Abstract
Background. Second-trimester medical abortion is the termination of pregnancy between 13 and 28 weeks of gestational age. Although the majority of abortions are performed in the first trimester, 10–15% of terminations of pregnancies have taken place in the second trimester globally. Objective. To identify the determinant factors of second-trimester safe termination of pregnancy in public health facilities of the Amhara region, northwest Ethiopia. Methods. An institution-based unmatched retrospective case-control study conducted from 01/10/2019–30/02/2020. A systematic random sampling technique was used to select 119 cases and 238 controls. An interviewer-administered questionnaire was used to collect the data. A binary logistic regression model was fitted to identify determinant factors. The odds ratio with 95% CI was computed to assess the strength and significance of the association between dependent and independent variables. Result. Rural resident (adjusted odds ratio (AOR) = 1.9; 95% CI 1.07–3.25), irregular menses (AOR = 1.8; 1.06–3.13), had no known symptoms of pregnancy (AOR = 1.9; (95% CI 1.06–3.46)), not knowing the abortion law (AOR = 3.0; (95% CI 1.63–5.60)), low level of education (1st–8th grade) (AOR = 2.7; (95% CI 1.06–6.60), opposition against abortion care (AOR = 2.6; (1.22–5.42)), delayed referral (AOR = 10.1 (95% CI 4.02–29.18)), and not undertaking pregnancy test (AOR = 2.2; (95% CI (1.21–4.04)) were determinants of second-trimester safe termination of pregnancy. Conclusion. Women being rural residents, irregular menses, not undertaking pregnancy test, not knowing the abortion law, low-level educational status, delayed referral, no knowledge about signs and symptoms of pregnancy, and opposition of safe abortion were determinants of second-trimester safe termination. The Regional Health Bureau and Health Facilities should give emphasis to women living in rural areas, and they should increase awareness towards abortion law and sign and symptoms of pregnancy and encourage female education.
Highlights
Abortion is the termination of pregnancy before 20 weeks of age in developed countries but up to 28 weeks of gestational age in Ethiopia with a fetus born weighing less than 500 gm by removal or expulsion of a conception tissue [1]
The prevalence of secondtrimester abortion was 19.2% [16]. erefore, the objective of this study was to assess determinant factors contributing to second-trimester safe termination of pregnancy in public health facilities, Amhara region, northwest Ethiopia
A facility-based unmatched retrospective case-control study design was conducted in Felege Hiwot Comprehensive Specialized Hospital (FHCSH) in Bahir Dar city, Gondar University Comprehensive Specialized Hospital (GUCSH) in Gondar town and Debre Markos Referral Hospital (DMRH) in Debre Markos town of Amhara region from November, 2019, to February, 2020
Summary
Abortion is the termination of pregnancy before 20 weeks of age in developed countries but up to 28 weeks of gestational age in Ethiopia with a fetus born weighing less than 500 gm by removal or expulsion of a conception tissue [1]. Second-trimester medical abortion is the termination of pregnancy between 13 and 28 weeks of gestational age [3]. 42 million abortions are performed annually and 10–15% of the cases take place in the second trimester period, over half of which are considered unsafe [4]. About 22 million women performed unsafe abortion every year [9]. Maternal mortality is still high in Ethiopia and the five major causes of maternal mortality (19.6%) occur due to abortion complications [13]. In the Amhara region, an estimated 45,812 women performed abortion in health facilities in 2014, while around 106,325 women terminated their pregnancy outside health facilities in the same year. Erefore, the objective of this study was to assess determinant factors contributing to second-trimester safe termination of pregnancy in public health facilities, Amhara region, northwest Ethiopia The prevalence of secondtrimester abortion was 19.2% [16]. erefore, the objective of this study was to assess determinant factors contributing to second-trimester safe termination of pregnancy in public health facilities, Amhara region, northwest Ethiopia
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