Pooled prevalence and associated factors of pregnancy termination among youth aged 15–24 year women in East Africa: Multilevel level analysis

Abstract

Background Most of unwanted pregnancies among adolescent girls and young women (AGYW) in Africa result in pregnancy termination. Despite attempts to enhance maternal health care service utilization, unsafe abortion remains the leading cause of maternal death in Sub-Saharan Africa (SSA), there is still a study gap, notably in East Africa, where community-level issues are not studied. Therefore, this study aimed to assess pooled prevalence pregnancy termination and associated factors among youth (15–24 year-old) women in the East Africa. Methods The study was conducted based on the most recent Demographic and Health Surveys (DHS) in the 12 East African countries. A total weighted sample of 44,846 youth (15–24) age group women was included in this study. To detect the existence of a substantial clustering effect, the Intra-class Correlation Coefficient (ICC), Median Odds Ratio (MOR), and Likelihood Ratio (LR)-test were used. Furthermore, because the models were nested, deviance (-2LLR) was used for model comparison. In the multilevel logistic model, significant factors related to pregnancy termination were declared using Adjusted Odds Ratios (AOR) with a 95%Confidence Interval (CI) and p-value of 0.05. Result The pooled prevalence of pregnancy termination in East African countries was 7.79% (95% CI: 7.54, 8.04) with the highest prevalence in Uganda 12.51% (95% CI: 11.56, 13.41) and lowest was observed in Zambia 5.64% ((95% CI: 4.86, 6.41). In multilevel multivariable logistic regression result, age 20–24 [AOR = 1.93; 95% CI: 1.71, 2.16], media exposure [AOR = 1.22; 95% CI: 1.12, 1.34], married [AOR = 1.32, 95% CI: 1.21, 1.43], had working [AOR = 1.13; 95% CI: 1.04, 1.23],no education[AOR = 3.98, 95% CI: 2.32, 6.81], primary education [AOR = 4.05, 95% CI: 2.38, 6.88], secondary education [AOR = 2.96, 95% CI: 1.74, 5.03], multiparous [AOR = 0.85; 95%CI: 0.79, 0.93], sexual initiation greater or equal to 15 [AOR = 0.82; 95%CI: 0.74, 0.99] were significantly associated with pregnancy termination. Conclusion The pooled prevalence of pregnancy termination in East Africa was high in this study. Maternal age, marital status, education status, parity, age at first sex, media exposure, working status and living countries were significantly associated with pregnancy termination. The finding provides critical information for developing health interventions to decrease unplanned pregnancies and illegal pregnancy termination.

Induced abortion in Africa: A systematic review and meta-analysis

“…Our meta-regression analysis showed that women with primary and secondary education were 3 times more likely to undergo induced abortion than their counter parts. This finding is consistent with studies conducted in East Africa, Sierra Leone, Iran, and Nepal [ 68 , 70 , 72 , 78 ]. However, there is a contrary finding from a study conducted in China [ 79 ], which reported a lower prevalence of induced abortion among women with higher educational status.…”

“…In this study, unmarried women were 4.49 times more likely to develop induced abortion than their counter part. Studies conducted in East Africa, Sierra Leone, and China have reported contrary result [ 68 , 70 , 79 ]. The discrepancy could be the cultural and social norms surrounding marriage and sexuality in these different regions.…”

“…The result of this study is much higher than the studies carried out in the Globe and Ethiopia with the same study design, which revealed 5.81% and 5.06% [66,67] respectively. Similarly, studies conducted in East Africa, worldwide in 2010-14, Sierra Leone, Indonesia, Iran, Turkey, Ethiopia, and Australia revealed that 7.79%, 35 abortions occurred annually per 1000 women, 9%, 42.5 abortions per 1,000 women, 3.8%, 10.9%, 23 per 1,000 women and 2.1/100 women [68][69][70][71][72][73][74][75] respectively. The difference might be due to the difference in study design, sample size, cultural, social, religious norms related to abortion, and access to reproductive health service including family planning and safe abortion.…”

Educational attainment, media and pregnancy termination among women of reproductive age in Ghana

“…Globally, between 2015 to 2019, it was estimated that 121 million unplanned pregnancies occurred per year. About 60% of the unplanned pregnancies and 29% of all pregnancies were terminated (Hailegebreal, Enyew, Simegn, Seboka, Gilano, Kassa, et al 2022).…”

Prevalence of pregnancy termination and associated factors among married women in Papua New Guinea: a nationally representative cross-sectional survey

“…Nearly half (45.2%) of all pregnancy terminations occurred in the Highlands region. Women aged [35][36][37][38][39][40][41][42][43][44], not working (aOR = 6.17; 95% CI: 2.26-16.85), owned a mobile phone (aOR = 3.77; 95% CI: 1.60-8.84), and lived in urban areas (aOR = 5.66; 95% CI: 1.91-16.81) were more likely to terminate a pregnancy. Women who experienced intimate partner violence (IPV) were 2.27 times (aOR = 2.27; 95% CI: 1.17-4.41) more likely to terminate a pregnancy compared to those who did not experience IPV.…”