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

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          Abstract

          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.

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          Most cited references 26

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          Timing of steps and reasons for delays in obtaining abortions in the United States.

          We studied the steps in the process of obtaining abortions and women's reported delays in order to help understand difficulties in accessing abortion services. In 2004, a structured survey was completed by 1209 abortion patients at 11 large providers, and in-depth interviews were conducted with 38 women at four sites. The median time from the last menstrual period to suspecting pregnancy was 33 days; the median time from suspecting pregnancy to confirming the pregnancy was 4 days; the median time from confirming the pregnancy to deciding to have an abortion was 0 day; the median time from deciding to have an abortion to first attempting to obtain abortion services was 2 days; and the median time from first attempting to obtain abortion services to obtaining the abortion was 7 days. Minors took a week longer to suspect pregnancy than adults did. Fifty-eight percent of women reported that they would have liked to have had the abortion earlier. The most common reasons for delay were that it took a long time to make arrangements (59%), to decide (39%) and to find out about the pregnancy (36%). Poor women were about twice as likely to be delayed by difficulties in making arrangements. Financial limitations and lack of knowledge about pregnancy may make it more difficult for some women to obtain early abortion.
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            Risk factors associated with presenting for abortion in the second trimester.

            To determine factors associated with delay of induced abortion into the second trimester of pregnancy. Using audio computer-assisted self-interviewing, 398 women from 5 to 23 weeks of gestation at an urban hospital described steps and reasons that could have led to a delayed abortion. Multivariable logistic regression identified independent contributors to delay. Half of the 70-day difference between the average gestational durations in first- and second-trimester abortions is due to later suspicion of pregnancy and administration of a pregnancy test. Delays in suspecting and testing for pregnancy cumulatively caused 58% of second-trimester patients to miss the opportunity to have a first-trimester abortion. Women presenting in the second trimester experienced more delaying factors (3.2 versus 2.0, P < .001), with logistical delays occurring more frequently for these women (63.3% versus 30.4%, P < .001). Factors associated with second-trimester abortion in logistic regression were prior second-trimester abortion, delay in obtaining state insurance, difficulty locating a provider, initial referral elsewhere, and uncertainty about last menstrual period. Factors associated with decreased likelihood of second-trimester abortion were presence of nausea or vomiting, prior abortion, and contraception use. Abortion delay results from myriad factors, many of them logistical, such as inappropriate or delayed referrals and delays in obtaining public insurance. Public health interventions could promote earlier recognition of pregnancy, more timely referrals, more easily obtainable public funding, and improved abortion access for indigent women. However, accessible second-trimester abortion services will remain necessary for the women who present late due to delayed recognition of and testing for pregnancy. II-2.
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              The Estimated Incidence of Induced Abortion in Ethiopia, 2008

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                Author and article information

                Affiliations
                [ ]Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark
                [ ]Department of Obstetrics and Gynaecology, Jimma University Specialized Hospital, Jimma, Ethiopia
                Contributors
                kristineivalu@gmail.com
                negussiedereje@yahoo.co.uk
                vrasch@health.sdu.dk
                Journal
                BMC Pregnancy Childbirth
                BMC Pregnancy Childbirth
                BMC Pregnancy and Childbirth
                BioMed Central (London )
                1471-2393
                19 December 2014
                19 December 2014
                2014
                : 14
                : 1
                416
                10.1186/s12884-014-0416-9
                4307197
                25524287
                © Bonnen et al.; licensee BioMed Central. 2014

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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                Research Article
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                © The Author(s) 2014

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