BACKGROUND: According to the World Health Organization (WHO) estimate, one-third of pregnancies end in miscarriage, stillbirth, or induced abortion in the world. There are various reasons for a woman to seek induced abortion. However, limited information is available so far in the country and particularly in the study area. Therefore, the aim of the current study was to identify the determinants of induced abortion among clients coming for abortion care services at Bahirdar Felegehiwote referral hospital, Northwest Ethiopia. METHODS: Institutional based unmatched case-control study was conducted from September to December 2014. Interview administered questioner was used to collect primary data. Enumeration and systematic random sampling (K = 3) method was used to select 175 cases and 350 controls. A binary logistic regression model was fitted to identify determinant factors. Odds ratio with 95% CI was computed to assess the strength and significance of the association. RESULTS: All sampled cases and controls were actually interviewed. The likelihood of abortion was higher among non-married women [AOR: 18.23, 95% CI: 8.04, 41.32], students [AOR: 11.46, 95% CI: 6.29, 20.87], and women having a monthly income of less than 500 ETB [AOR: 11.46, 95% CI: 6.29, 20.87]. However, the likelihood of abortion was lower among women age greater than 24 years [AOR: 0.29, 95% CI: 0.11, 0.79] and who had the previous history of induced abortion [AOR: 0.31, 95% CI: 0.15, 0.65]. CONCLUSIONS: The study identified being non-married, student, women age less than 24 years, having the previous history of induced abortion, and low monthly income as an independent determinant of induced abortion. Interventions focused on the identified determinant factors are recommended.
BACKGROUND: Every year, an estimated 19–20 million unsafe abortions take place, almost all in developing countries, leading to 68,000 deaths and millions more injured many permanently. Many women throughout the world, experience more than one abortion in their lifetimes. Repeat abortion is an indicator of the larger problem of unintended pregnancy. This study aimed to identify determinants of repeat abortion in Tigray Region, Ethiopia. METHODS: Unmatched case–control study was conducted in hospitals in Tigray Region, northern Ethiopia, from November 2014 to June 2015. The sample included 105 cases and 204 controls, recruited from among women seeking abortion care at public hospitals. Clients having two or more abortions (“repeat abortion”) were taken as cases and those who had a total of one abortion were taken as controls (“single abortion”). Cases were selected consecutive based on proportional to size allocation while systematic sampling was employed for controls. Data were analyzed using SPSS version 20.0. Binary and multiple variable logistic regression analyses were calculated with 95% CI. RESULTS: Mean age of cases was 24 years (±6.85) and 22 years (±6.25) for controls. 79.0% of cases had their sexual debut in less than 18 years of age compared to 57% of controls. 42.2% of controls and 23.8% of cases cited rape as the reason for having an abortion. Study participants who did not understand their fertility cycle and when they were most likely to conceive after menstruation (adjusted odds ratio [AOR] = 2.0, 95% confidence interval [CI]: 1.1–3.7), having a previous abortion using medication (AOR = 3.3, CI: 1.83, 6.11), having multiple sexual partners in the preceding 12 months (AOR = 4.4, CI: 2.39,8.45), perceiving that the abortion procedure is not painful (AOR = 2.3, CI: 1.31,4.26), initiating sexual intercourse before the age of 18 years (AOR = 2.7, CI: 1.49, 5.23) and disclosure to a third-party about terminating the pregnancy (AOR = 2.1, CI: 1.2,3.83) were independent predictors of repeat abortion. CONCLUSION: This study identified several factors correlated with women having repeat abortions. It may be helpful for the Government of Ethiopia to encourage women to delay sexual debut and decrease their number of sexual partners, including by promoting discussion within families about sexuality, to decrease the occurrence of repeated abortion.
BACKGROUND: Ethiopia has one of the highest maternal mortality ratios in the world (420 per 100,000 live births in 2013), and unsafe abortion continues to be one of the major causes. To reduce deaths and disabilities from unsafe abortion, Ethiopia liberalized its abortion law in 2005 to allow safe abortion under certain conditions. This study aimed to measure how availability and utilization of safe abortion services has changed in the last decade in Ethiopia. METHODS: This paper draws on results from nationally representative health facility studies conducted in Ethiopia in 2008 and 2014. The data come from three sources at two points in time: 1) interviews with 335 health providers in 2008 and 822 health care providers in 2014, 2) review of facility logbooks, and 3) prospective data on 3092 women in 2008 and 5604 women in 2014 seeking treatment for abortion complications or induced abortion over a one month period. The Safe Abortion Care Model was used as a framework of analysis. RESULTS: There has been a rapid expansion of health facilities eligible to provide legal abortion services in Ethiopia since 2008. Between 2008 and 2014, the number of facilities reporting basic and comprehensive signal functions for abortion care increased. In 2014, access to basic abortion care services exceeded the recommended level of available facilities providing the service, increasing from 25 to 117%, with more than half of regions meeting the recommended level. Comprehensive abortion services increased from 20% of the recommended level in 2008 to 38% in 2014. Smaller regions and city administrations achieved or exceeded the recommended level of comprehensive service facilities, yet larger regions fall short. Between 2008 and 2014, the use of appropriate technology for conducting first and second trimester abortion and the provision of post abortion family planning has increased at the same time that abortion-related obstetric complications have decreased. CONCLUSION: Ten years after the change in abortion law, service availability and quality has increased, but access to lifesaving comprehensive care still falls short of recommended levels. "
BACKGROUND: Evidence from developed countries has shown that abortion-related mortality and morbidity has decreased with the liberalization of the abortion law. This study aimed to assess the trend of hospital-based abortion complications during the transition of legalization in Ethiopia in May 2005. METHODS: Medical records of women with abortion complications from 2003 to 2007 were reviewed (n = 773). Abortion and its complications with regard to legalization were described by rates and ratios, and predictors of fatal outcomes were analyzed by logistic regression. RESULTS: The overall and abortion-related maternal mortality ratios (AMMRs) showed a Non-statistically significant downward trend over the 5-year period. However, the case fatality rate of abortion increased from 1.1% in 2003 to 3.6% in 2007. Late gestational age, history of interference and presenting after new abortion legislation passed have been found to be significant predictors of mortality. CONCLUSION: Decreased trends of abortion ratio and the AMMR were identified, but the severity of abortion complications and the case fatality rate increased during the transition of legal revision.
It is ten years this month since the Choice on Termination of Pregnancy (CTOP) Act of 1996 was enacted. The passing of this Act was in keeping with the South African Constitution and represented a major breakthrough for women's reproductive rights. The Act allows for abortion on request to be performed at a designated health facility. This may be performed by a doctor or, during the first trimester, by a registered midwife who has completed the prescribed training course. In the second trimester, abortions may be performed by doctors up to 20 weeks' gestational age. This applies if the pregnancy endangers a woman's physical or mental health, if there is a risk of fetal abnormality, in the case of rape or incest, or if the continued pregnancy could adversely affect a woman's socio-economic situation. The Act has increased women's legal access to safe abortion services, leading to a dramatic decline in morbidity and mortality associated with unsafe abortions. However, numerous barriers continue to limit service access. One indicator of this is that almost a quarter of abortions are performed after 12 weeks of pregnancy. In addition, there is evidence that some women continue to have abortions outside of designated facilities.
To address the knowledge gap that exists in costing unsafe abortion in Ethiopia, estimates were derived of the cost to the health system of providing post-abortion care (PAC), based on research conducted in 2008. Fourteen public and private health facilities were selected, representing 3 levels of health care. Cost information on drugs, supplies, material, personnel time, and out-of-pocket expenses was collected using an ingredients approach. Sensitivity analysis was used to determine the most likely range of costs. The average direct cost per client, across 5 types of abortion complications, was US $36.21. The annual direct cost nationally ranged from US $6.5 to US $8.9 million. Including indirect costs and satisfying all demand increased the annual national cost to US $47 million. PAC consumes a large portion of the total expenditure in reproductive health in Ethiopia. Investing more resources in family planning programs to prevent unwanted pregnancies would be cost-beneficial to the health system.
"OBJECTIVE: To implement the Safe Abortion Care (SAC) model in public health facilities in the Tigray region of Ethiopia and document the availability, utilization, and quality of SAC services over time. METHODS: The project oriented providers in 50 public health facilities in Tigray to the SAC model. Changes in SAC indicators between baseline and endline were assessed using a retrospective review of procedure logbooks at baseline and prospective monitoring of procedure logbooks for facility performance after introduction of the SAC model. RESULTS: Availability of SAC services increased from 39% to 86% of the recommended number of 5 facilities per 500000 population, primarily as a result of functional improvements at health centers. Decentralization was accompanied by a 94% increase in the annualized number of women who received services. The proportion of uterine evacuation procedures for induced abortion rose from 7% to 60% (P0.01), and the proportion performed with recommended technology increased from 30% to 85% (P0.01). The proportion of abortion patients who received modern contraception also increasedfrom 31% to 78% (P0.01). DISCUSSION: While widespread service delivery improvements were recorded using the SAC monitoring appoach, the project design was built around existing programmatic activities of the local health authority and reflects some related research limitations. For example, there was No comparison group of facilities, timing did Not allow for prospective collection of the baseline data before the intervention, and facilities received different levels of monitoring support. CONCLUSION: Using the SAC model, public health facilities tracked progress and made needed adjustments, which improved service delivery. Continued focus on critical safe abortion care elements should increase the availability, quality, and use of life-saving are to reduce preventable abortion mortality in the region."
Complications of an unsafe abortion are a major contributor to maternal deaths and morbidity in Africa. When abortions are performed in safe environments, such complications are almost all preventable. This paper reports results from a nationally representative health facility study conducted in Ethiopia in 2008. The safe abortion care (SAC) model, a monitoring approach to assess the amount, distribution, use and quality of abortion services, provided a framework. Data collection included key informant interviews with 335 health care providers, prospective data on 8911 women seeking treatment for abortion complications or induced abortion and review of facility logbooks. Although the existing hospitals perform most basic abortion care functions, the number of facilities providing basic and comprehensive abortion care for the population size fell far short of the recommended levels. Almost one-half (48%) of women treated for obstetric complications in the facilities had abortion complications. The use of appropriate abortion technologies in the first trimester and the provision of post-abortion contraception overall were reasonably strong, especially in private sector facilities. Following abortion law reform in 2005 and subsequent service expansion and improvements, Ethiopia remains committed to reducing complications from an unsafe abortion. This study provides the first national snapshot to measure changes in a dynamic abortion care environment.
The high demand for abortion related services in Addis Ababa, Ethiopia indicates a reliance on abortion to control fertility and highlights an opportunity to increase access to contraceptives and improve post-abortion care. We analyzed the medical records of 1,200 women seeking abortion related services. Logistic regression was used to determine factors associated with use of modern or long-acting contraceptive post-abortion. Multivariate results illustrate that women aged 40-44, students, employed women, receipt of services in private clinics, number of children, and number of previous abortions were significantly associated with the odds of adopting any modern contraceptive post-abortion. The odds of choosing a long-active contraceptive method were significantly and positively associated with being age 25-29, attaining secondary or higher education, and number of children. Improved services and information along with reliable access to modern and long-acting contraceptives can reduce the need to use abortion to control fertility among women in Addis
BACKGROUND: In 2005 Ethiopia took the important step to protect women's reproductive health by liberalizing the abortion law. As a result women were given access to safe pregnancy termination in first and second trimester. This study aims to describe socio-economic characteristics and contraceptive experience among women seeking abortion in Jimma, Ethiopia and to describe determinants of second trimester abortion. METHODS: A cross-sectional study conducted October 2011 - April 2012 in Jimma Town, Ethiopia among women having safely induced abortion and women having unsafely induced abortion. In all 808 safe abortion cases and 21 unsafe abortion cases were included in the study. Of the 829 abortions, 729 were first trimester and 100 were second trimester abortions. Bivariate and multivariate logistic regressions were used to determine risk factors associated with second trimester abortion. The associations are presented as odds ratios (OR) with 95% confidential intervals. Age stratified analyses of contraceptive experience among women with first and second trimester abortions are also presented. RESULTS: Socio-economic characteristics associated with increased ORs of second trimester abortion were: age < 19 years, being single, widowed or divorced, attending school, being unemployment, being nullipara or para 3+, and having low education. The contraceptive prevalence rate varied across age groups and was particularly low among young girls and young women experiencing second trimester abortion where only 15% and 19% stated they had ever used contraception. CONCLUSION: Young age, poor education and the prospect of single parenthood were associated with second trimester abortion. Young girls and young women were using contraception comparatively less often than older women. To ensure women full right to control their fertility in the setting studied, modern contraception should be made available, accessible and affordable for all women, regardless of age.