Estimating unintended pregnancy and induced abortion in Liberia: A nationally representative cross-sectional survey

Abstract Background: More than 60% of unintended pregnancies end in induced abortions globally. In Liberia, limited access to contraceptives caused by health system challenges and sociocultural barriers leads to many unintended pregnancies. Nevertheless, very little is known about the incidence of induced abortion and unintended pregnancy in the country. This study aimed to estimate the incidence of induced abortion and unintended pregnancy in Liberia in 2021. Methods: The study utilized the Abortion Incidence Complications Method. First, we estimated the total number of induced abortions that resulted in women seeking facility-based post-abortion care in 2021 using data from a nationally representative sample of health facilities (n=128). Next, we used data from a survey of experts on abortion in Liberia (n=89) to estimate the proportion of induced abortions that resulted in complications treated in health facilities in 2021. The inverse of this proportion is a multiplier, which was applied to the estimate of the total number of induced abortion-related complications treated in health facilities to obtain the total number of induced abortions in 2021. We complemented this estimate of induced abortion with the Demographic Health Survey data to estimate the incidence of unintended pregnancies in Liberia in 2021. Results: We estimated that 14,555 patients received post-abortion (PAC) treatment in Liberia in 2021. Approximately 58% of these post-abortion care cases (n=8,461) were due to induced abortions. Accounting for induced abortions that had complications that did not require facility-based treatment and those without complications, we estimated that 38,779 induced abortions occurred in Liberia in 2021, corresponding to a national induced abortion incidence rate of 30.7 per 1,000 women of reproductive age (15–49). The unintended pregnancy rate among women of reproductive age was 86.54 per 1,000, and approximately 35% of all pregnancies ended in an abortion. Conclusions: Despite the legal restrictions on abortions, study findings show that unintended pregnancy and induced abortion are common in Liberia. There is a need for strengthened efforts to increase access to contraceptives, safe abortion care under legal indications, and quality PAC to improve socioeconomic and health outcomes for women and girls in Liberia.