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Terms of Reference (TOR) for Baseline survey on unsafe Abortion in Ethiopia

Introduction

Unsafe abortions are of major public health significance. Half of abortions globally are unsafe or estimated to be between 21 -22 million globally. Therefore around one in ten pregnancies ends in an unsafe abortion. Almost all of them occur in developing countries, with the higher number of deaths concentrated in Africa, especially Sub-Saharan Africa, and South Asia. At the same time, there is a global shortage of health care providers with many countries prioritizing scarce human resources for a variety of pressing health problems.

Unsafe abortion is still common and demands a heavy toll on women in Ethiopia. According to a study conducted in 2014, an estimated 620, 000 women underwent an abortion in Ethiopia. The abortion rate is highest (92 per 1,000) in Addis Ababa, where demand for family planning is high. The densely populated urban regions of DireDawa and Harari also had a high abortion rate relative to other regions (78 per 1,000). Only 53% of these abortions were safe and took place in health facilities; the balance, some 290,000 women, underwent an unsafe abortion. Since 2006, Ethiopia has had a relatively liberal abortion legislation. The revised law, enacted by Ethiopia’s parliament in 2005, allows a woman to obtain a safe, legal abortion if she became pregnant through rape or incest, has physical or mental disabilities, would be putting her life or physical health at risk if she continues her pregnancy, or is younger than 18 and physically or mentally unprepared for childbirth. Where legally permitted, safe abortion technologies are available and accessible and consequently the (still high) unsafe abortion rate is declining.

Still, there is a high unmet need (22%) for contraceptives in Ethiopia, an estimated 38% of all pregnancies are unwanted. This resulted the prevalence of high rate abortion. As the contraceptive prevalence rate is still low, the uptake of modern contraceptives will avert unintended pregnancies and therefore reduce the number of abortions (and unsafe abortions). Despite government efforts, some women don’t know that safe abortion services are available or may fear the stigma associated with abortion. This reality must be addressed by educating women about the legal status of abortion and combatting stigma associated with abortion and by expanding family planning services to reduce unintended pregnancy rates. As such, Ethiopia is exemplary for other countries.

Therefore, this study is designed to assess perception of women and health care providers towards safe abortion service and associated factors.

Purpose and Objectives of the Survey

A major barrier in preventing unsafe abortions is a lack of knowledge and awareness among (young) women about reproduction, pregnancy and (modern) contraception, often leading to unintended pregnancies. (Young) women also lack awareness, knowledge and skills on when, where and how to access the health-services which can help to prevent unsafe abortion – and they also do not know how to access the safe post-abortion care to help them with the complications of unsafe abortion. A situation which is further aggravated by prevailing, myths and misconceptions about abortion in society. All leading to women not receiving the care they need. 

Therefore, the overall purpose of this study is to conduct a baseline survey to collect information that help for the designing and implementing strategies aimed at preventing unsafe abortion and providing quality abortion services – where the law permits it – and post-abortion care in Ethiopia.

The specific objectives are:

  • Understanding the root causes of abortion stigma (unpacking stigma) and the social and economic barriers women face in accessing abortion.
  • What women understand about medical abortion, myths and misconceptions, and what more they require in terms of knowledge.
  • Understanding why some young women (positive deviants) decide to have a safe abortion, while other in similar socio-economic circumstances undergo an unsafe abortion. What are the barriers and, more interesting, what are the enablers.
  • Bolstering the evidence around provision of abortion by diverse providers, such as midwives and community health workers.
  • What is the role of backstreet doctors/quacks/traditional healers in accessing unsafe abortion and contraceptive use and can they play a role in averting unsafe abortion and unintended pregnancies.
  • Evaluating community-based interventions to enhance women’s ability to access safe, high-quality abortion care, including for survivors of sexual violence.

Currently DKT/E would like to hire consulting firm to carry out the baseline survey on unsafe abortion in Ethiopia. The findings of this study will be used to define our information and education messages and advocacy actions aimed at changing prevailing negative norms, values and perceptions on abortion as well as to know the training need of service providers on abortion care services and products.

Methodology

Study Area

The baseline survey willbe conducted in 10 towns of Ethiopia where abortion rate is higher and have large volume of Abortion products distributed by DKT/E:  Addis Ababa, Dire Dawa, Harar,Adama, Hawassa, Nekemte, Bale Robe, Jimma, Dessie and Mekelle.  Dire Dawa and Harar are selected based on their highest abortion rates. While Addis Ababa selected in its highest abortion rate as well as large volume of Abortion products distributed in the city.  while other Towns selectedbased on large volume of Abortion productswere distributed by DKT/E to the Towns in the last three years.

Study Design and Methods

A Facility based cross-sectional study design will be used.The study will involve both private and public health institutions in the selected 10 Towns which are providing safe abortion and post abortion services.

Both quantitative and qualitative data collection approaches will be used. The quantitative approach will usea facility -based study designtargeting both public and private health facilities (hospitals, clinics, health centers) found in the selected town.  In quantitative survey women (15-49 years)who are available during data collection time in selected health facilities to obtain family planning, safe abortion or post abortion services will be the target group.

while the qualitative approach will use key informant interview. Key informant interview will be conducted with health providers in each selected health facility. Detail methodological approaches should be clearly stated in the technical proposal.

Scope of work

  • This study is expected to encompass 10 Towns of Ethiopia. The consultant should determine the total sample size of the survey (Both for quantitative and qualitative).
  • The consultant should provide detail  research design and methodology
  • The consultant will develop data collection tools (Both quantitative and qualitative) and provide for comments for DKT/E team and finalized based on the feedback given from DKT/ E.
  • Hire enough number of interviewers and supervisors who have participated in large-scale socio-demographic/ household and facility based surveys and can speak the local languages.
  • Provide intensive training that includes both theoretical and field (practical) training.
  • Pilot testing – in areas which are not selected for the actual study
  • In order to guide the process, the consultant will submit the pilot data set for analysis and inception report which include interpretation and understanding of the deliverables, time frame of the task, tools to be used for collecting data (after pretesting of tools) and a summary describing the whole process and how to go about the next steps before proceeding to the actual data collection.

Key Activities and Responsibilities

  • All interested firms are expected to develop technical proposal that clearly defines the time line and methodological approach for data collection, data quality assurance technique, data entry and analysis and report writing. Include their comment and suggestion on terms of reference (TOR) (indicate your understanding and feedback on the TOR)
  • Prepare a detailed financial proposal

Specific activities after agreement

a)    Preparation Phase:

  • Provide study proposal including specific objectives, methodology, sampling procedures, timeline, data collection, field supervision, quality control, data entry, data analysis and reporting.
  • Prepare and finalize data collection tools and translate to local language/s
  • Submit the final technical approaches and tools to DKT team for approval
  • Submit operation plan/inception report

b)    Training and Pre-testing Phase

  • Conduct pre-testing of survey tools and present the findings to DKT team and get approval for the actual data collection
  • Train the data collection team in collaboration with DKT team

c)    Data collection

  • Conduct field supervision and monitoring during the data collection
  • Provide technical assistance during the data collection period

d)    Data processing and reporting

  • Submit data entry template for the study to DKT team before starting data entry (using CSPro) for approval
  • Perform the data entry  
  • Conduct data cleaning
  • Conduct data analysis
  • Develop draft reports and submit to DKT Ethiopia for feedback
  • Debriefing at DKT Ethiopia office.
  • A final report will be produced at the end of the agreement period, eight weeks,

Deliverables: DKT Research team will oversee the process and be responsible for accountability and guidance throughout all phases of execution, and approval of all deliverables

  • Data collection tools,
  • Work plan and proposed outline of the pilot test report will be submitted within one week after signing the agreement
  • Raw data sets in SPSS version and CSPro
  • Syntax used for analysis
  • Draft survey report for review
  • The Final report (both in hard and soft copies) will be submitted to DKT Ethiopia incorporating all comments and feedback. All reports should have standard report writing sections with all required annexes included. All data collection tools used (both in English and Amharic) and the datasets should also be delivered to DKT Ethiopia.

Criteria for Selecting Consultant

Qualifications and Experience

  • The consultant team shall consist of professionals and should possess a minimum of postgraduate degree in the field of Demography/Population Studies, Public Health, Health,Statistics, Development Studies or related fields and should have at least 5 years of proven experience in undertaking projects of similar scope. Applicants should also have excellent analytical and report writing skill.

Timing and Reporting

  • The data collection and production of final report is to be completed within eight weeks period. The contract is for a fixed period of eight weeks and is not subject to renewal.

Payment:  40 % upon signing of contract, 30% after submitting first draft report and the rest 30% upon completion of final report

Submission of Proposal:Interested consultants are expected to collect the TOR prepared by DKT team free of charge and submit proposals within 10 days after the date of advertisement. Technical and Financial proposal including, timelines and budget estimates, should be submitted in separate envelopes and should be submitted to DKT Ethiopia office in person.

Note: Documents such as personal profiles and other credentials with a covering letter should be included to the Technical proposal.

Technical and financial proposals should be submitted to DKT Ethiopia to the address given below before or on October 13, 2018  (in person)

DKT Ethiopia

In front of Bole Bridge Near to Brass Hospital

WOMSADCO Building, 3rd floor

Tel No: +251-11-6632222