Safe abortion service utilization and associated factors among insecurely housed women who experienced abortion in southwest Ethiopia, 2021: A community-based cross-sectional study

Prevalence and determinants of pregnancy termination for childbearing women using the modified Poisson regression model: a cross-sectional study of the Tanzania Demographic and Health Survey (TDHS) 2022

BACKGROUND

Termination of pregnancy continues to be one of the major public health problems. The prevalence and determinants associated with pregnancy termination among women from low-middle income countries such as Tanzania have previously not been thoroughly investigated. Therefore, this study aims to explore the prevalence and determinants associated with pregnancy termination among Tanzanian women.

METHODS

Data for this study was extracted from the 2022 Tanzania Demographic and Health Survey (TDHS). A total of 15,254 women aged 15-49 years, clustered in selected enumerated areas, participated in the survey. A modified Poisson regression model with sampling weights was used to find the factors that are associated with pregnancy termination.

RESULTS

The prevalence of pregnancy termination was 14.3% (95% CI: 13.81-14.75%). Our findings reveal that several factors are significantly associated with pregnancy termination. In particular, women's age, level of education, marital status, history of pregnancy losses, wealth status, attempt to delay or avoid getting pregnant outside the ideal birth spacing, and recent internet use, total children ever born, desire for more children, were significantly associated with pregnancy termination. Women who reside in rural areas, those covered by health insurance and those using contraceptives had a significantly lower likelihood of terminating pregnancy compared to their counterparts.

CONCLUSIONS

The findings highlighted that the prevalence of terminating pregnancy is alarming in Tanzania, signaling a significant public health challenge. To address the concerning rates of pregnancy termination, the government of Tanzania and other institutions are advised to enhance the accessibility and quality of healthcare services for women, particularly in rural and underserved areas. Bridging socio-economic inequalities and removing geographic barriers to healthcare access will ensure women receive timely and adequate support.

Factors associated with pregnancy termination in six sub-Saharan African countries

Pregnancy termination continues to be a leading cause of maternal morbidity and mortality among young women in Africa. The sub-Saharan Africa region has the highest rate of abortion-related deaths in the world, at 185 maternal deaths per 100,000 abortions. The aim of this study is to investigate the factors associated with pregnancy termination among women aged 15 to 29 years in six sub-Saharan African countries. We used secondary data from the most recent Demographic and Health Survey of six sub-Saharan African countries: Kenya, Tanzania, Ethiopia, Burundi, Nigeria, and Rwanda. A total weighted sample of 74,652 women aged 15-29 were analyzed. A multivariable logistic regression model was used to identify the factors associated with pregnancy termination at a p-value < 0.05. Results were presented using adjusted odds ratios (AOR) with 95% confidence interval. The study showed that 6.3% of women aged 15-29 reported pregnancy termination with a higher prevalence rate in Tanzania (8.8%) and lowest in Ethiopia (4%). Highest odds of pregnancy termination occurred among women aged 20-24 as compared to women aged 15-19 in Rwanda (AOR: 4.04, 95%CI 2.05, 7.97) followed by Nigeria (AOR: 2.62, 95% CI 1.99, 3.43), Kenya (AOR: 2.33, 95%CI 1.48, 3.66), Burundi (AOR: 1.99 95%CI 1.48, 2.85), Tanzania (AOR: 1.71 95%CI 1.29, 2.27), and Ethiopia (AOR: 1.69, 95% CI 1.19, 2.42). Women with no education had 4 times higher odds of pregnancy termination compared to women with higher education in Tanzania (AOR: 4.03 95%CI 1.00, 16.13) while women with no education and primary level education were 1.58 times (AOR: 1.58 95% CI 1.17, 2.13) and 1.78 times (AOR: 1.78 95% CI 1.34, 2.37) as likely to terminate pregnancy in Ethiopia. In Tanzania, the likelihood of a pregnancy termination was associated with a relationship to the household head; head (AOR: 3.66, 95% CI (2.32, 5.78), wife (AOR: 3.68, 95% CI 2.60, 5.12), and in-law (AOR:2.62, 1.71, 4.03). This study revealed that a significant number of women had pregnancy termination. Being in the age group of 20-24 & 25-29, having a lower level of education, being a domestic employee and professional, being single/never-in-union, being in the poorest and richer wealth quantile category, and being head, wife, daughter, and in-law to the household head were the significantly associated with pregnancy termination. Taking these socio-economic factors into consideration by stakeholders and specific sexual education targeted to women aged 15 to 29 would help tackle the problem.

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.