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The Magnitude and factors associated with repeat Induced Abortion in Debre

The Magnitude and factors associated with repeat Induced Abortion in Debre Markos town health institutions , Amhara Regional State, Ethiopia. By: Tewodros Seyoum (Ass.Prof of midwifery, PhD fellow) April 4-6/2019.

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The Magnitude and factors associated with repeat Induced Abortion in Debre

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  1. The Magnitude and factors associated with repeat Induced Abortion in Debre Markos town health institutions , Amhara Regional State, Ethiopia. By: Tewodros Seyoum (Ass.Prof of midwifery, PhD fellow) April 4-6/2019

  2. Presentation outline • Introduction • Objectives • Methods and materials • Result and discussion • Limitations • Conclusion and implications

  3. Introduction (1#3) • Unsafe abortion- 14 % of maternal deaths in Africa • 5-6% in Ethiopia • In 2014, an estimated 620,300 abortions were performed in Ethiopia ( Ipas,2016) • Associated with adverse effects (Thorp JM,eta’l,2003, Heikinheimo O eta’l,2008 • Despite the adverse effects on health, a significant proportion of women procure more than one abortion during their reproductive lifetime. • 16 %) Kenya ( (Maina et al.,2015) • 40%) in Sudan (Kinaro J, et al.,2009) • 30%- 33.6% in Ethiopia (), (Getachew et al.,2014, Bethelihem A. et al, 2015).

  4. Introduction (2#3) • Lots of efforts done in Ethiopia so far • Liberalization of the national abortion law • Proportion of post abortion care increased nationally (36% to 56% ) (Ipas, 2014) . • ICPDP program of Action states that: “In no case should abortion be promoted as a method of family planning” (Ashford, 2004). • But younger women in Ethiopia who want to space births are using induced abortion (Ipas, 2010)

  5. Introduction (3#3) • Vast majority of adolescents seeking legal abortion or post abortion care were not using a family planning method (20-25% (Ipas, 2018 ) • Contributes of high unplanned pregnancy after safe abortion • Contributes for high magnitude of repeated induced abortion • Despite the high magnitude, there is scarcity of Evidence on factors associated with repeat induced abortions in Ethiopia.

  6. Objectives General objectives • To asses the magnitude and factors associated with repeat Induced Abortion in DebreMarkos town health institutions , Amhara Regional State, Ethiopia. Specific objectives • To determine the magnitude of repeated induced abortion • To identify factors associated with repeated induced abortion

  7. Methods and materials (1#3)

  8. Methods and materials (2#3) Sample size and sampling technique • A total of 567 participants included in the study • Both private public health institutions were involved • Multi stage sampling technique was used to select the sampling population Measurements: • Induced abortion • Repeated induced abortion

  9. Methods and materials (3#3) • Used interviewer administered questionnaire • Data quality was assured • Binary logistic regression was employed with STATA 14 • Ethical issues was affirmed

  10. Result and discussions (1#10) Socio demographic characteristics • A total 547 participants were participated in the study with the response rate of 96.5%. • The mean age of the participants was found to be 23.98 years + SD 4.27 years • 42.6% of the participants were in the age group of 20-24 years • About half, 73.8%). %, of participants were single • Regarding religion ; the majority (89.6%), of participants were Orthodox • Urban residents (82.6%),

  11. Result and discussion (1#10) Magnitude of repeated induced abortion • Among 547 participants, 191 (34.9%), 95% CI [30.7, 38.8], had at least one previous abortion. • This finding is comparable with the other studies done in Addis Ababa, 31% and 33.6% (Getachewetal, 2014, Bethelihem A. et al.,2015). • But higher than the study done in Kenya(16%) (Beatrice W. et al.,2015)) and Nigeria((23%) (Lamina, 2015)..

  12. Result and discussion (2#10) This may be due to: • the liberalized abortion law in Ethiopia • the illegality or the highly restrictive abortion law in Kenya and Nigeria • may led women to under report or it may led women to seek abortion care service elsewhere.

  13. Results and discussion (3#10) Factors Associated with repeated induced abortion • No education and less educated • Students • Urban residents • Multiple sexual partner • Use of alcohol • Victims of physical violence were significantly associated with repeated induced abortion.

  14. Results and discussion (4#10) • The odds of having repeated induced abortion were in women with educational level of primary and secondary were 5.46 (AOR=5.46, 95%CI:2.06-14.47) times than those who had an educational level of more than secondary. • This finding is consistent with the study in Ethiopia, Kenya, Monastir (Tunisia),Georgia, and Russia (Getacheweta’l, 2014, BeatriceW.et al., 2015), Sana El., (2015) , Ekaterine PP, 2016, Keenan K, 2014). • This could be due to the poor knowledge of contraception and use among those with a lower educational level (primary and secondary).

  15. Results and discussion (5#10) • Urban residents had a 5(AOR=5.14, 95%CI:2.29-11.53) time higher risk of having repeated induced abortion than rural residents. • This finding is consistent with the study done in Kenya (Caroline W., 2016) • This may be due to: • Urban women are more prone to adopting Western values, embraced sexual freedom, getting in a high risk activities than their rural counter parts. • The other explanation could be, rural residents may not travel to urban area to get an abortion service

  16. Results and discussion (6#10) • Those who had multiple sexual partner were 6.16 (AOR=6.16, 95%CI; 3.25, 11.68) times more likely to report of having a repeated induced abortion than those who did not. • This finding is consistent with the study done in Addis Ababa, Ethiopia and in Britain (Getacheweta’l, 2014, Nicole eta’l, 2011). • This could be due to being in an unstable relationship, which in turn may lead women not to use contraceptive on a regular basis.

  17. Results and discussion (7#10) • The odds of having repeated induced abortion in participants who had used alcohol had were 2.7 (AOR=2.77, 95% CI: 1.52-5.05) times than non users . • This finding is consistent with the research done in USA and Russia (Prager SW et al., 2007, Keenan K, 2014). • This may be due to : • Because of the impact of alcohol on logical thinking of women, which might lead them to have unprotected sex. • The other explanation could be some men might use alcohol to take advantage of women by using alcohol.

  18. Results and discussion (8#10) • The odds of having repeated induced abortion among respondents who had a history of physical violence by a male partner had a 2.6 (AOR=2.68, 95%CI: 1.45-4.94) times higher than those who did not have a history of physical violence. • This result is consistent with the studies done in Tunisia and Canada, Ontario(William A. Fisher, 2005, Sana El Mhamdi, (2015) ). • This could be due to: • Fear of telling her male partner about the pregnancy • The other explanation could be lack of control over decision making on the outcome of pregnancy. • It could also be due to male partner influence on use of contraceptive while the woman wants to avoid pregnancy.

  19. Results and discussion (9#10) • The odds of having repeated induced abortion among students were a 2.6 (AOR=2.62, 95%CI:1.06-6.45) times than those who were unemployed. • This may due to : • Because of not having the financial freedom may get them to be more vulnerable which could made them a target for richer and older men who want to use this as an advantage.

  20. limitations • The main limitation in this study was that the information on repeat abortion was relied on participants self-report. • Due to the sensitivity of this issue, participants may tend to under report history of past abortion

  21. Conclusion • The magnitude of repeat induced abortion in DebreMarkos town health institutions was found to be high. • Being less educated, urban residents, multiple sexual partner, reason for abortion, use alcohol, and victims of physical violence were significantly associated with repeated induced abortion.

  22. IMPLICATIONS • Investing on women education at the grass root level • Awareness creation on violence better and sexual health be made through mass media and health education programs. • Create an illegal drug free school environment. • Providers should assess the risk of violence and history of alcohol exposure and sexual history • Apply the principles PAC

  23. THANK YOU ALL!

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