Background: Due to restrictive laws and limited service provision, globally the majority of induced abortions are unsafe and remain largely undocumented, despite their negative impact on women’s health. Objective: The purpose of this study is to test Respondent-Driven Sampling – used previously in HIV research – for abortion, and to measure abortion safety characteristics in the small town of Kaya and surrounding villages (Burkina Faso) and in the slums of Nairobi (Kenya). Methods: A preliminary qualitative study confirmed that women disclose to network members when seeking an abortion. Using RDS, we recruited 481 abortion-seekers from 12 seeds in Kaya (in max. 10 waves) and 551 abortion-seekers from 8 seeds in Nairobi (in max. 5 waves) in 2021. These respondents reported 487 (Kaya) and 595 (Nairobi) abortions in the previous 3 years. Results: Standard diagnostics showed that the safety characteristics of the abortions of the recruited women were independent of those of the seeds, but sample-wide convergence was reached at relatively high sample sizes (around 300 in Kaya and 400 in Nairobi). More advanced checks indicated convergence (or tendency towards convergence) across seeds, except for one indicator in one site. In Kaya, most women used plant-based methods (50%) and unidentified pills (Medical Abortion (MA) in appearance) (33%). In Nairobi, women used unidentified pills (likely MA) (38% of abortions), followed by plant-based (21%) and known harmful methods (19%); pharmacists were frequent providers (45%). In Kaya, abortions occurred in the first trimester (98%), but less so in Nairobi (70%). The level of reported likely infected complications was similar across sites (6.2% in Kaya versus 9.6% in Nairobi). Conclusions: While the RDS misses non-networked abortion-seekers (an arguably small share of abortion-seekers in the sites), the different available quality checks yielded positive signals as to the possibility of using RDS to obtain data representative of networked abortions. The data revealed contrasting safety characteristics and abortion-seeker profiles across sites. Contribution: RDS is cheap, yields large and diverse samples of abortion-seekers, and is equipped with built-in quality tests: it is a promising avenue for collecting data on abortions in restrictive settings where abortion-seekers are highly networked, although a number of limitations remain and further development is needed.

中文翻译：

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使用受访者驱动抽样来衡量限制性环境下的堕胎安全：卡亚（布基纳法索）和内罗毕（肯尼亚）的结果（作者：Lonkila Moussa Zan、Onikepe Owolabi、Adama Baguiya、Ramatou Ouedraogo、Martin Bangha、Caron Kim、Clémentine Rossier）


背景：由于限制性法律和有限的服务提供，全球范围内大多数人工流产都是不安全的，并且基本上没有记录，尽管它们对妇女的健康产生了负面影响。目的：本研究的目的是测试以前在艾滋病毒研究中使用的受访者驱动抽样法对堕胎的影响，并测量卡亚小镇和周边村庄（布基纳法索）以及内罗毕贫民窟的堕胎安全特征（肯尼亚）。方法：一项初步定性研究证实，女性在寻求堕胎时会向网络成员透露情况。使用 RDS，我们于 2021 年在卡亚的 12 个种子中招募了 481 名堕胎寻求者（最多 10 波），在内罗毕从 8 个种子中招募了 551 名堕胎寻求者（最多 5 波）。这些受访者报告了 487 名（卡亚）和 595 名寻求堕胎的人。 （内罗毕）过去 3 年堕胎。结果：标准诊断显示，招募的妇女堕胎的安全特征与种子的安全特征无关，但在相对较高的样本量（卡亚大约 300 个，内罗毕大约 400 个）下达到了样本范围的收敛。更高级的检查表明，除一个地点的一项指标外，种子之间的收敛（或趋于收敛的趋势）。在卡亚，大多数女性使用植物性方法（50%）和不明药物（外观为药物流产（MA））（33%）。在内罗毕，妇女使用不明药物（可能是 MA）（占堕胎的 38%），其次是植物性药物（21%）和已知有害方法（19%）；药剂师是频繁的提供者（45%）。在卡亚，堕胎发生在妊娠早期（98%），但在内罗毕则较少（70%）。各地点报告的可能感染并发症的水平相似（卡亚为 6.2%，内罗毕为 9.6%）。 结论：虽然 RDS 漏掉了非网络堕胎寻求者（可以说是站点中寻求堕胎者的一小部分），但不同的可用质量检查产生了关于使用 RDS 获取代表网络堕胎数据的可能性的积极信号。这些数据揭示了不同地点的安全特征和堕胎寻求者概况的对比。贡献：RDS 价格低廉，可产生大量且多样化的寻求堕胎者样本，并配备内置质量测试：它是在寻求堕胎者高度网络化的限制性环境中收集堕胎数据的一个有前景的途径，尽管有一些堕胎寻求者高度网络化。仍然存在局限性，需要进一步发展。