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. 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.
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.
