Knowledge, Attitude and Practice towards Induced Abortion and Associated Factors among Female students in Yebu Secondary School, Jimma zone, South West Ethiopia
Rahel Yaecob1, Deriba Abera2 and Asrat Meleko3
1Department of Midwifery, MizanTepi University, Ethiopia
2Department of Public Health, Jimma University, Ethiopia
3Department of Public Health, Mizan-Tepi University, Ethiopia
Submission: June 01, 2018;Published: July 10, 2018
*Corresponding author: Asrat Meleko, Department of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Teferi, Ethiopia, Tel: +251-941-9897-97; Email email@example.com
How to cite this article: Rahel Y, Deriba A,Asrat M. Knowledge, Attitude and Practice towards Induced Abortion and Associated Factors among Female
students in Yebu Secondary School, Jimma zone, South West Ethiopia. Glob J Reprod Med. 2018; 5(2): 555659.DOI:10.19080/GJORM.2018.05.555659.
Background: Induced abortion is considered to be the intentional termination of pregnancy before the fetus can live independently which might be in unsafe manner. Unsafe abortion is one of the three leading causes of maternal mortality globally. In Africa, unsafe abortion accounts for more than a quarter of causes for maternal deaths. Ethiopia is one of the east African countries with highest incidence of unsafe abortion.
Objective: The main objective of this study was to assess knowledge, Attitude and Practice of female students at Yebu secondary school towards induced abortion and associated factors.
Method: Cross-sectional study was conducted in Yebu secondary school female students from May to June, 2016. The students were selected by systemic random sampling technique. The data was collected using self-administered questionnaires. The data was entered and analyzed using SPSS software. Chi-square (χ2) test was used to look for association of variables.
Results: More than half, 110 (55.5%), of respondents knew at least one methods of abortion and 188 (94.9%) of them knew at least one type of abortion complication. From the total respondents 32 (16.2%) of them had sexual intercourse at least once. Only 5(2.5%) of respondents had induced abortion before. Marital status and family income has statistical association with knowledge towards induced abortion.
Conclusion: More than 70% of the respondents were lacking knowledge and had negative attitude towards induced abortion. Therefore, it would be better to disseminate health education to increase awareness and knowledge regarding induced abortion.
Keywords: Induced abortion; Maternal mortality; Female students; Jimma zone; Ethiopia; Unsafe abortion; Cross-sectional; Fetus; Adolescent girls; Single women; Infertility; Pelvic inflammatory disease; Morbidity; Inclusion criteria; Exclusion criteria; Population; Random sampling technique; Socio-demographic; Sexual practice; Condom; Sexual partner; Chi-square (χ2) test
Abbreviations WHO: World Health Organization; RTI: Reproductive Tract Infections; JUSRP: Jimma University Student Research Programme
Induced abortion is considered to be the intentional termination of a pregnancy before the fetus can live independently. Induced abortion may be commenced voluntarily based on a woman’s personal choice due to various reasons or it may be commenced in-order to preserve the health or save the life of a pregnant woman . Different studies showed that most induced abortions takes place in unsafe manner. Based on World Health Organization (WHO) definition unsafe abortion is a procedure for terminating an unintended pregnancy carried out either by persons lacking the necessary skills or in an environment that does not comply with minimal medical standards or both . Abortion is the major reproductive problem that affects all women of reproductive age group especially young women and adolescent girls who may prefer induced abortion than other ways. Unsafe abortion is more common among single women,
teenagers, students and factory workers . It is confirmed
that unsafe abortion has been one of the three leading causes
of maternal mortality along with hemorrhage and sepsis from
childbirth along with thousands of disabilities like reproductive
tract infections (RTI), pelvic inflammatory disease and infertility.
Each year, approximately 21 million unsafe abortions are
performed worldwide with a number of negative consequences
World health organization (WHO) estimates revealed
that about 25.0% of all pregnancies globally end in induced
abortion, which means approximately 50 million each year.
Of these abortions, about 20 millions are being performed
under dangerous conditions, either by untrained providers or
using unsafe procedures, or both . Globally, the commonly
reported reason for having an induced abortion is to post pone
child birth. The other factors identified are socio economic
concerns including disruption of education or employment,
lack of support from family, desire to provide schooling for
existing children, poverty, unemployment or inability to afford
additional child . Even if maternal mortality declined over
the past two decades, it has been a serious global problem
and unsafe abortion is unquestionably one of the main causes
of maternal mortality. Complications from unsafe abortion
accounted for estimated 13% of all maternal deaths worldwide
in both years. In United States alone legally induced abortion
contributed for 0.6 death /100,000 . In developing countries,
attitudes are often negative (rejection) and the treatment of
abortion complications is delayed, providing evidence of a nonacceptability
to health professionals of treating women admitted
for abortion complications. Deaths as a result of unsafe abortions
in developing countries are estimated at 80, 000 annually, i.e.
400 deaths per 100, 000 abortions. Although over the past 10
years there have been improvements in the safety of the abortion
procedures used and access to treatment for complications for
some women in developing countries, the number of women
requiring treatment for serious complications of unsafe abortion
remains very high and many women never receive care at all .
Guttmacher institute 2012 of estimated 40 million abortions
take place annually in developing country; many are unsafe
and result in serious complications. Half of the abortion in the
world are unsafe and nearly all unsafe abortion (98%) occur
in developing. 56% of all abortion in developing country are
unsafe. In 2008 alone 38 million abortions were performed in
developing countries . Failure to recognize the cause and
the consequences of unsafe abortion takes greatest toll on
developing countries women, because all most all maternal
death from unsafe abortion takes place in developing countries
. Ethiopia is one of the east African countries with highest
incidence of unsafe abortion. In Africa different studies indicate
unsafe abortion accounts for more than a quarter of causes of
maternal deaths. The burden of unsafe abortion on women,
their families and communities and all the limited resources
of the Ethiopian health system are enormous. It is also the
leading cause of maternal mortality and morbidity. Despite all
effort to promote modern family planning in service Ethiopia
demonstrate alarming increase in incidence of unwanted
pregnancy, incomplete and septic abortions particularly among
To undertake appropriate intervention regarding problems
associated with induced abortion it is important to have
adequate baseline data. However, there was no study conducted
before which reveal the status of knowledge, attitude and
practice towards induced abortion among Yebu secondary
school female students. Therefore, this study would be carried
out to assess knowledge on induced abortion, attitudes towards
induced abortion and abortion law and their previous practice.
The study would provide base line information for further study
on the problem and feasible recommendation would be given for
stakeholders who had been involved in this sector.
This study was conducted in Yebu secondary school from
May to June, 2017. Yebu secondary school is found in Yebu town
which is about 25 km away from Jimma town on the way to
Agaro. The town has one high school with a total number of 418
female students and one health center. Yebu town is the capital
city of Manna woreda of Jimma zone with a climate of Woinadega
and altitude of 1600-1700 m above sea level.
To determine the sample size the 95% level of confidence,
5% margin of error and proportion of (P=50%) were used. Based
on this assumption, the actual sample size for the study was
calculated using single population proportion formula. Since the
total population was less than 10,000, where the total number
of female students was 418, correction formula was used to
calculate the actual sample size. Finally, the total sample size
including the non response rate was decided to be 220 female
A stratified systemic random sampling technique was used to
select appropriate sample. First the students were stratified by
their grade and the same grade of different shifts was combined
together. Then the required sample was taken from each stratum
proportional to their size. From each stratum students were
selected using systematic random sampling technique.
The data collection tool used in this study was self
administered questionnaire. The data was collected by trained
health officer intern students using. Sampled students from each
class were informed about the confidentiality of the study while
distributing and collecting questionnaires.
The dependent variables in this study were knowledge,
attitude and practice of female students towards induced
abortion. Whereas socio-demographic condition of respondents,
history of sexual practice, condomuse and number of sexual
partner are some of the independent variables.
Induced abortion: Interference with provable concepts
with the aim of termination of pregnancy
Unsafe abortion: Abortion technique that lack or inadequate
skill of provider, hazardous technique and unsanitary conditions.
Knowledge: In this study knowledge used for explaining
awareness of students about induced abortion.
Attitude: In this study attitude was used to describe the
views of students towards induce abortion.
Practice: Practice used to describe any experience of
abortion among female students included in this study.
Knowledge scores: In this study “Good knowledge”
represents that respondents who answered 70% and above of
the statement on knowledge questions, while “Poor knowledge”
represents those who answered below 70% of the statement on
Attitude scores: In this study “Favorable (positive)” attitude
was for those who answer 70% and above of the statement on
attitude, whereas “Unfavorable (negative)” attitude was for
those who answer below 70% of the statement on attitude.
Collected data was cleaned, edited and checked for
completeness and consistency. The data was processed using
SPSS software. To look for association of socio demographic
characteristics with knowledge, attitude and practice of
respondentschi-square (χ2) test was used (P<0.05). The final
result was presented by frequency tables and graphs.
The principal investigators made routine and onsite
supervision for the completeness and consistency of data
collected by each data collectors. All materials used for data
collection was arranged sequentially. Training was given for data
collectors and supervisors prior to actual data collection time.
Formal letter was written from Jimma University student
research programme (JUSRP) to Yebu secondary school in order
to conduct the study. The objective of the study was discussed with
the students and staff members to obtain desired cooperation.
In addition to this, willingness of the school members was
requested to give necessary information during data collection.
Consent from female students was obtained orally and they were
informed regarding confidentiality of any information.
Out of the total, 220, estimated sample size, 198 respondents
had finished the provided questionnaire completely. Nine (9)
questionnaires were discarded because of inconstancy and
incompleteness, while 13 students were refused to participate in
the study. Hence the response rate in this study was 90%.
Majority, 196 (98.9%), of respondents were found in the age
range of 15-19 years. Regarding religion almost all, 193 (97.5%),
of them were Muslims. Majority, 195 (98.5%), of the respondents
were single and 194 (96.0%) of them were found to be Oromo
Ethnic group. Majority, 194 (98.0%), of respondents have family
with income level of below 2950 birr per month (Table 1).
From the total study participants more than half, 110
(55.5%), of them knew at least one method of abortion.
Majority, 188 (94.9%), of the respondents knew at least one
type of complication of abortion and most, 80 (40.4%), of them
described hemorrhage (bleeding) as one of the complication
which might cause due to unsafe abortion. Only 29 (14.6%) of
respondents were aware about the legal status of abortion in
Ethiopia (Table 2).
Twelve (12) questions were prepared to assess overall
knowledge of respondents towards induced abortion.
Accordingly, only 18 (9.1%) of students had good knowledge on
induced abortion. On the contrary majority, 180 (90.9%), of them
had poor knowledge regarding induced abortion. According to
the finding marital status of respondents (P=0.00), and income
status of students’ family (P=0.000) were found to be statistically
significant with overall knowledge of respondents towards
induced abortion. The other factors including grade of students
(P=0.337) and their religion (P=0.364) were not associated with
their knowledge towards induced abortion (Table 3).
Most, 110 (55.6%), of respondents were disagreed with
legalization of abortion in Ethiopia. Majority, 166 (83.8%), of
them agreed as abortion has complication and 160 (80.8%)
responded that abortion shouldn’t done everywhere. The finding
also showed that 134 (67.7%) of the respondents disagreed that
women should decide herself to abort or not, not her family or
clinician (Table 4).
A total of 10 questions were prepared to assess the overall
attitude of respondents towards induced abortion. Based on the
calculated attitude score, majority 152 (76.8%) of respondents
had negative attitude towards induced abortion. The finding
revealed that the attitude of the students toward induced
abortions was not showed statistically significant association
with any variables including religion, marital status and their
grade (Table 5).
Among the respondents 32 (16.2%) had sexual intercourse
at least once before data collection time. Among those who
experienced sexual intercourse before, 28 (87.5%) of them
used family planning. Eleven (34.4%) of them used condom
while they had sex and 6 (54.5%) of them used condom to
prevent pregnancy, HIV/AIDS and other STIs. Reasons for induce
abortion includes still in school (40.0%) and fear of cost to raise
children (20.0%). Among those who experienced sexual inter
course 5(15.6%) of them had induced abortion. From those who
had induced abortion, 3(60%) of them were induced abortion
by health professionals and the rest 2 (40%) were induced by
non health professionals. Modern medicine was used by most,
3(60.0%), students to induce abortion (Table 6).
The World Health Organization (WHO) estimates that every
year, nearly 5.5 million African women have an unsafe abortion
. To minimize this burden associated with unsafe abortion
it is important to legalize abortion which might enhance the
provision of quality service. In addition to this improving
the knowledge, attitude and practice of females towards safe
abortion is critical. This study was intended to assess the
knowledge, attitude, practice of female students towards
induced abortion and associated factors.This study showed that
94.9% of study participants were aware of at least one type of
complication due to induced abortion.The most commonly cited
complications include, bleeding (40.4%), infection (25.3%)
and infertility (10.2%). This finding was nearly coherent with
a finding obtained in Kampala, Uganda, where most (93.1%)
of participants knew at least one complication of an induced
abortion . The variation might be occurred due to difference
in access to health information in different settings.Majority
of the respondents 55.6% opposed legalization of abortion in
Ethiopia. This finding was lower from the study conducted in
Jimma where 67% of study participants opposed its legalization
. On the contrary the result was much higher than a study
conducted in Argentina among college students where only
4.6% of study participants opposed the legalization of induced
abortion . The reason why most respondents opposed might
be religion and cultural factors which has its influence on one’s
attitude. Regarding the decision to be made to abort pregnancy,
32.3% of the respondents believed that the right of abortion was
the woman’s herself rather than her family or clinician.
The finding of this study showed that, from total respondents
participated in this only 23.2% of them had showed a positive
attitude towards induced abortion. This finding was higher
than a finding obtained in Chelia Woreda, Oromia Region,
where only 11.4% of respondents had positive attitude towards
induced abortion . The legal status of abortion would be a
key determinant of access to safe abortion. However, in this
area the proportion of individuals who had adequate awareness
about legalization of induced abortion was low. According to the
finding of this study only 29 (14.6%) of students know the legal
status of induced abortion in Ethiopia. This study was found to
be much lower than a result obtained in Nepal among medical
college students where satisfactory proportions (66.5%) of the
respondents were aware about legalization of abortion with
in the country . This might be attributed to the difference
in level of education among students in two study areas.This
study identified that among the respondents who experienced
sex, 87% of them used family planning method. The common
type of family planning method used by students was condom
(39.3%). This finding was found to be higher a result obtained in
Jimma comprehensive school where 27.2% of study participants
who had sex used family planning methods . The difference
might be due to increased awareness of HIV/AIDS transmission
prevention method resulted in use of condom more than ever
The prevalence of induced abortion in this was 2.5%. This
result was much lower than a finding obtained in Uganda
where among total participants who had terminated pregnancy
previously, 74.2% of them had undergone an induced abortion
. This might be due to the increased level of awareness on risk
of induced abortion and difference in other factors including
religious and culture in those study areas.As revealed in this
study most of the induced abortions (60%) were conducted
by health professionals. It was lower than the finding obtained
in Jimma where 84% of induced abortions were conducted by
health professionals . The variation might be due to lack of
access to health institution and economic problems.The problem
of unwanted pregnancies and induced abortion is of very large
impact to thehealth of women worldwide, but school youths are
still shown to be highly affected due various reasons. For example,
students might prefer to undertake induced abortion to avoid
having their educational aspirations terminated . The result
of this study showed that among those who experienced induced
abortion, (40%), of them stated as they are still in school which
was the main reason why the commence induced abortion.Based
on the finding of this study a significant association was found
between marital status (P=0.000), family income (P=0.000) and
overall knowledge of female students towards induced abortion.
This finding was found to be congruent with a result obtained in
Chelia Woreda, Oromia Region [11,14].
This study had showed that the study population had poor
level of knowledge about induced abortion.Also most of the
studied participants had showed unfavorable/negative attitude
toward induced abortion. Regarding practice towards induced
abortion most students were in a good condition. However,
there were students practicing sex without using any family
planning methods as a result some students tried inducing
abortion at home using local herbs. Majority of the respondents
who participated in inducing abortion gave reason for their
intervention of the pregnancy was still they were in school. Most
of the abortions were performed by health professionals using
modern medicine.Based on the finding of this study a significant
association was found between marital status, family income
and overall knowledge of female students towards induced
abortion. While any of variables were not showed a significant
association with attitude of respondents towards induced
abortion. Based on the finding of the study it was recommended
that health information should be disseminated to school about
the effect of unsafe abortion and importance of sex education
in preventing unwanted and unplanned pregnancy. Health
information and education on modern contraceptive methods
should be encouraged and modern contraceptives should be
available.It would be better if there are conditions where young
people discuss about sexual and reproductive health issues with
their parents, friends and others. Finally, it was recommended
that further study should be done on knowledge, attitude and
practice towards induced abortion in this area.