Spatial distribution and determinants of abortion among reproductive age women in Ethiopia, evidence from Ethiopian Demographic and Health Survey 2016 data: Spatial and mixed-effect analysis

Determinants of abortion among women of reproductive age in Ghana: multilevel analysis evidence from the 2022 Ghana demographic and health survey

INTRODUCTION

Due to data gaps in most countries, the factors that affect the prevalence of abortion among women from a variety of social and economic backgrounds, especially in Africa, are little understood. We investigated abortion and its determinants among women of reproductive age in this study with the aim of providing policymakers in Ghana specific information.

METHODS

After obtaining authorization to analyze data on abortion among women of reproductive age, we looked at the data from the Ghana demographic health survey 2022 that we obtained from the DHS website. We used binary logistic regression, both bivariate and multilevel. A three-level binary logistic regression analysis was performed on community and individual-level abortion predictors, using p-values less than 0.05 and adjusted odds ratios (AOR) with 95% confidence intervals (CI).

RESULTS

In the current study, the prevalence of abortion was 39.84%. Factors associated with abortion were age group 20-24 (AOR = 1.65, 95%CI = 1.05-2.61), 25-29 (AOR = 2.55, 95%CI = 1.60-4.08), 30-34 (AOR = 2.97, 95%CI = 1.54-4.81), 35-39 (AOR = 2.54, 95%CI = 1.54-4.17), 40-44 (AOR = 4.73, 95%CI = 2.74-8.15), 45-49 (AOR = 4.73, 95%CI = 2.21-9.45), married women (AOR = 1.48, 95%CI = 1.07-2.04), women living with their partner (AOR = 1.42, 95%CI = 1.02-1.98), intention to use contraceptives (AOR = 0.73, 95%CI = 0.61-0.88), smokers (AOR = 0.05, 95%CI = 0.06-0.43), Northern region (AOR = 0.50, 95%CI = 0.26-0.96), North East region (AOR = 0.26, 95%CI = 0.11-0.59), Upper East region (AOR = 0.33, 95%CI = 0.16-0.71), and Upper West region (AOR = 0.29, 95%CI = 0.12-0.67).

CONCLUSION

The magnitude of abortion was relatively higher than that of other African countries including Mozambique, Ghana, Côte d'Ivoire and Ethiopia. Education status, age, intention of using contraceptives, smoking, and region were determinants of abortion in Ghana. Therefore, comprehensive and culturally acceptable sexual and reproductive health services for women must be provided by those in charge. It is important to establish programs that support women's livelihood and education so that they can make educated decisions about things like using contraception and avoiding unintended pregnancies.

Pregnancy Termination Among Women of Reproductive Age: Evidence from the Indonesian Demographic and Health Survey

The consequences associated with pregnancy termination have garnered attention from healthcare professionals, particularly in Indonesia. However, national-level evidence on the factors driving pregnancy termination in Indonesia remains limited. This research aimed to identify patterns and characteristics associated with pregnancy termination among reproductive-age women in Indonesia. A cross-sectional study analyzed secondary data from the 2012 and 2017 Indonesian Demographic and Health Survey, involving women aged 15-49. The weighted sample included 42,269 individuals in 2012 and 47,001 in 2017. Binary logistic regression identified the correlates of pregnancy termination. Among 89,270 women of reproductive age, the prevalence of pregnancy termination was 12.68% in 2012 and 12.95% in 2017. Pregnancy termination was more frequently reported among women aged 44-49 years (adjusted odds ratio (AOR): 4.34, 95% confidence interval (CI): 3.54-5.33), those with secondary education (AOR: 1.29, 95% CI: 1.14-1.46), married women (AOR: 195.40, 95% CI: 114.70-332.90), employed women (AOR: 1.05, 95% CI: 1.00-1.09), individuals with health insurance (AOR: 1.07, 95% CI: 1.02-1.11), those who had experienced domestic violence (AOR: 1.07, 95% CI: 1.02-1.11), and regular television viewers (AOR: 1.10, 95% CI: 1.05-1.15). Conversely, pregnancy termination was less commonly reported among women with 1-2 living children (AOR: 0.80, 95% CI: 0.74-0.87), those who expressed no preference for having more children (AOR: 0.89, 95% CI: 0.84-0.94), and women using modern contraception (AOR: 0.76, 95% CI: 0.72-0.80). The findings revealed that the prevalence did not observe any changes in the incidence of pregnancy terminations between 2012 and 2017. Further evaluation by healthcare professionals is crucial to understanding the reasons behind pregnancy termination, especially among women of reproductive age. Insights into factors related to pregnancy termination, especially sociodemographic factors, can help mitigate the pregnancy termination in this population.

Employing machine learning models to predict pregnancy termination among adolescent and young women aged 15-24 years in East Africa

Pregnancy termination is still a sensitive and continuing public health issue due to several political, economic, religious, and social concerns. This study assesses the applications of machine learning models in the prediction of pregnancy termination using data from eleven national datasets in East Africa. Nine machine learning models, namely: Random Forests (RF), Decision Tree, Logistic Regression, Support Vector Machine, eXtreme Gradient Boosting (XGB), AdaBoost, CatBoost, K-nearest neighbor, and feedforward neural network models were used to predict pregnancy termination, with six evaluation criteria utilized to compare their performance. The pooled prevalence of pregnancy termination in East Africa was found to be 4.56%. All machine learning models had an accuracy of at least 71.8% on average. The RF model provided accuracy, specificity, precision, and AUC of 92.9%, 0.87, 0.91, and 0.93, respectively. The most important variables for predicting pregnancy termination were marital status, age, parity, country of residence, age at first sexual activity, exposure to mass media, and educational attainment. These findings underscore the need for a tailored approach that considers socioeconomic and regional disparities in designing policy initiatives aimed at reducing the rate of pregnancy terminations among younger women in the region.

Prevalence and determinants of termination of pregnancy among reproductive-age women who had a short preceding birth interval in Sub-Saharan Africa: a multilevel analysis

Background

Termination of pregnancy is one of the biggest five causes of maternal mortality in countries with low and middle incomes. Although termination of pregnancy is hazardous, its prevalence and determinates are not well studied in developing countries. Therefore, this study aims to assess the prevalence and determinants of termination of pregnancy among reproductive-age women who had a short preceding birth interval in Sub-Saharan Africa.

Methods

Data from the most recent Demographic and Health Surveys, which covered 21 Sub-Saharan African countries from 2015 to 2022, were used for secondary data analysis. The study used a total of 283,785 women. Stata 14 was used to analyze the data. The determinants of termination of pregnancy were determined using a multilevel mixed-effects logistic regression model. Significant factors associated with termination of pregnancy were declared significant at p-values < 0.05. The result was interpreted using the confidence interval and adjusted odds ratio. The best-fit model was determined to be the one with the highest log likelihood ratio and the lowest deviance.

Results

In Sub-Saharan Africa, one in ten women with short birth intervals experienced pregnancy termination. Individual factors, including the sex of the preceding birth (AOR = 1.21, 95% CI: 1.05, 1.40), maternal age (AOR = 1.57, 95% CI: 1.27, 1.95), pregnancy complications (AOR = 1.28, 95% CI: 1.09, 1.49), No ANC visits (AOR = 2.29, 95% CI: 1.26, 4.14), previous cesarean section delivery (AOR = 1.74, 95% CI: 1.32, 2.30), <6 months of breastfeeding (AOR = 1.56, 95% CI: 1.35, 1.81), traditional contraception usage (AOR = 1.67, 95% CI: 1.13, 2.46), poor wealth status (AOR = 1.50, 95% CI: 1.22, 1.85), and community-level factors such as urban residence (AOR = 1.31, 95% CI: 1.06, 1.62) had higher odds of pregnancy termination.

Conclusions

This study concludes that termination of pregnancy rates among women with short preceding birth interval is high. The study identified that both individual and community-level variables were determinants of termination of pregnancy. Therefore, the ministries of health in Sub-Saharan African countries should give attention to those women who underutilize antenatal care services and to women from urban areas while designing policies and strategies targeting reducing termination of pregnancy rates.

Missed opportunities of method information index plus (MII+) counseling among current modern contraceptive users. multi-level analysis from the Ethiopian PMA 2021 data set

INTRODUCTION

In Ethiopia, there is a decrease in percentage of women who receive method information index counseling service from 39% (95%CI: 33%, 44%) in 2015 to 12% in 2019 (95% CI: 10%, 14%) nationally, and less than 40% of these services provided are high quality. Therefore, the aim of this study was to identify modern contraceptive users-related factors at individual level and community level associated with missed opportunities of method information index plus counseling.

METHODS

This study used the datasets from the 2019 Performance Monitoring for Action Ethiopia Survey, which comprised a total of 8,365 households (98.9%) and 7,988 women (98.8%). The data analysis was done with Stata version 14. Using multilevel mixed effect logistics regression, both individual and community-level factors were found to be associated with missed opportunities of method information index plus counseling. a P-value of less than 0.05 was used to declare statistical significance. The association was presented using an adjusted odds ratio with a 95% confidence interval.

RESULTS

The study shows that the prevalence of missed opportunity MII + family planning counseling among current modern contraceptive users was 81% (79.15, 82.66) and factors significantly associated with missed opportunities of method information index plus counselling are educational status, low level of media exposure, religion, receiving the service in health centers and health posts, never heard of any other methods, number of children at first contraceptive use and region.

CONCLUSIONS

In Ethiopia 81% of women had a missed opportunities of MII + counseling service. In order to address this, we recommend policy makers to focus on training of health care workers and pharmacists about MII + counseling, and establishing ways to improve access to media exposure.

Delays in seeking abortion and its determinants among reproductive-age women based on the Ethiopian Demographic and health survey

INTRODUCTION

Delaying in seeking abortion services causes adverse public health outcomes, which increases maternal mortality rates due to complications from abortion. However, evidence shows that there are limited factors associated with delayed abortion. Therefore, the study aims to determine the magnitude and identify factors associated with delayed seeking abortion among reproductive-aged women in Ethiopia.

METHODS

Secondary cross-sectional data analysis was conducted on the Ethiopian Demographical and Health Survey dataset. A total weighted sample of 2198 reproductive-aged women was considered in this study. All data processing and statistical analyses were performed using R-software version 4.2.3. Multilevel binary logistic regression analysis was used to identify a significant predictor for delays in seeking abortion. An adjusted odds ratio with a 95 % confidence interval was used to measure a statistical association.

RESULT

The prevalence of delays in seeking abortion among women in Ethiopia was 32 %. Educational status (AOR = 0.63; 95 % CI: 0.37-0.78), marital status (AOR = 2.12; 95 % CI: 1.38-3.74), wealth index (AOR = 0.54; 95 % CI: 0.41-0.75), frequency of listening a radio (AOR = 0.61; 95 % CI: 0.45-0.75), live births (AOR = 0.43; 95 % CI: 0.25-0.72), pregnancy wanted status (AOR = 0.59; 95 % CI: 0.4-0.79), contraceptive use (AOR = 0.46; 95 % CI: 0.34-0.69), and place of residence (AOR = 2.31; 95 % CI: 1.67-3.19) were statistically significantly variables associated with delays in seeking abortion.

CONCLUSIONS

Delayed seeking abortion remains high in Ethiopia. The study is vital for policymakers, healthcare providers, and advocates to improve training on the importance of early abortion care, develop targeted interventions for better accessibility to abortion services, expand health education programs to raise awareness about reproductive rights and empower women with information for informed reproductive health decisions. Health education programs, specifically targeting uneducated women, poorer women, rural resident women, and women who do not use contraceptives, would decrease delays in accessing abortion services.

What are the associated factors of low husbands/partners independent decision-maker in women's contraceptive use decision-making process in Ethiopia? Multilevel analysis

BACKGROUND

Many married women of reproductive age with husbands or partners are less cooperative in using contraceptives, often resulting in unintended pregnancies or secret contraceptive use. This private use of contraceptives causes women to suffer from side effects without proper support, and many women in Ethiopia die due to unintended pregnancies. However, the involvement of husbands or partners in the contraceptive decision-making process in Ethiopia is often neglected. There is also a lack of evidence regarding the determinants of husbands' or partners' decision-making power on contraceptive use in Ethiopia.

OBJECTIVE

This study aimed to assess the determinants of low involvement of husbands/partners in women's contraceptive use decision-making processes in Ethiopia.

METHODS

This study was based on Ethiopian Demographic and Health Survey data, collected from January 18 to June 27, 2016. Weighted samples of 3,669 reproductive-age women were included. Husbands'/partners' independent decision-making was measured by whether the husband/partner decided independently or alone about contraceptive use, categorized as "Yes" or "No". A multilevel logistic regression model was fitted, and ICC (Intra-class Correlation Coefficient), MOR (Median Odds Ratio), PCV (Proportion Change in Variance), and deviance were used to assess model fitness and comparison. Variables with a p-value of ≤ 0.2 in the bivariate analysis were considered candidates for multivariable multilevel analysis. An adjusted odds ratio with a 95% confidence interval was used to determine both the direction and strength of the association, and a p-value of < 0.05 was used to declare statistical significance.

RESULTS

Husbands'/partners' independent decision-making in women's contraceptive use was found to be 5.41% [4.72-6.19%]. Significant factors associated with this included: Husbands/partners aged 31-59 years (Adjusted Odds Ratio (AOR) = 1.3; Confidence Interval (CI) 2.3-5.4) and over 59 years (AOR = 2.3; CI 1.2-4.3), Educational level of husbands/partners: primary education (AOR = 3.2; CI 2.9-4.3), secondary education (AOR = 3.9; CI 2.7-4.4), and higher education (AOR = 4.3; CI 2.8-5.0), Media exposure (AOR = 4.5; CI 2.2-5.4), History of pregnancy termination (AOR = 3.3; CI 2.6-4.1), Perception that distance to health facilities is not a significant problem (AOR = 3.0; CI 1.7-4.7) and Urban residency (AOR = 3.5; CI 1.6-4.2).

CONCLUSIONS

In Ethiopia, the involvement of husbands/partners in the contraceptive use decision-making process is low. To increase their decision-making power, attention should be given to factors such as age, educational level, media exposure, history of pregnancy termination, distance to health facilities, and urban residency.

Spatial distribution of pregnancy and early motherhood among late adolescent girls in Ethiopia using data from the Ethiopia Demographics and Health Survey 2019: Spatial and multilevel analyses

BACKGROUND

Various governmental and non-governmental organizations in Ethiopia are striving to decrease adolescent pregnancy by enacting laws against early marriage, developing a national youth and adolescent reproductive health strategy, legalizing abortion, and developing an HIV/AIDS policy for youth; however, the issue of teenage pregnancy& early motherhood remains a major concern.

METHODS

Data were obtained from the Ethiopian Demographics and Health Survey (EDHS) in 2019. A total sample of 2210 adolescents was included in our study. Spatial autocorrelation, hotspot analysis, and spatial interpolation were used to observe significant spatial variation and clustering and to predict the prevalence of pregnancy in an unsampled area among adolescent girls in Ethiopia; a multilevel binary logistic regression model was fitted to identify factors associated with the outcome variable. The adjusted odds ratio was calculated with a 95% confidence interval, and the variables with a p-value 0.05 in the multivariable multilevel logistic regression were determined to be statistically significant.

RESULTS

Global spatial autocorrelation analyses showed that the spatial distribution of late-adolescent pregnancy and early motherhood varied across Ethiopia (the Global Moran's Index I value showed GMI = 0.014, P 0.001). The spatial distribution revealed a high cluster (hot spot) of late-adolescent pregnancy and early motherhood in most parts of Gambella, Afar, Benishangul-Gumuz, the eastern part of Oromia, and Somalia. In the multivariable multilevel analysis, being 17 years old (AOR = 3.43; 95% CI: 1.54-7.59), 18 years old (AOR = 14.92; 95% CI: 6.78-32.8), and 19 years old (AOR = 8.44; 95% CI: 4.06, 17.56), married (AOR = 25.38; 95% CI: 15.33, 42.02), having completed primary, secondary, and higher education (AOR = 0.45; 95% CI: 0.21-0.95), and being at Gambela (AOR = 3.64; 95% CI: 1.04, 12.75) were significant predictors of late adolescent pregnancy and early motherhood.

CONCLUSION

Overall, the prevalence of late-adolescent pregnancy and early motherhood was found to be high. At the individual level, marital status, educational attainment, and age of adolescents were significant predictors of pregnancy and early motherhood, and regions were found at a community level associated with pregnancy and early motherhood among late adolescents. Therefore, late-adolescent girls should be educated about menstruation, sexual intercourse, pregnancy, and contraceptives before they reach early adolescence.

Trends, spatiotemporal variation and decomposition analysis of pregnancy termination among women of reproductive age in Ethiopia: Evidence from the Ethiopian demographic and health survey, from 2000 to 2016

Background

Pregnancy termination is a major public health problem, and complications of unsafe abortion are among the proximate and major causes of maternal mortality. Mapping the trend and spatiotemporal variation and identifying factors that are responsible for the changes in pregnancy termination help achieve the sustainable development goal of reducing maternal mortality in Ethiopia by understanding the epidemiology and regional variations.

Methods

Data from the 2000-2016 Ethiopian Demographic and Health Survey were analyzed with a total weighted sample of 40,983 women of reproductive age. Variables with a p-value <0.05 in a logit multivariable decomposition analysis were considered significant predictors of the decline in pregnancy termination over time. Spatial analysis was used separately for each survey to show the changes in regional disparities in pregnancy termination in Ethiopia.

Results

The magnitude of pregnancy termination among women of reproductive age decreased by 39.5 %, from 17.7 % in 2000 to 10.7 % in 2016. The difference in the effects of literacy, working status, marital status, age at first intercourse, age at first cohabitation, knowledge about contraceptives, and knowledge of the ovulatory cycle were the significant predictors that contributed to the change in pregnancy termination over time. Significant clusters of pregnancy terminations were observed in central and northern Ethiopia (Addis Ababa, eastern Amhara, and Tigray regions).

Conclusions

Despite the substantial decrease in terminated pregnancies over time in Ethiopia, the magnitude is still high. The government should focus on promoting education for girls and women, providing reproductive health education, including access to contraceptives, and raising the minimum age for girls to engage in sexual activities or marriage by implementing policies.

Mixed-methods approach in evaluating safe abortion care services at public health facilities in North Shewa zone, central Ethiopia: a multicenter institutional cross-sectional study

Background

Of the 55.7 million abortions that were performed globally, 25.1 million (45.1%) were not safe. Nearly 97% of these took place in developing countries. Approximately 71% of economically developed countries allow safe abortion care (SAC) services, whereas only 16% of developing countries permit it. In sub-Saharan Africa, 92% of mothers live in 43 countries where SAC services are restricted by law. Most Ethiopian women continue to self-terminate unwanted pregnancies in hazardous conditions. The aim of this evaluation was to assess input, care providers' compliance with national guidelines, and clients' satisfaction.

Methods

A multicenter cross-sectional study design with a mixed-methods approach was used. Seven public health facilities were randomly selected where 75 health caseworkers were directly observed; 296 clients and 14 key informants were interviewed, respectively. A resource inventory checklist was used to assess all inputs. The overall SAC services evaluation was summarized from 40 indicators: 13 resource availability indicators, 14 healthcare workers' compliance to national guidelines indicators, and 13 clients' satisfaction toward SAC services indicators. A multivariate logistic regression model was fit to determine factors that affect client satisfaction at a p-value <0.005.

Results

There were 75 healthcare providers in the maternal and child health departments in the study area. Except for the interruption of water and electricity, maternal waiting area, counseling, and procedural room, all are available making 94% of resources availability. All healthcare workers were compliant in providing anti-pain medication during procedures, identifying clients if they were targeted for an HIV/AIDS test, and providing their test results as per the guideline. Nevertheless, they were poorly compliant in respecting the clients (9, 12%) and taking vital sign (33, 44%). The overall compliance was 62.3%, while only 51% were satisfied with waiting time and privacy of counseling room. The overall client satisfaction was 65%. The overall evaluation of SAC services was 72.9%.

Conclusion

Resource availability was excellent, which was in line with national SAC expectations while the healthcare workers' compliance to national guidelines was fair, which deviated from expectations. The clients' satisfaction and the overall evaluation were good, which was below the hypothesized expectation.

Prevalence and determinants of pregnancy termination in Ethiopia: a systematic review and meta-analysis

OBJECTIVE

This review aims to determine the prevalence of pregnancy termination and its determinant factors in Ethiopia.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Relevant articles were retrieved from databases such as PubMed, EMBASE, Medline and other search engines.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

The research design for this study had no restrictions, allowing for the inclusion of cross-sectional and case-control studies that examined the prevalence or determinants of pregnancy termination. However, case reports, case series, reviews, editorials and studies published as abstracts only were excluded from the analysis.

DATA EXTRACTION AND SYNTHESIS

The review was precisely in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria, and the quality of the review was assessed using the Joanna Briggs Institute critical appraisal checklist. Heterogeneity was indicated by the p value for I2 statistics less than 0.05. Data were entered into Microsoft Excel, and the analysis was conducted by using Stata V.16.

RESULTS

The pooled prevalence of pregnancy termination in Ethiopia was 21.52% (95% CI 15.01% to 28.03%). Women who had their first sexual initiation before the age of 18 (OR 1.78; 95% CI 1.13 to 2.82, p=0.14), had irregular menstrual bleeding (OR 1.86; 95% CI 1.25 to 2.77, p=0.76), being a student (OR 4.85; 95% CI 1.98 to 11.91, p=0.20) and had multiple sexual partners (OR 4.88; 95% CI 3.43 to 6.93, p=0.33) were significantly associated with pregnancy termination.

CONCLUSIONS

One in five women terminated their pregnancies, which is higher than in other sub-Saharan countries. Being a student, irregular menstrual bleeding, early initiation of sexual intercourse and multiple sexual partners were determinants of pregnancy termination. Special attention is needed in avoiding early sexual initiation and in reducing sexual risk behaviours.

Pregnancy termination and determinant factors among women of reproductive age in Kenya, evidence from Kenyan Demographic and Health Survey 2022: Multilevel analysis

BACKGROUND

Pregnancy termination is one of the common causes of maternal mortality, particularly in developing countries, and remains a global public health concern despite the efforts made to enhance maternal healthcare services. Maternal mortality is still the highest in sub-Saharan Africa, including Kenya, due to pregnancy termination.

OBJECTIVES

This study aimed to investigate the current burden of pregnancy termination and its determinants among reproductive-age women in Kenya.

DESIGN

A cross-sectional study design with multilevel analysis.

METHODS

The total weighted samples of 19,530 women of reproductive age were included in this study. The data were taken from the Kenyan Demographic and Health Survey 2022. A multilevel multivariable logistic regression model was used to identify the determinant factors of pregnancy termination. In the multivariable multilevel analysis, the adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to declare significant determinants of pregnancy termination among women of reproductive age.

RESULTS

The overall prevalence of pregnancy termination among women of reproductive age in Kenya was 14.19%. The determinant factors associated with pregnancy termination were the age of the women; as age increased, the risk of pregnancy termination increased, 25-29 years (AOR = 2.23; 95 CI (1.08-4.60)), 30-34 years (AOR = 2.98; 95% CI (1.43-6.18)), 35-39 years (AOR = 3.24; 95% CI (1.55-6.76)), 40-44 years (AOR = 4.57; 95% CI (2.16-9.68)), 45- 49 years (AOR = 5.16; 95% CI (2.33-9.98)); marital status: married (AOR = 5.63; 95% CI (3.08-10.29)), ever married (AOR = 5.05; 95% CI (2.74-9.33)); wealth index: richest (AOR = 1.32; 95% CI (1.05-1.63)); employment status: employed (AOR = 1.23; 95% CI (1.09-1.38)); preceding birth interval: greater than 24 months (AOR = 1.21; 95% CI (1.06-1.38)); urban residence (AOR = 1.25; 95% CI (1.06-1.46)); and Islamic followers (AOR = 1.64; 95% CI (1.31-2.06)).

CONCLUSION

Pregnancy termination among women of reproductive age in Kenya has become an important public health concern. Policymakers and other stakeholders should focus on maternal healthcare service programs to prevent the termination of pregnancy. The determinant factors are an important input to developing strategies to improve the accessibility of maternal healthcare services in the country.

Patterns and Predictors of Abortion Care-Seeking Practices in India: Evidence From a Nationally Representative Cross-Sectional Survey (2019-2021)

Background India continues to have unsafe abortions despite progressive legislation since the past five decades facilitating ease of access to abortion services. This study describes abortion care-seeking patterns (social/therapeutic/humanitarian/sex-selective/safe/unsafe), preferences (public/private/at home), and their determinants among Indian women. Methods Data were taken from the Indian National Family and Health Survey (NFHS-5) (2019-2021) including women aged 15-49 years, who had terminated their last pregnancy by induced abortion within five years prior to the survey (N = 5,856). A bivariate analysis, followed by a multinomial logistic regression model, was performed to assess the predictors affecting the choice of healthcare facility type for an abortion. Predictors of unsafe and self-managed abortions were examined using binary logistic regression. Results About 665,671 women in the reproductive age group responded to the survey, of which 3.42% (n=22,767) reported their most recent pregnancy within the last five years terminated in either a miscarriage, stillbirth or abortion, of which 5,856 (25.72%) underwent an induced abortion. Women undergoing surgical abortion were more likely to avail of either a public (adjusted relative risk ratio (aRRR)=38.06 (23.62, 61.35)) or a private facility (aRRR=44.53 (28.11,70.53)) compared to at-home abortions. Women reporting a social and humanitarian reason for abortion were less likely to undergo an abortion at a public (aRRR=0.25 (0.17,0.35)) or private facility (aRRR=0.32 (0.23,0.44)) than at home. Furthermore, a total of 147 (2.43%) abortions were classified as unsafe. Women reporting sex-selective reasons for abortion were observed to have a higher likelihood of engaging in an unsafe abortion (adjusted odds ratio (aOR)= 1.61 (0.70, 3.70)) compared to those citing a therapeutic reason. Conclusions Self-managed abortions at home were more prevalent in women of lower socioeconomic status, adolescent girls, and those reporting sex-selective reasons for abortion. Furthermore, the reproductive-health program in India should enhance capacity-building initiatives for primary-care healthcare providers, including doctors, nurses, and pharmacists, to effectively prescribe and supervise abortion through medication methods.

Spatial distribution of short birth interval and associated factors among reproductive age women in Ethiopia: spatial and multilevel analysis of 2019 Ethiopian mini demographic and health survey

BACKGROUND

Short Birth Interval negatively affects the health of both mothers and children in developing countries. Studies conducted in Ethiopia on the spatial variation and determinants of individual and community-level factors about short birth intervals were limited. Thus, this study was intended to assess the spatial variation of the short birth interval and its determinants in Ethiopia.

METHODS

This study is a secondary analysis of the Ethiopian Demographic and Health Survey (mini EDHS 2019). A total of 1784 reproductive-age women were included in the analysis. The global spatial autocorrelation (Global Moran's I) and the Getis-Ord statistics tool were used to detect the presence of clustering and the high/low hotspot areas of SBI respectively. Ordinary kriging was used to interpolate short birth intervals, and spatial scan statistics were employed to identify spatial clusters with high and low SBI. A multilevel multivariable model was used to identify predictors of a short birth interval.

RESULTS

The prevalence of SBI was 62.89% (95%CI: 59.3, 69.7) in Ethiopia. High clustering of SBI was observed in all parts of Somali, in Afar (zones 1, 3, 4, &5), Oromia (Guje, Bale, & West Harerge), and northern Tigray. The most likely significant primary cluster was observed in the Somali region. Women who lived in the primary cluster were 24% more likely to have a short birth interval than those who lived outside the window. In the multilevel mixed-effect analysis age 25-34 [(AOR = 0.40, 95% CI: 0.35, 0.45)], 35-49 [(AOR = 0.44, 95% CI: 0.38, 0.51)], Muslim religion follower [(AOR = 3.5, 95% CI: 2.7, 4.69)], no formal education [(AOR = 0.5, 95% CI: 0.37, 0.70)], primary education[(AOR = 0.4, 95%CI: 0.28, 0.53)], and secondary education [(AOR = 0.3, 95% CI: 0.24, 0.48)], middle [(AOR: 1.3, 95% CI: 1.2, 1.52)], rich wealth status [(AOR: 1.4, 95% CI: 1.3, 1.68)], female sex children [(AOR: 1.2, 95% CI: 1.09, 1.42)], and two or fewer ideal number of children [(AOR = 0.2, 95% CI: 0.25, 0.32)] were found to be significant predictors of SBI.

CONCLUSION

Overall, SBI was high and significantly clustered across the region of Ethiopia. Age, religion, education, wealth status, the sex of the indexed child, and the ideal number of children were found to be significantly associated with short birth intervals. Hence, the government should design a health promotion strategy and public health awareness in the identified hotspot areas of SBI and should scale up family planning and the wealth status of reproductive-age women.

Determinants of induced abortion among women of reproductive age: evidence from the 2013 and 2019 Sierra Leone Demographic and Health Survey

BACKGROUND

Worldwide, pregnancy termination due to unintended pregnancy is crucial in maternal health, particularly in settings where abortion laws are restrictive. Presently, there is a paucity of literature on determinants of induced abortion among women of reproductive age in Sierra Leone. The study findings could be used to improve the country's maternal mortality indices and inform health programs and reproductive health policies geared toward tackling induced abortion.

METHODS

We analyzed secondary data from the 2013 and 2019 Sierra Leone Demographic and Health Surveys. The surveys were nationally representative, with weighted samples comprising 16,658 (2013) and 15,574 (2019) women of reproductive age. Descriptive statistics, including frequencies and percentages, were computed, while Chi-square and Binomial Logistics Regression were employed to identify correlates of induced abortion.

RESULTS

The results showed that a minority (9%) of the participants had induced abortion in both surveys. Abortion was significantly associated with age, marital status, employment status, education, parity, and frequency of listening to the radio and watching television (p < 0.05). For instance, women aged 45-49 years (AOR = 7.91; 95% CI: 5.76-10.87), married women (AOR = 2.52; 95% CI: 1.95-3.26), and working women (AOR = 1.65; 95% CI: 1.45-1.87) had a higher likelihood of induced abortion compared to their counterparts. Moreover, women with primary education (AOR = 1.27; 95% CI:1.11-1.46) and those who watch television once a week (AOR = 1.29; 95% CI: 1.11-1.49) were more likely to terminate a pregnancy. Women with six or more children (AOR = 0.40; 95% CI: 0.31-0.52) were less likely to terminate a pregnancy compared to those with no child.

CONCLUSION

The study revealed that a minority of the women had induced abortions. The prevalence of induced abortion did not change over time. Induced abortion was influenced by age, marital status, employment status, education, parity, and exposure to mass media. Therefore, policies and programs to reduce unwanted pregnancies should focus on increasing access to modern contraceptives among women of lower socio-economic status.

Association of alcohol consumption with abortion among ever-married reproductive age women in Ethiopia: A multilevel analysis

Background

A miscarriage or a spontaneous loss of a pregnancy that occurs before the 20th week is an abortion. Even though numerous recommendations state that pregnant women should abstain from alcohol at all stages of pregnancy, alcohol intake among pregnant women is common. However, there are few papers addressing the effect of alcohol use on miscarriage using nationally representative data. Moreover, the association of alcohol use with abortion and its mechanisms is not well studied in the Ethiopian region. Therefore, the objective of the current study was to estimate the association of alcohol use with abortion rates among reproductive age (15-49) women in Ethiopia.

Methods

Using the most recent findings of the Ethiopian Demographic and Health Survey (EDHS), secondary data analysis was performed among pregnant women in Ethiopia. A total of 11,396 women between the ages of 15 and 49 years who were of reproductive age were included in the research. To characterize the study population, descriptive statistics were used. The variability was considered using the multilevel binary logistic regression model. A multilevel binary logistic model was used to determine the effect of alcohol intake on abortion while controlling for potential confounders. In the multivariable analysis, variables with a P-value of less than 0.05 were considered statistically significant for the response variable.

Results

The proportion of women who had an abortion was 10.46% with a 95% CI of 9.92-11.03. In the final model of the multilevel analysis, age group [adjusted odds ratio (AOR) = 6.13; 95% CI: 3.86-9.73], education level (AOR = 1.29; 95 and CI: 1.10-1.51), alcohol consumption (AOR = 1.38; 95% CI: 1.18-1.61), age at first sex (AOR = 1.20; 95% CI: 1.03-1.39), media exposure (AOR = 1.28, CI: 1.10-1.48), contraceptive use (AOR = 1.34, CI: 1.16-1.56), and occupation of respondent (AOR = 1.21, CI: 1.06-1.38) were identified to be significant determinants of abortion in Ethiopia.

Conclusion

Sexual and reproductive health education and family planning programs should target older women in the reproductive age group, women with primary educational status, working women, and those who initiated sexual intercourse at a younger age considering it could reduce abortion and unintended pregnancy. Furthermore, as part of sexual and reproductive health education, the adverse effect of alcohol consumption on abortion should be emphasized.

Prevalence and correlates of induced abortion: results of a facility-based cross-sectional survey of parturient women living with HIV in South Africa

BACKGROUND

There is a paucity of studies examining the prevalence and correlates of induced abortion among women living with HIV. Our study fills this gap by examining the prevalence and correlates of induced abortion among parturient women living with HIV in Eastern Cape, South Africa.

METHODS

We analysed cross-sectional survey data of the East London Prospective Cohort Study, which took place between September 2015 and May 2016 in three large maternity facilities in the Buffalo/Amathole districts of the Eastern Cape Province of South Africa. A total of 1709 parturient women living with HIV who gave birth over the study period were recruited. We carried out descriptive and inferential statistics.

RESULTS

The prevalence of induced abortion was 19% (95% CI: 17.2-20.9%), but varied by women's socio-demographic characteristics. Induced abortion prevalence was higher among women aged 25 years and over (21.4%), than among women aged less than 25 years (11.0%). Those ever married or cohabiting (26.8%) reported a higher level of induced abortion than those never-married women (15.6%). Those already diagnosed HIV positive before their index pregnancy (20.2%) had a higher prevalence of induced abortion than those diagnosed during their index pregnancy (14.1%). In the adjusted logistic regression, women were more likely to have ever induced abortion if they were ever married or cohabiting (aOR; 1.86 95% CI; 1.43-2.41), ever smoked (aOR: 1.51; 95% CI: 1.01-2.28) and diagnosed with HIV before their index pregnancy (aOR:1.44; 95% CI: 1.02-2.05) but less likely if younger than 25 years (aOR; 0.51 95% CI:0.35-0.73).

CONCLUSION

About one in five women living with HIV had ever induced abortion in the study settings, indicating that abortion service is one of the main reproductive health services needed by women living with HIV in South Africa. This is an indication that the need for abortion is somewhat high in this group of women. The finding, therefore, highlights the need for concerted efforts from all stakeholders to address the unmet need for contraception among women living with HIV to prevent unintended pregnancy.

Spatiotemporal Patterns of Adverse Pregnancy Outcomes in Rural Areas of Henan, China

The spatial patterns of adverse pregnancy outcomes (APOs) are complex, vary by place, and remain not entirely clear. This study investigated spatiotemporal patterns of APOs in rural areas of Henan, China. We used data from 1,315,327 singleton pregnancies during 2013-2016 in rural areas of Henan, China, from the National Free Pre-pregnancy Checkup Program (NFPCP). A spatiotemporal analysis of APOs was conducted based on the time of conception and current address. Results of seasonality decomposed showed a slight decline in the incidence rate of APOs (12.93% to 11.27% in the compound trend) among the participants from 2013 to 2016 and also variation in annual periodicity (peaking in autumn at 12.66% and hitting bottom in spring at 11.16%). Spatial clusters of APOs were concentrated in an intersection band of northwestern to southeastern Henan Province (with a relative risk ratio ranging from 3.66 to 1.20), the northwestern and northern portion for temporal variation (having a trend in the cluster ranged from -6.25% to 83.93). This study provides an overall picture of APOs that presented downward trends over time, seasonal fluctuation, and clustered patterns across space and over time in Henan Province-the most populated province in China. The findings of this study warrant future studies to investigate underlying influential factors of spatial variation of APOs.

Sexual violence and adverse reproductive health outcomes among youth females in North Shoa zone, Oromia, Ethiopia: A community-based cross-sectional study

Objective:

The aim of this study is to assess the magnitude of sexual violence, its adverse reproductive health outcomes, and associated factors among female youth in the Northern Shoa zone, Oromia region, Ethiopia.

Methods:

A community-based cross-sectional study design was employed among 590 female youth from 1 December to 30 January 2021. A multi-stage sampling technique and a pretested structured interviewer-administered questionnaire were used. The data were entered into EpiData version 3.1 and then transferred to SPSS 23 for analysis. Descriptive statistical analysis was done, and an association between an outcome variable and independent variables was examined in logistic regression models.

Results:

According to the study, the respective rates of sexual violence and harmful sexual reproductive consequences were 20.7% and 11.9%. Sexual violence was significantly associated with alcohol consumption (adjusted odds ratio = 2.549, 95% confidence interval = (1.548, 4.195)) and childhood exposure to inter-parental violence (adjusted odds ratio = 1.66, 95% confidence interval = (1.002, 2.888)). Rural childhood residence (adjusted odds ratio = 0.037, 95% confidence interval = (0.007, 0.192)), fathers with college degrees (adjusted odds ratio = 0.037, 95% confidence interval = (0.013, 0.106)), and readiness for first sex (adjusted odds ratio = 0.073, 95% confidence interval = (0.028, 0.189)) were all independent predictors of adverse reproductive health outcomes.

Conclusion:

In this study, young females frequently experience sexual violence and poor reproductive health outcomes. Alcohol consumption and having experienced parental conflict as a child were found to be risk factors for sexual violence, while residing contracts during childhood, the father’s level of education, and willingness to engage in the first sexual encounter were linked to adverse reproductive health outcomes.

How applicable is geospatial analysis in maternal and neonatal health in sub-Saharan Africa? A systematic review

Background

Sub-Saharan Africa (SSA) has the world's highest maternal and neonatal morbidity and mortality and has shown the slowest progress in reducing them. In addition, there is substantial inequality in terms of maternal and neonatal morbidity and mortality in the region. Geospatial studies can help prioritize scarce resources by pinpointing priority areas for implementation. This systematic review was conducted to explore the application of geospatial analysis to maternal and neonatal morbidity and mortality in SSA.

Methods

A systematic search of PubMed, SCOPUS, EMBASE, and Web of Science databases was performed. All observational and qualitative studies that reported on maternal or neonatal health outcomes were included if they used a spatial analysis technique and were conducted in a SSA country. After removing duplicates, two reviewers independently reviewed each study's abstract and full text for inclusion. Furthermore, the quality of the studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists. Finally, due to the heterogeneity of studies, narrative synthesis was used to summarize the main findings, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was strictly followed to report the review results. A total of 56 studies were included in the review.

Results

We found that geospatial analysis was used to identify inequalities in maternal and neonatal morbidity, mortality, and health care utilization and to identify gaps in the availability and geographic accessibility of maternal health facilities. In addition, we identified a few studies that used geospatial analysis for modelling intervention areas. We also detected challenges and shortcomings, such as unrealistic assumptions used by geospatial models and a shortage of reliable, up-to-date, small-scale georeferenced data.

Conclusions

The use of geospatial analysis for maternal and neonatal health in SSA is still limited, and more detailed spatial data are required to exploit the potential of geospatial technologies fully.

Individual and community-level factors of abortion in East Africa: a multilevel analysis

Background

Abortion is one of the top five causes of maternal mortality in low and middle-income countries. It is associated with a complication related to pregnancy and childbirth. Despite this, there was limited evidence on the prevalence and associated factors of abortion in East African countries. Therefore, this study aimed to investigate the prevalence and associated factors of abortion among reproductive-aged women in East African countries.

Methods

The Demographic and Health Surveys (DHS) data of 12 East African countries was used. A total weighted sample of 431,518 reproductive-age women was included in the analysis. Due to the hierarchical nature of the DHS data, a multilevel binary logistic regression model was applied. Both crude and Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was calculated for potential associated factors of abortion in East Africa. In the final model, variables with a p value < 0.05 were declared as statistically significant factors of abortion.

Results

Around 5.96% (95%CI: 4.69, 7.22) of reproductive-aged women in East Africa had a history of abortion. Alcohol use, tobacco or cigarette smoking, being single, poorer wealth index, currently working, traditional family planning methods, and media exposure were associated with a higher risk of abortion. However, higher parity, having optimum birth intervals, and modern contraceptive uses were associated with lower odds of abortion.

Conclusions

The prevalence of abortion among reproductive-aged women in East Africa was high. Abortion was affected by various socio-economic and obstetrical factors. Therefore, it is better to consider the high-risk groups during the intervention to prevent the burdens associated with abortion.

Time to Resumption of Menses, Spatial Distribution, and Predictors Among Post-partum Period Women in Ethiopia, Evidence From Ethiopian Demographic and Health Survey 2016 Data: Gompertz Inverse Gaussian Shared Frailty Model

Background

The timing of the resumption of post-partum menses is important for a woman who intends to avoid subsequent unintended pregnancy, and it has key implications on maternal, neonatal, and child health outcomes. Despite this, information is scant about the time to resumption of post-partum menses and predictors in Ethiopia. Therefore, this study aimed to determine the time it takes to start menses and spatial distribution among post-partum period women in Ethiopia and identify its predictors.

Methods

A secondary data analysis was conducted based on 2016 Ethiopian Demographic and Health Survey (EDHS). A total weighted sample of 6,489 post-partum women was included in the analysis. STATA 14 was used to weigh, clean, and analyze the data. The shared frailty model was applied since the EDHS data have a hierarchical nature. For checking the proportional hazard assumption, the Schenefold residual test, Log-Log plot, Kaplan–Meier, and predicted survival plot were applied. Akakie Information Criteria (AIC), Cox–Snell residual test, and deviance were used for checking model adequacy and for model comparison. Based on these, the Gompertz inverse Gaussian shared frailty model was the best-fitted model for this data. Variables with a p &lt; 0.2 were considered for the multivariable Gompertz inverse Gaussian shared frailty model. Finally, the adjusted hazard ratio (AHR) with a 95% confidence interval (CI), and a p &lt; 0.05 was reported to identify the significant predictors of time to the resumption of post-partum menses.

Results

The median survival time to post-partum menses resumption was 14.6 months. In this study, 51.90% [95% CI: 50.03, 53.76] of post-partum period women had resumed, and the risk of menses resumption was 1.17 times [AHR: 1.17; 95% CI: 1.03–1.33] higher among urban resident, 1.14 times [AHR: 1.14; 95% CI: 1.0–1.24] in women who had attended formal education, and 1.63 times [AHR: 1.63; 95% CI: 1.4–1.7] higher among women who used hormonal contraceptives. However, the risk of post-partum menses resumption was lower among 7–24 months breastfeeding women by 36% [AHR: 0.64; 95% CI: 0.5–0.76], women with child alive by 26% [AHR: 0.74; 95% CI: 0.6–0.85], and multiparous women by 27% [AHR: 0.73; 95% CI: 0.6–0.80].

Conclusion

Almost half of the participants had resumed post-partum menses, with the median survival timing of menses resumption at 14.5 months. Women residing in urban areas, who attended formal education, and using hormonal contraceptives have a shorter time to resume post-partum menses, whereas a woman with an alive child, breastfeeding practice, and multiple parity has a longer time to resume post-partum menses. Therefore, the healthcare providers and program managers should act on the resumption of post-partum menses through health education and promotion to cultivate the 14 months lag period identified by considering the significant factors.

Regional and residential disparities in knowledge of abortion legality and availability of facility-based abortion services in Ethiopia

Objectives

To generate regional, residential, and nationally representative estimates of knowledge of abortion legality and availability among women of reproductive age in Ethiopia, and examine how knowledge varies across regions and by urban/rural residence.

Study Design

Our study draws on data from a nationally representative, cross-sectional survey implemented in 2019 in each of Ethiopia's regional and administrative states, yielding a sample of 8,837 women aged 15 to 49. We compare weighted estimates and regional distributions of 3 outcomes: (1) general awareness and (2) correct knowledge of the abortion law, and (3) knowledge of facility-based abortion service availability.

Results

Significant regional and urban/rural disparities in knowledge of abortion legality and availability exist. Nationally, 27% of women are aware of the abortion law and just 5% of women have comprehensive knowledge of the law, while 30% know where to access facility-based abortion services. Regionally, estimates range significantly, from 2% in Somali to 45% in Addis Ababa for general awareness of the law, 0% in Afar to 27% in Harare for comprehensive knowledge of the law, and 8% in Afar to 57% in Tigray for knowledge of abortion availability. Knowledge of all measures is higher in urban than in rural areas.

Conclusions

Regional disparities in abortion knowledge may contribute to geographic inequities in access to and use of safe abortion care. Efforts to expand knowledge of abortion legality and availability are needed and should be tailored to regional contexts.

Implications

Knowledge of abortion legality and availability is imperative to protecting and expanding access to safe abortion care, especially in contexts like Ethiopia where abortion is available for multiple indications. Efforts to improve knowledge of abortion legality and availability are needed, and should be locally tailored to address regional inequities.

Regional and residential disparities in knowledge of abortion legality and availability of facility-based abortion services in Ethiopia

OBJECTIVES

To generate regional, residential, and nationally representative estimates of knowledge of abortion legality and availability among women of reproductive age in Ethiopia, and examine how knowledge varies across regions and by urban/rural residence.

STUDY DESIGN

Our study draws on data from a nationally representative, cross-sectional survey implemented in 2019 in each of Ethiopia's regional and administrative states, yielding a sample of 8,837 women aged 15-49. We compare weighted estimates and regional distributions of three outcomes: 1) general awareness and 2) correct knowledge of the abortion law, and 3) knowledge of facility-based abortion service availability.

RESULTS

Significant regional and urban/rural disparities in knowledge of abortion legality and availability exist. Nationally, 27% of women are aware of the abortion law and just 5% of women have comprehensive knowledge of the law, while 30% know where to access facility-based abortion services. Regionally, estimates range significantly, from 2% in Somali to 45% in Addis Ababa for general awareness of the law, 0% in Afar to 27% in Harare for comprehensive knowledge of the law, and 8% in Afar to 57% in Tigray for knowledge of abortion availability. Knowledge of all measures is higher in urban than in rural areas.

CONCLUSIONS

Regional disparities in abortion knowledge may contribute to geographic inequities in access to and use of safe abortion care. Efforts to expand knowledge of abortion legality and availability are needed and should be tailored to regional contexts.

IMPLICATIONS

Knowledge of abortion legality and availability is imperative to protecting and expanding access to safe abortion care, especially in contexts like Ethiopia where abortion is available for multiple indications. Efforts to improve knowledge of abortion legality and availability are needed, and should be locally tailored to address regional inequities.

Determinants of abortion among youth 15-24 in Ethiopia: A multilevel analysis based on EDHS 2016

INTRODUCTION

Determinants of the magnitude of abortion among women of diverse social and economic status, particularly in Africa poorly understood because of the missing information in most countries. In this study, we addressed abortion and its determinants among youth women of 15-24 ages to provide clear direction for policymaking in Ethiopia.

METHODS

We examined the 2016 Ethiopian demographic health survey data downloaded from the EDHS website after obtaining permission on abortion among 15-24 age women. We applied bivariate and multilevel binary logistic regression. Community and Individual level abortion predictors passed through a three-level binary logistic regression analysis where we used p-value <0.05 and adjusted odds ratios (AOR) with 95% confidence intervals (CI).

RESULT

The abortion among the youth population in this study was 2.5%. Factors associated with pregnancy were age group 20-24 2.5(1.6-3.8), youth with one birth 0.65(0.44-0.96), youth with 2-5 births 0.31(0.18-0.55), age ≥18 0.50(0.33-0.76), married 38(17-84), divorced 20(7-55), birth in the last five years 0.65(0.44-0.96), middle wealth youth 1.7(1.0.4-2.8), being in Amhara0.31(0.11-0.85), and 0.30(0.12-0.77).

CONCLUSION

Less abortion occurred in economically poor youths. It is a noble finding; however, the access problem might lead to the result. We observed more abortions in age <18years; those have not given birth until the data collection date. It portrays forth clear policy direction for politicians and all other stakeholders to intervene in the problem. The analysis also showed abortion increased with age. It shows that as age increased, youths disclose abortion which is rare at an early age, and again given an essential clue for the next interventions. The fact in this study is both age and marriage affected abortion similarly. It might be because of various culture-related perceptions where it is not appropriate for an unmarried woman to appear with any pregnancy outcome as the reason behind the decreased number of abortions at a younger age. Thus, more attention is required during implementation for unmarried and lower age youth regardless of the magnitude of the abortion.