Study title

Evidence – qualitative and quantitative – was generated from interviews with adolescents aged 10-19 years in Ethiopia, Malawi, and Zambia to understand how adolescent abortion-related care-seeking differs across a range of socio-legal national contexts. Our comparative study design includes countries with varying levels of restriction on access to abortion: Ethiopia (abortion is legal and services implemented); Zambia (legal, complex services with numerous barriers to implementations and provision of information); and Malawi (legally highly restricted). Most adolescents (98%) in Ethiopia obtained a medically safe abortion, with most adolescents (64%) in Zambia and almost all adolescents (94%) in Malawi obtaining a less medically safe abortion. A total of 313 facility-based interviews were carried out with adolescents aged 10-19 in 2018/19 in Ethiopia (n=99), Malawi (n=104), and Zambia (n=110). Adolescents were seeking public sector care for either safe abortion or post-abortion care for complications from an abortion initiated elsewhere. Adolescent recruitment was initiated by a study-trained senior nurse, who identified and invited eligible participants to participate in the study upon their readiness for discharge. Our research assistants (RAs) were all females in their twenties or early thirties and were recruited after the completion of intensive (two weeks) training from the project team that included role-playing and pilot interviews. We completed paid training for more RAs than the project required; performance during training and piloting were explicitly part of our RA recruitment process. Interviews with adolescents were conducted in a private setting in each facility by RAs fluent in all major local languages. Informed consent was obtained from adolescents aged 18 and above, while for those under 18, consent was sought from an accompanying parent or guardian with the respondent's assent. Unaccompanied respondents under 18 were considered emancipated...