Determinants of first and second trimester induced abortion - results from a cross-sectional study taken place 7 years after abortion law revisions in Ethiopia

Magnitude of second-trimester-induced abortion and associated factors among women who received abortion service at public hospitals of Arba Minch and Wolayita Sodo towns, southern Ethiopia: A cross-sectional study

Introduction

Second-trimester abortion accounts for 10-15% of all induced abortions, with varying rates across countries, and is responsible for two-thirds of major abortion complications. It is also associated with higher medical costs, morbidity, and mortality rates than first-trimester abortion. Even though it is a significant burden, there is a lack of adequate information about second-trimester-induced abortion, especially in the study area. As a result, the primary purpose of this study is to fill this research gap and assess the magnitude and associated factors of second-trimester-induced abortion in the public hospitals of Arba Minch and Wolayita Sodo towns, southern Ethiopia.

Methods

A facility-based cross-sectional study was conducted. Systematic sampling was used to select 353 study participants. Data were collected through face-to-face interviews using a structured questionnaire and record review by using Kobo collect version 3.1. Analysis was done by STATA 14. Logistic regression was used to identify associated factors of the second-trimester-induced abortion.

Results

The magnitude of second-trimester-induced abortion in the study setting was 23% (95%CI: 18.5%, 27.4%). The factors associated with second-trimester-induced abortion among women received abortion care services were respondent's age 25-29 and 30-34 years old (AOR = 0.38, 95%CI:0.15, 0.96 and (AOR = 0.31, 95%CI:0.10, 0.97, respectively), planned pregnancy (AOR = 0.22, 95%CI:0.11, 0.44), and delay confirming pregnancy (AOR = 2.21, 95%CI:1.15, 4.23).

Conclusion

This study showed that more than one-fifth of women who presented for abortion care services had second-trimester-induced abortions. Health institution organizations working on maternal health at various levels should provide counseling to women to help them early confirm their pregnancy and make decisions about whether or not to continue it as early as possible.

Intentional abortion and its associated factors among female sex workers in Iran: Results from national bio-behavioral surveillance-2020

Purpose

In addition to estimating the prevalence of intentional abortion in Iranian female sex workers (FSWs), this study identified related factors using the data of a national study.

Methods

This cross-sectional study utilizes the third round of integrated bio-behavioral surveillance-III data in Iranian FSWs in December 2019 and August 2020, and 1515 Participants were selected in 8 geographically diverse cities in Iran. Logistic regression was performed using unweighted analysis to identify factors associated with intentional abortion. Stata software (version 14), respondent-driven sampling analyses, and R (version 4.1.2) was used for data analysis.

Results

From 1390 participants with valid responses to the abortion question, 598 (37.3%; 95% CI: 32.43, 42.11%) reported intentional abortion during their life. According to the age groups, the highest prevalence of abortion was in the age group of 31 to 40 years (42.60%). In the multivariate logistic regression model, the marital status (divorced women (AOR = 2.05, 95% CI: 1.29, 3.27), concubines (AOR = 1.78, 95% CI: 1.02, 3.11)), work experience in brothels (AOR = 1.39, 95% CI: 1.04, 1.84), the type of sex (AOR = 2.75, 95% CI: 1.35, 5.58), the history of sexual violence (AOR = 1.54, 95% CI: 1.19, 2.01), and alcohol consumption (AOR = 1.53, 95% CI: 1.18, 2.01) were significantly associated with a history of intentional abortion.

Conclusion

Intentional abortion’s prevalence among Iranian FSWs has been much higher than that of the general female population in Iran, which is an alarming issue in the public health of this group and needs more effective interventions. In addition, alcohol consumption, working in a brothel, and being divorced are essential factors in increasing abortions among sex workers.

ASRHR in Ethiopia: reviewing progress over the last 20 years and looking ahead to the next 10 years

Over the last two decades, improvements in Ethiopia’s socio-economic context, the prioritization of health and development in the national agenda, and ambitious national health and development policies and programmes have contributed to improvements in the living standards and well-being of the population as a whole including adolescents. Improvements have occurred in a number of health outcomes, for example reduction in levels of harmful practices i.e., in child marriage and female genital mutilation/cutting (FGM/C), reduction in adolescent childbearing, increase in positive health behaviours, for example adolescent contraceptive use, and maternal health care service use. However, this progress has been uneven. As we look to the next 10 years, Ethiopia must build on the progress made, and move ahead understanding and overcoming challenges and making full use of opportunities by (i) recommitting to strong political support for ASRHR policies and programmes and to sustaining this support in the next stage of policy and strategy development (ii) strengthening investment in and financing of interventions to meet the SRH needs of adolescents (iii) ensuring laws and policies are appropriately communicated, applied and monitored (iv) ensuring strategies are evidence-based and extend the availability of age-disaggregated data on SRHR, and that implementation of these strategies is managed well (v) enabling meaningful youth engagement by institutionalizing adolescent participation as an essential element of all programmes intended to benefit adolescents, and (vi) consolidating gains in the area of SRH while strategically broadening other areas without diluting the ASRHR focus.

Mind the Gap: Understanding Differences Between Sexual and Reproductive Health-Related Legal Frameworks on Paper and in Practice

Introduction

UNFPA recently developed a composite indicator to assess sexual and reproductive health (SRH)-related laws as part of the Sustainable Development Goals monitoring framework (Indicator 5.6.2). However, there is still little understanding of how best to ensure a supportive SRH-related legal framework can improve SRH outcomes. This research draws on country case studies (Colombia, Malawi, Uruguay, Zambia) to provide more generalizable lessons on the processes by which these laws are translated into practice and their impact on lived realities.

Methods

Peer-reviewed and gray literature on laws and policies related to maternity care, contraception, sexuality education, HIV and HPV was reviewed. Key informant interviews were carried out with 8–16 people in each country, including representatives of government, civil society and academia to understand factors affecting implementation of relevant laws and policies. Findings were thematically analyzed by country and contextualized within each country's score on Indicator 5.6.2 and relevant SRH outcome data.

Findings

Across these countries, some common organizational steps help move from laws on paper to impacting people's lives including budget allocation, development of technical guidance, health worker training, population awareness creation and demand generation. It is also important to address sociocultural challenges such as entrenched inequalities, conservative cultural and religious beliefs and the potential existence of customary law. Challenges can be encountered across all these steps and can vary based on the area of SRH: implementation of laws to reduce maternal mortality is generally less controversial than laws around abortion, often making the latter harder to implement. Local specificities in structures, systems and cultures bring opportunities and challenges, highlighting the need for tailored actions.

Discussion

A legal framework supportive to SRH is critical, particularly in the face of backlash against sexual and reproductive rights, but alone it is insufficient. Understanding that a generic pathway exists for moving laws into practice is a critical starting point for exploring the specificities of each national context as a way of identifying entry points for action. These findings can be used to inform advocacy and monitoring to help ensure that the potential benefits of supportive SRH-related laws can be realized in these four countries and around the world.

Determinants of induced abortion among women received maternal health care services in public hospitals of Arba Minch and Wolayita Sodo town, southern Ethiopia: unmatched case-control study

Background

About 210 million women become pregnant per year, with one out of every ten pregnancies terminating unsafely worldwide. In developing countries, unsafe induced abortion is a leading cause of maternal mortality and morbidity. In addition, the burden of public health is also greatest in developing regions. In Ethiopia, abortion was responsible for 8.6% of maternal deaths. Despite the problem's significance, little is known about the factors that lead to women terminating their pregnancies. Therefore, this study aims to identify the factors associated with having induced abortion in public hospitals of Arba Minch and Wolayita Sodo town, Southern Ethiopia.

Methods

An institutional-based unmatched case–control study was conducted among 413 women from 15th April to 15th June 2021 in selected public hospitals of Arba Minch and Wolayita Sodo town, Southern Ethiopia. Cases were women who received induced abortion care services or who received post-abortion care services after being presented to the selected public hospital with an attempt of induced abortion whereas controls were women who came for maternal health care (antenatal or postnatal care) services in selected public hospitals and never had history of induced abortion. The data were collected by pretested and structured questionnaires with face-to-face interviews via Kobo Collect v3.1 mobile tools and analyzed by STATA version14. Logistic regression model was used to identify factors associated with induced abortion. In this study P-value less than 0.05 with 95% CI was declared a result as statistically significant.

Results

In this study, 103 cases and 309 controls were participated. Urban residence (AOR = 2.33, 95%CI:1.26, 4.32), encountered first sex at age of 20–24 years (AOR = 0.51, 95%CI:0.27,0.97), multiple sexual partner (AOR = 5.47, 95%CI: 2.98,10.03), women who had one child (AOR = 0.32, 95%CI: 0.10, 0.99), and good knowledge of contraceptives (AOR = 0.12, 95%CI: 0.03, 0.46) were identified as determinants of induced abortion.

Conclusions

Interventions focusing on those identified factors could probably reduce the burden and consequences of induced abortion. Sexual and reproductive health education and family planning programs would target urban dwellers, women who start sexual intercourse between the ages of 15 and 19, women with more than one sexual partner, women with a desire to limit childbearing, and women with poor contraceptive knowledge in order to reduce induced abortion.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01695-0.

Abortion Care Beyond 13 Weeks' Gestation: A Global Perspective

The majority of abortions are performed early in pregnancy, but later abortion accounts for a large proportion of abortion-related morbidity and mortality. People who need this care are often the most vulnerable-the poor, the young, those who experience violence, and those with significant health issues. In settings with access to safe care, studies demonstrate significant declines in abortion-related morbidity and mortality. This review focuses on evidence-based practices for induced abortion beyond 13 weeks' gestation and post-abortion care in both high- and low-resource settings. We also highlight key programmatic issues to consider when expanding the gestational age for abortion services.

Medical abortion at 13 or more weeks gestation provided through telemedicine: A retrospective review of services

Objectives

To evaluate medical abortion effectiveness and safety in women at 13 or more weeks gestation provided care through Women on Web's telemedicine service.

Study Design

We conducted a retrospective case study of abortions at 13 or more weeks gestation provided by Women on Web between 2016 and 2019. Women received mifepristone and misoprostol or misoprostol alone for abortion. We extracted demographic characteristics and outcome data for cases with pregnancy continuation outcomes.

Results

We identified 144 women who used medical abortion at 13 or more weeks; 131 (91%) provided abortion outcome data. Almost all, 118 (90%) received mifepristone and misoprostol. The population had an average age of 26 ± 5.8 years, 102 (78%) reported a gestational age of 13 to 15 weeks, 114 (87%) had experienced prior pregnancy, and represented all world regions. Overall, 13 (10%) women reported a continuing pregnancy, with 5 (5%) among women 13 to 15 weeks and 8 (28%) among those ≥16 weeks (p = 0.001); 38 (29%) reported adverse events (heavy bleeding, fever), 53 (43%) sought additional care from a health provider, and 18% of all cases received treatment with D&C/aspiration.

Conclusions

Efficacy of self-administered medical abortion decreases as gestational age increases, risking continuation of pregnancy. Provision through telemedicine at 13 to 15 weeks appears safe and effective.

Implications

Limited data suggest that medical abortion through telemedicine services may be a safe option through 15 weeks gestation in settings where there is ready access to the formal health system. More research with adequate sample sizes and high rates of follow-up is needed to inform on the safety of telemedicine for pregnancies 13 weeks and greater.

Determinants of Second-Trimester Safe Termination of Pregnancy in Public Health Facilities of Amhara Region, Northwest Ethiopia: An Unmatched Case-Control Study

Background. Second-trimester medical abortion is the termination of pregnancy between 13 and 28 weeks of gestational age. Although the majority of abortions are performed in the first trimester, 10–15% of terminations of pregnancies have taken place in the second trimester globally. Objective. To identify the determinant factors of second-trimester safe termination of pregnancy in public health facilities of the Amhara region, northwest Ethiopia. Methods. An institution-based unmatched retrospective case-control study conducted from 01/10/2019–30/02/2020. A systematic random sampling technique was used to select 119 cases and 238 controls. An interviewer-administered questionnaire was used to collect the data. A binary logistic regression model was fitted to identify determinant factors. The odds ratio with 95% CI was computed to assess the strength and significance of the association between dependent and independent variables. Result. Rural resident (adjusted odds ratio (AOR) = 1.9; 95% CI 1.07–3.25), irregular menses (AOR = 1.8; 1.06–3.13), had no known symptoms of pregnancy (AOR = 1.9; (95% CI 1.06–3.46)), not knowing the abortion law (AOR = 3.0; (95% CI 1.63–5.60)), low level of education (1st–8th grade) (AOR = 2.7; (95% CI 1.06–6.60), opposition against abortion care (AOR = 2.6; (1.22–5.42)), delayed referral (AOR = 10.1 (95% CI 4.02–29.18)), and not undertaking pregnancy test (AOR = 2.2; (95% CI (1.21–4.04)) were determinants of second-trimester safe termination of pregnancy. Conclusion. Women being rural residents, irregular menses, not undertaking pregnancy test, not knowing the abortion law, low-level educational status, delayed referral, no knowledge about signs and symptoms of pregnancy, and opposition of safe abortion were determinants of second-trimester safe termination. The Regional Health Bureau and Health Facilities should give emphasis to women living in rural areas, and they should increase awareness towards abortion law and sign and symptoms of pregnancy and encourage female education.

Magnitude and Determinants of the Late Request for Safe Abortion Care Among Women Seeking Abortion Care at a Tertiary Referral Hospital in Ethiopia: A Cross-Sectional Study

Background

Second-trimester abortions disproportionately contribute to the increased medical cost, maternal morbidity, and mortality compared to the first trimester. Therefore, the aim of the current study was to determine the magnitude and determinants of late presentation for safe abortion care at a tertiary hospital in Ethiopia.

Methods

We conducted a cross-sectional study among pregnant women who requested safe abortion care from January 2019 to April 2020. Participants were selected using systematic sampling and data were collected using the interviewer-administered questionnaire. P-value adjusted odds ratios (AOR) with their 95% confidence interval (CI) were used to determine the association between variables.

Results

The prevalence of second-trimester abortion was 53.4%. Young age, ≤ 19 years (AOR= 6.37, 95% CI=1.84–22.06), decision ambivalence (AOR=5.64, 95% CI=1.71–18.61), delay to suspect pregnancy (AOR= 8.56, 95% CI=2.11–34.57), delay to diagnose pregnancy (AOR=3.83, 95% CI=1.51–9.75), lack of awareness on pregnancy signs and symptoms (AOR=4.22, 95% CI=1.59–11.23), delay to get the service (AOR =4.43, 95% CI=1.43–13.67), and lack of information where to get the abortion service (AOR=3.90, 95% CI=1.53–9.96) were significantly associated with presentation in second trimester.

Conclusion

More than half of women who request safe abortion at Saint Paul’s Hospital Millennium Medical College do so in the second trimester. Young age, delay in diagnosis of pregnancy, delayed decision, and lack of information where to get service were contributing factors. Therefore, comprehensive adolescent sexuality education, increasing access to contraception, and safe abortion service including self-care interventions are very imperative to avert late gestation abortion and its consequences.

Abortion knowledge, attitudes and experiences among adolescent girls: a review of the literature

Adolescent girls comprise a considerable proportion of annual abortion deaths, worldwide, with 15% of all unsafe abortions taking place among girls under 20 years of age. Despite recent global attention to the health and welfare of adolescent girls, little is known about their abortion experience, particularly of those under the age of 15 years. This review examines existing peer-reviewed and grey literature on abortion-related experiences of adolescent girls, paying particular attention to girls ages 10-14. In December 2019, the authors conducted a comprehensive search of five major online resource databases, using a two-part keyword search strategy for articles from 2003 to 2019. Of the original 3,100+ articles, 1,228 were individually screened and 35 retained for inclusion in the analysis. Findings show that while adolescent girls may have knowledge of abortion in general, they lack specific knowledge of sources of care and delay care-seeking due to the fear of stigma, lack of resources and provider bias. Adolescent girls do not experience higher rates of physical complications compared to older cohorts, but they are at risk of psychosocial harm. For girls ages 10-14, abortion experience may be compounded by pregnancy due to sexual abuse or transactional sex, and they face even more barriers to care than older adolescents in terms of provider bias and lack of agency. Adolescents have unique needs and experiences around abortion, which should be accounted for in programming and advocacy. Adolescent girls need information about safe abortion at an early age and a responsive and stigma-free health system.

Adolescent sexual and reproductive health and universal health coverage: a comparative policy and legal analysis of Ethiopia, Malawi and Zambia

Universal Health Coverage (UHC) forces governments to consider not only how services will be provided – but which services – and to whom, when, where, how and at what cost. This paper considers the implications for achieving UHC through the lens of abortion-related care for adolescents. Our comparative study design includes three countries purposively selected to represent 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); Malawi (legally highly restricted). Our policy and legal analyses are supplemented by comparative vignettes based on interviews (n = 330) in 2018/2019 with adolescents aged 10–19 who have sought abortion-related care in each country. We focus on an under-considered but critical legal framing for adolescents – the age of consent. We compare legal and political commitments to advancing adolescent sexual and reproductive health and rights, including abortion-related care. Ethiopia appears to approach UHC for safe abortion care, and the legal provision for under 18-year-olds appears to be critical. In Malawi, the most restrictive legal environment for abortion, little progress appears to have been made towards UHC for adolescents. In Zambia, despite longstanding legal provision for safe abortion on a wide range of grounds, the limited services combined with low levels of knowledge of the law mean that the combined rights and technical agendas of UHC have not yet been realised. Our comparative analyses showing how policies and laws are framed have critical implications for equity and justice.

Factors associated with induced abortion among women of reproductive age attending selected health facilities in Addis Ababa, Ethiopia: a case control study

Background

There has been a significant reduction of abortion rates in high-income countries, while the rates remain unchanged in low- and middle-income countries. In Ethiopia, for example, the number of women of reproductive age seeking an induced abortion is increasing. However, there is limited information concerning the reasons why the occurrence of this procedure is increasing. Thus, this study aimed to identify factors associated with having induced abortion in Addis Ababa, Ethiopia.

Methods

An unmatched case-control study was conducted using a semi-structured, interviewer-administered questionnaire from October to December 2017. The cases were 147 women of reproductive age who underwent abortion in a health facility or presented with complications due to induced abortion conducted outside the health facility. The controls were 295 women who came for antenatal care and who reported never having had an induced abortion. The cases were selected by consecutive sampling from nine health facilities, whereas the controls were selected by systematic sampling from the same health facilities. Bivariate and multivariate logistic regression models were employed using STATA version 14 to identify factors associated with induced abortion.

Results

The mean age of cases was 26.5 ± 5.7 years, while for the controls it was 28.1 ± 4.8 years. Being unmarried (AOR = 9.6; 95% CI: 1.5–61.7), having primary (AOR = 5.3; 95% CI: 1.5–18.3) and tertiary (AOR = 5.7; 95% CI: 1.6–21.1) education, earning monthly income 100–300 USD (AOR = 0.2; 95% CI: 0.1–0.4) and >  300 USD (AOR = 0.1; 95% CI: 0.0–0.2), initiating first intercourse between ages of 15 and 19 (AOR = 4.7; 95% CI: 1.4–15.6), marrying before the age of 18 (AOR = 2.9; 95% CI: 1.3–6.7), and having two children (AOR = 4.7; 95% CI: 1.8–12.7) were independent predictors of induced abortion.

Conclusion

Family planning programs hoping to reduce the occurrence of induced abortion should specifically target unmarried women, low income, and those who have two children. The government should also work on preventing early marriage and providing sexual and reproductive health education to help adolescents delay age at first sexual experience.

Delay in decision and determinants for safe abortion among women at health facilities in south West Ethiopia: facility based cross sectional study

BACKGROUND

Delayed safe abortion is the most common cause of gynecologic admission in developing countries. The study, therefore, assessed the delay decision for safe abortion and determinant factors among women at health facilities in South West Ethiopia.

METHODS

Facility-based cross-sectional study was conducted among 384 women who were selected from health facilities by using simple random sampling. A pre-tested structured questionnaire was used for data collection. Data were entered into Epidata and exported to SPSS for analysis. Binary Logistic regression was used and Variables with P-value < 0.25 during bivariate analysis were included in the multivariable logistic regression model. Finally, variables with p-value ≤0.05 were judged as a statistically significant association.

RESULTS

The magnitude of delay decision for safe abortion services was 70.8% (0.66, 075). Place of residence [AOR 2.44 (95% C.I: (1.39, 4.30)], lack of formal education [AOR: 2.41 (95% C.I:(1.08, 3.59)], level of education [AOR: 2.22 (95% C.I: (1.19, 4.11)], history of previous abortion [AOR: 3.47 (95% C.I: (1.74, 8.6.91)] and late confirmation of pregnancy [AOR: 1.64 (95% C.I: (1.01-2.65)] were the determinant factors for delay in decision for safe abortion.

CONCLUSION

This study revealed that the majority of women were delayed for the decision of safe abortion services. Place of residence of the women, lack of formal education, history of previous abortion and late confirmation of pregnancy were the determinant factors for women's decision for safe abortion. Therefore, it is better to work on awareness creation the timing of safe abortion and complication of delay abortion especially for the women from rural area.

Induced Second Trimester Abortion and Associated Factors at Debre Markos Referral Hospital: Cross-Sectional Study

BACKGROUND

Although most induced abortions in Ethiopia are performed in the first trimester, many women will still require second trimester abortions. While access to abortion in Ethiopia is limited, few data are being available concerning the demand for and associated outcomes of second trimester abortions. This knowledge is important for planning the health service response to abortion.

OBJECTIVE

The main objective of this study was to determine the proportion and associated factors of second trimester abortion among women presenting for abortion care services at Debre Markos Referral Hospital, Debre Markos, Northwest Ethiopia.

METHODS

An institution-based cross-sectional study was conducted at Debre Markos Referral Hospital on a sample of 262 calculated using the single population proportion formula. Women who sought abortion services were interviewed consecutively from 12 February 2017 to 14 March 2017. Data were collected in a face-to-face exit interview and document review and analyzed using SPSS version 24.0 software. Bivariate and multivariable analyses were undertaken to identify factors.

RESULT

Of the women who presented for abortion care services in Debre Markos Referral Hospital, 73 (29.6%) had induced second trimester abortion. Unmarried women (adjusted odds ratio = 4.93, 95% confidence interval = 1.41-17.16) and women employed at private business (adjusted odds ratio = 6.17, 95% confidence interval = 1.16-32.76) were associated with induced second trimester abortion.

CONCLUSION

This study revealed that almost one-third of women who presented for abortion care services at Debre Markos Referral Hospital had induced second trimester abortions. Raising awareness of the health consequence of second trimester abortion at community levels and counseling to avoid further occurrences are helpful to minimize the problem. Furthermore, early management of induced second trimester abortion is very crucial to prevent further complications.

Determinants and Outcome of Safe Second Trimester Medical Abortion at Jimma University Medical Center, Southwest Ethiopia

BACKGROUND

Although the vast majority of abortions are performed in the first trimester, still 10-15% of terminations of pregnancies have taken place in the second trimester globally. As compared to first trimester, second trimester abortions disproportionately contribute to maternal morbidity and mortality especially in low-income countries where access to safe second trimester abortion is limited. The objective of this study was to identify factors affecting and outcome of induced safe second trimester medical abortion in Jimma University medical center, Southwest Ethiopia.

METHODS

Institution based cross-sectional study design was used to conduct a study among women who seek safe second trimester medical abortion services and admitted at gynecology ward. All (201) eligible study subjects included were those who came for safe medical abortion service during data collection period. Data collected using pretested structured questionnaire through exit-interviewing and some clinical data abstracted from their chart. The data was entered into EpData version 3.1 then exported to SPSS version 21.0 for analysis. Variables with P-value less than 0.25 in bivariate analysis were entered into the final predictive model. Multivariable logistic regression was used to identify determinants with 95% CI and P-value < 0.05. Hosmer and Lemeshow test were used to check model fitness at P-value of 0.05. Ethical clearance was obtained and confidentiality kept using codes and patient's chart number.

RESULTS

In this study the response rate was 98.1%. Out of 201 women who participated in the study and were addmitted for safe second trimester medical abortion, 154 (76.6%) of them had complete abortion without any complication while the remaining 47 (23.4%) had incomplete abortion with one or more complication. Previous experience of abortion [AOR= 6.00, 95% CI= (3.77, 8.88)], gestational age [AOR=0.90, 95% CI= (0.07, 0.99)], parity [AOR=2.38, 95% CI= (1.04, 3.69)], cervical status [AOR=8.00, 95% CI= (5.72, 10.02)], overall waiting time for more than two weeks [AOR=0.53, 95% CI= (0.50, 0.96)], overall waiting time for two weeks [AOR=0.05, 95% CI= (0.01, 0.45)], and moderate anemia -(Hgb:7-10g/dl)-[AOR=0.07,95% CI= (0.01, 0.16)] were independent predictors for outcome of safe second trimester medical abortion.

CONCLUSION

This finding implied that proportion of complete abortion without any complication overweighs incomplete abortions with one or more complication through induced safe second trimester medical abortion method. The outcome is strongly determined by gestational age, cervical status, previous experience of abortion, parity, moderate anemia, and overall waiting time. Induced second trimester medical abortion is already known as an effective and safe method. However, much should be done to reduce proportion of incomplete abortions by minimizing overall waiting time through intervening at low gestational age. Therefore, it is recommended that safe second trimester medical abortion services should be continued under a certain legal circumstances so as to reduce maternal morbidity and mortality.

Playing it Safe: Legal and Clandestine Abortions Among Adolescents in Ethiopia

PURPOSE

The 2005 expansion of the Ethiopian abortion law provided minors access to legal abortions, yet little is known about abortion among adolescents. This paper estimates the incidence of legal and clandestine abortions and the severity of abortion-related complications among adolescent and nonadolescent women in Ethiopia in 2014.

METHODS

This paper uses data from three surveys: a Health Facility Survey (n = 822) to collect data on legal abortions and postabortion complications, a Health Professionals Survey (n = 82) to estimate the share of clandestine abortions that resulted in treated complications, and a Prospective Data Survey (n = 5,604) to collect data on abortion care clients. An age-specific variant of the Abortion Incidence Complications Method was used to estimate abortions by age-group.

RESULTS

Adolescents have the lowest abortion rate among all women below age 35 (19.6 per 1,000 women). After adjusting for lower levels of sexual activity among adolescents however, we find that adolescents have the highest abortion rate among all age-groups. Adolescents also have the highest proportion (64%) of legal abortions compared with other age-groups. We find no differences in the severity of abortion-related complications between adolescent and nonadolescent women.

CONCLUSIONS

We find no evidence that adolescents are more likely than older women to have clandestine abortions. However, the higher abortion and pregnancy rates among sexually active adolescents suggest that they face barriers in access to and use of contraceptive services. Further work is needed to address the persistence of clandestine abortions among adolescents in a context where safe and legal abortion is available.

Negotiating the social and medical dangers of abortion in Addis Ababa: An exploration of young, unmarried women's abortion-seeking journeys

Unmarried, young women constitute a significant proportion of women who undergo unsafe abortion in Ethiopia. Based on material from an ethnographic study, the experiences of young, unmarried women who had been admitted to the hospital in the aftermath of an unsafe, clandestine abortion are explored in this article. The routes the young women followed in their search of abortion services and the concerns and realities they had to negotiate and navigate are at the fore. Despite their awareness of the dangers involved in clandestine and illegal abortion, the young women felt they had no choice but to use medically unsafe abortion services. Two reasons for this are highlighted: such services were affordable and, significantly, they were considered socially safe in that the abortion remained unknown to others and the stigma of abortion and its consequences could hence be avoided. In situations in which choices had to be made, social safety trumped medical safety. This indicates a need for abortion services that address both the medical and social safety concerns of young women in need of such services.

Legal rights to safe abortion: knowledge and attitude of women in North-West Ethiopia toward the current Ethiopian abortion law

OBJECTIVE

To assess women's knowledge and attitude toward Ethiopian current abortion law.

STUDY DESIGN

A quantitative, community-based cross-sectional survey.

METHODS

Women of reproductive age in three selected lower districts in Bahir Dar, North-West Ethiopia, were included. Multi-stage simple random sampling and simple random sampling were used to select the districts and respondents, respectively. Data were collected using a structured questionnaire comprising questions related to knowledge and attitude toward legal status of abortion and cases where abortion is currently allowed by law in Ethiopia. Descriptive statistics were used to summarize the data and multivariable logistic regression computed to assess the magnitude and significance of associations.

RESULTS

Of 845 eligible women selected, 774 (92%) consented to participate and completed the interview. A total of 512 (66%) women were aware of the legal status of the Ethiopian abortion law and their primary sources of information were electronic media such as television and radio (43%) followed by healthcare providers (38.7%). Among women with awareness of the law, 293 (57.2%) were poor in knowledge, 188 (36.7%) fairly knowledgeable, and 31 (6.1%) good in knowledge about the cases where abortion is allowed by law. Of the total 774 women included, 438 (56.5%) hold liberal and 336 (43.5%) conservative attitude toward legalization of abortion. In the multivariable logistic regression, age had a significant association with knowledge, whereas occupation had a significant association with attitude toward the law. Women who had poor knowledge toward the law were more likely to have conservative attitude toward the law (adjusted odds ratio, 0.40; 95% confidence interval, 0.23-0.61).

CONCLUSION

Though the Ethiopian criminal code legalized abortion under certain circumstances since 2005, a significant number of women knew little about the law and several protested legalization of abortion. Countries such as Ethiopia with high maternal mortality records need to lift high-impact interventions that would trigger women to understand and exercise their legal rights to safe abortion and other reproductive health securities.

Unmet/met need for contraception and self-reported abortion in Ghana

BACKGROUND

Unmet need for contraception in several sub-Saharan African countries, including Ghana, remains high, with implications for unintended pregnancies and unsafe abortion, associated maternal morbidity and mortality. In this paper, we analysed for any associations between unmet/met need for contraception and the prevalence of abortion.

METHODS

The paper utilizes the 2014 Ghana Demographic Health Survey dataset. Applying descriptive statistics initially, and later, a binary logistic regression, we estimate two different models, taking into account, unmet/met need for contraception (Model 1) and a multivariable one comprising socioeconomic, spatial, cultural and demographic behaviour variables (Model 2) to test the associations between unmet/met need for contraception in Ghana.

RESULTS

One-fourth (25%) of sampled women in 2014 had ever had an abortion. The bivariate results showed that women who reported "no unmet" considerably tended to report abortion more than the reference category - not married and no sex in the last 30days. The elevated odds among respondents who indicated "no unmet need" persisted even after controlling for all the relevant confounders. Relatedly, unlike women with an unmet need for spacing, women who desired to limit childbearing had a slightly higher tendency to report an abortion.

CONCLUSION

The linkage between unmet need for contraception appears more complex, particularly when the connections are explored post-abortion. Thus, while an abortion episode is most likely due to unintended pregnancy, contraception may still not be used, after an abortion, probably because of failure, side effects or simply, a dislike for any method.

INDUCED ABORTIONS IN PAKISTAN: EXPOSITIONS, DESTINATIONS AND REPERCUSSIONS. A QUALITATIVE DESCRIPTIVE STUDY IN RAWALPINDI DISTRICT

Over 2 million abortions occur annually in Pakistan, mostly in a clandestine and unsafe environment. This is an area of grave concern for the reproductive health of women. A dearth of credible data and incomplete information make the problem more difficult to address. This qualitative study was conducted in semi-urban settings in Pakistan to record perceptions and practices concerning care seeking, experiences and outcomes regarding induced abortions and post-abortion care services. Women who had had induced abortions and abortion service providers were interviewed. Unwanted pregnancies and poverty were found to be the main reasons for seeking an abortion. Moreover, the unwanted pregnancies occurred due to low use of contraceptives, mainly due to a fear or past experience of their side-effects, unfamiliarity with correct usage and perceived inefficacy of the methods, especially condoms. There is an obvious need for practical and innovative interventions to address unmet need for birth spacing through improved access to contraceptives. Contraceptive providers should be provided with up-to-date and detailed training in family planning counselling, and perhaps allowed unrestricted provision of contraceptives. As a long-term measure, improvement in access to education and formal schooling could increase young girls' and women's knowledge of the benefits of family planning and the risks of unsafe abortion practices. Males must be involved in all the initiatives so that both partners are in agreement on correct and consistent contraceptive use.