DOI: 10.3886/icpsr38812.v1
title: Tanzania Abortion Incidence Study, 2012-2014
title: Version 1

description: Unsafe abortions account for roughly 13 percent of maternal deaths worldwide. In addition, millions of women suffer nonfatal health consequences of unsafe abortion every year. Information on unsafe abortion can be instrumental in helping policy makers and program planners identify measures needed to improve maternal health. Insufficient information at the country level perpetuates the invisibility of the problem of unsafe abortion and results in governments giving it little priority in policy decisions, service delivery or program implementation. This project was the first-ever national study of the incidence of induced abortion and health consequences of unsafe abortion in Tanzania. The three-year project aimed to: Provide evidence on the incidence of induced abortion in Tanzania, at the national and regional levels and by women's place of residence and economic status Document the incidence of abortion complications Document the methods and providers used to perform abortions in Tanzania
description: To provide information to fill knowledge gaps and enable the Tanzanian government, international agencies, health professionals and nongovernmental organizations (NGOs) to deal more forthrightly with the abortion issue in order to reduce maternal morbidity and mortality.
description: <strong>Heath Facilities Survey</strong> A structured questionnaire was administered by an interviewer to the most qualified staff member or the person in charge of providing post-abortion care (PAC) in each facility, typically the chief of the Obstetrics and Gynecology department in larger facilities, and the facility head in health centers or dispensaries. Respondents were asked whether their facilities provide treatment for abortion complications (from both spontaneous and induced abortion), and if so, to estimate the number of PAC patients treated as outpatients and inpatients, in an average month and the past month. Specifying two time frames increases the likelihood of capturing variation from month to month. These two numbers were subsequently averaged and multiplied by 12 to produce an estimate for the 2013 calendar year. <strong>Health Professionals Survey</strong> The Health Professionals Survey interviewed a purposive sample of 202 experts knowledgeable about abortion provision in Tanzania. Forty-six percent were health professionals, including obstetricians/gynecologists, midwives and nurses from the public and private sector, as well as a sizeable proportion of non-formally trained health workers such as community health workers, traditional birth attendants and traditional healers (15 percent of total sample). The remaining 54 percent of the sample was composed of researchers, reproductive health advocates, non-governmental organization (NGO) and women's groups' representatives, lawyers, journalists working on reproductive health issues, program managers and policy makers, community leaders, and youth leaders. Respondents were distributed equally between the 8 zones. Questionnaires sought information on the proportion of women who experience a complication from an induced abortion, and the proportion likely to receive care in a facility should they experience a complication, separately for rural and urban, poor and non-poor women.
description: Variables in the data pertain to the services that health facilities and professionals provide in the context of abortion care. Demographic variables present in the data include gender and age.
description: Response Rates: For the Health Facilities Survey, the sampling frame was stratified by facility level within each zone, to ensure that the estimates of abortion incidence were representative at both the national and zonal levels. Within each zone, 100 percent of consultant and regional hospitals, 66 percent of non-regional hospitals, 45 percent of health centers, and 44 percent of dispensaries equipped to offer PAC were selected, resulting in a total of 487 health facilities in the initial sample. Of these, 481 agreed to participate in the survey. To minimize refusals, letters from the Ministry of Health introducing and authorizing the study were sent to all facilities in advance of the fieldwork, and facility in-charges were contacted to inform them about the upcoming survey. Of the facilities that responded, 448 (93 percent) actually provided PAC services. Most health facilities in Tanzania are government owned, and this is reflected in the sample: only 26 percent of all facilities (mostly hospitals) were private or faith-based. For the Health Professionals Survey, all 202 prospective respondents agreed to participate.
description: <strong>Heath Facilities Survey</strong> The sampling frame consisted of the Ministry of Health's most recent list of all health facilities (public and private) considered likely to provide post-abortion care (PAC). A separate list of all public and private facilities was obtained from the Zanzibar Ministry of Health. Facilities that did not provide primary care, that were specialized in non-reproductive services, or that otherwise lacked the capacity to provide PAC (as for some dispensaries), were excluded from the sampling frame. To ensure that the list was up to date, all district medical officers in the country were contacted to confirm that all health facilities in their district were included in the list, and to determine which facilities were equipped to provide PAC. The final sampling frame of facilities likely to provide PAC included 952 facilities, of which 5 (0.5 percent) were consultant hospitals, 20 (2.1 percent) regional hospitals, 224 (23.6 percent) sub-regional hospitals (district hospitals or other hospitals), 526 (55.2 percent) health centers and 177 (18.6 percent) dispensaries. Although there were thousands of dispensaries in Tanzania, only 177 provided or were expected to provide PAC at the time the study was conducted. The nomenclature for facilities in Zanzibar is slightly different, with Primary Health Care Centers (PHCCs) being the equivalent of health centers, and Primary Health Care Units (PHCUs) being the equivalent of dispensaries. Within PHCUs, some provide only basic primary care services (PHCU), while others are equipped to provide a wider range of services including PAC (PHCU+). PHCCs and PHCU+ were combined with health centers and dispensaries respectively in the national level analyses. <strong>Health Professionals Survey</strong> The Health Professionals Survey interviewed a purposive sample of 202 experts knowledgeable about abortion provision in Tanzania. The sample was created through consultation with a broad network of colleagues engaged in research, policy, community and regional-level public health programs, which aimed to identify the individuals most knowledgeable about the provision of abortion at the national level, as well as in each zone. The experts came from a wide range of professions. Forty-six percent were health professionals, including obstetricians/gynecologists, midwives and nurses from the public and private sector, as well as a sizeable proportion of non-formally trained health workers such as community health workers, traditional birth attendants and traditional healers (15 percent of total sample). The remaining 54 percent of the sample was composed of researchers, reproductive health advocates, non-governmental organization (NGO) and women's groups' representatives, lawyers, journalists working on reproductive health issues, program managers and policy makers, community leaders, and youth leaders. Respondents were distributed equally between the 8 zones. Particular effort was made to ensure that there was sufficient representation of experts with knowledge of rural areas. About 36 percent of respondents had worked at least 6 months in rural areas during the last 5 years.
description: Datasets: DS0: Study-Level Files DS1: Health Facilities Survey DS2: Health Professionals Survey
description: Health professionals and facilities that provide abortion and reproductive care in Tanzania. Smallest Geographic Unit: Region
description: on-site questionnaireFor additional information on this study, please visit the Guttmacher Institute website.