The Magnitude and factors associated with repeat Induced Abortion in - PowerPoint Presentation

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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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Presentation

outlineIntroductionObjectivesMethods and materialsResult and discussionLimitationsConclusion and implications3/23/20192

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Introduction (

1#3)Unsafe abortion- 14 % of maternal deaths in Africa5-6% in EthiopiaIn 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,2008Despite 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).

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Introduction

(2#3)Lots of efforts done in Ethiopia so farLiberalization of the national abortion lawProportion 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)

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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 abortionContributes for high magnitude of repeated induced abortionDespite the high magnitude, there is scarcity of Evidence on factors associated with repeat induced abortions in Ethiopia.3/23/20195

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Objectives

General objectivesTo asses the magnitude and factors associated with repeat Induced Abortion in Debre Markos town health institutions , Amhara Regional State, Ethiopia.Specific objectivesTo determine the magnitude of repeated induced abortionTo identify factors associated with repeated induced abortion

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Methods and materials (1#3)

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Methods and materials (2#3)

3/23/20198Sample size and sampling techniqueA total of 567 participants included in the studyBoth private public health institutions were involvedMulti stage sampling technique was used to select the sampling populationMeasurements:Induced abortionRepeated induced abortion

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Methods and materials (3#3)

Used interviewer administered questionnaireData quality was assuredBinary logistic regression was employed with STATA 14 Ethical issues was affirmed3/23/20199

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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 years42.6% of the participants were in the age group of 20-24 yearsAbout half, 73.8%). %, of participants were single Regarding religion ; the majority (

89.6%), of participants were Orthodox

Urban residents (82.6%),

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Result and discussions (1#10)

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Result and discussion (1#10)

Magnitude of repeated induced abortionAmong 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% (Getachew etal, 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

)..

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Result and discussion (2#10)

This may be due to: the liberalized abortion law in Ethiopiathe illegality or the highly restrictive abortion law in Kenya and Nigeriamay led women to under report or it may led women to seek abortion care service elsewhere. 3/23/201912

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Results and discussion

(3#10)Factors Associated with repeated induced abortionNo education and less educatedStudentsUrban residentsMultiple sexual partner Use of alcoholVictims of physical violence were significantly associated with repeated induced abortion.

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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 (Getachew eta’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).

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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 service3/23/2019

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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 (Getachew eta’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.

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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.

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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.

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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. 3/23/201919

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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 abortion3/23/201920

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Conclusion

The magnitude of repeat induced abortion in Debre Markos 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.3/23/201921

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IMPLICATIONS

Investing on women education at the grass root levelAwareness 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 PAC3/23/2019

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23THANK YOU ALL!