based safe abortion and PAC services. Qualitative data established the range of reasons why women sought abortion, and why they used or did not use safe abortion services, and explored the social costs and benefits of their trajectories, and the policy implications.

Data creators:

Creator Name	Affiliation	ORCID (as URL)
Coast Ernestina	LSE	http://orcid.org/0000-0002-8703-307X
Freeman Emily	LSE
Murray Susan	KCL
Leone Tiziana	LSE
Parmar Divya	LSE
Vwalika Bellington	UNZA
Sikateyo Bornwell	UNZA

Contributors:

Name	Affiliation	ORCID (as URL)
Mwense Taza	UNZA
Chifump Erica	UNZA
Mwanza Doreen	UNZA
Saina Victoria	UNZA

Sponsors:

Economic and Social Research Council

Grant reference:

RES-167-25-0626

Topic classification:

Health

Keywords:

zambia, abortion (induced), women, adolescents, health, contraception, contraceptives, costs

Project title:

Pregnancy termination trajectories in Zambia: The socio-economic costs

Grant holders:

Ernestina Coast, Bellington Vwalika, Susan F Murray, Tiziana Leone, Divya Parmar

Project dates:

From	To
1 December 2011	30 November 2014

Date published:

07 Feb 2018 10:21

Last modified:

07 Feb 2018 10:22

Coverage and Methodology

Collection period:

Date from:	Date to:
1 January 2013	31 December 2013

Geographical area:

Lusaka, Zambia

Country:

Zambia

Data collection method:

Over a 12 month period, all women identified as having undergone either a safe abortion or having received PAC following an attempted induced abortion at a Zambian government health facility were approached for inclusion in the study. We did not interview women identified as having received PAC following a spontaneous abortion. Undoubtedly, some women claiming to have had a spontaneous abortion had in fact attempted to induce an abortion, and at times medical evidence suggested so, however we could not interview them about the attempt as they were not willing to disclose any information on an attempted abortion. As part of the research team we employed two midwives working on the obstetrics and gynaecology ward to act as gatekeepers, identifying suitable women for recruitment and asking them to participate in the study. The research used an innovative mixed methods interview which combined quantitative and qualitative techniques in one interview. Each participant was interviewed by two research assistants (RAs). One RA led the interview, using a conventional interview schedule in the manner of a qualitative semi-structured interview, while the second RA listened and, where possible, completed the quantitative ‘data sheet’. When the first RA has completed the qualitative part of the interview, interviewer two took over and asked the participant any remaining questions not yet answered on the data sheet. This technique allowed us to capture both the individual fine-grained narratives, which are not easily captured in a questionnaire-type survey, especially on such a sensitive area, as well as survey data. Rather than conducting an in-depth qualitative interview and a survey, our method reduced the burden on the respondent, avoiding repetition of questions and reducing the time taken.

Observation unit:

Individual

Kind of data:

Text

Type of data:

Qualitative and mixed methods data

Resource language:

English

Access and Administration

Data sourcing, processing and preparation:

1 in 10 transcripts were quality checked and reviewed by the Zambian postdoctoral projector officer against the original audio recording of the interview. All transcripts have been anonymised using a standardised protocol to remove all direct and indirect identifiers. The Zambia-based research assistants removed all direct identifiers from the transcripts after full transcription. Subsequently, a second member of the UK-based team reviewed these transcripts and removed all indirect identifiers to create the final anonymised transcripts that have been deposited. To indicate when an identifier has been removed we use curly brackets { } and replace the identifier with something more general to show what was said without giving too much information. For example, deletion of a person’s name and replace it with {name}, or for a company name replace with {company name} or for place names eg: Sun Hotel to {hotel name}, and Garden Compound to {compound in Lusaka}. Text in square brackets [ ] is used to indicate the comments of the person transcribing, for example when there is laughter or crying or an interruption in the interview. Each participant gave written informed consent before being interviewed. This included permission for the interview to be audio-recorded. Where this was not given the second interviewer made handwritten verbatim notes during the interview. Interviewer one transcribed and simultaneously translated the audio-recording to English. Interviews were conducted in a private room within the hospital, in the language of the interviewee’s choice. We rented an office next to the ward and interviews were conducted either here or in the office of the sister-in-charge. Interviews were conducted privately with women prior to discharge and after any prescriptions etc. have been given. Over a 12 month period, all women identified as having undergone either a safe abortion or having received PAC following an attempted induced abortion at UTH were approached for inclusion in the study. We did not interview women identified as having received PAC following a spontaneous abortion. As part of the research team we employed two midwives working on the obstetrics and gynaecology ward to act as gatekeepers, identifying suitable women for recruitment and asking them to participate in the study.

Rights owners: