Late request for safe abortion and its determinants among reproductive age women in Ethiopia: systematic review and meta-analysis

Abstract

Late requests for safe abortion during the second trimester are strongly associated with severe maternal complications, including infertility, preterm birth, low birth weight, and maternal mortality, especially in developing countries. These delays also contribute to adverse pregnancy outcomes beyond direct maternal deaths. Despite these serious concerns, data on the prevalence and contributing factors of late abortion requests in Ethiopia remain limited. To estimate the pooled prevalence of late requests for safe abortion and identify the determinants among Ethiopian women of reproductive age. This systematic review and meta-analysis was conducted following the PRISMA 2020 guidelines. A comprehensive search was performed across major international databases, including PubMed, Cochrane Library, Google Scholar, Hinari, Scopus, Web of Science, and African Journals Online, using the CoCoPop strategy. Study quality was assessed using the Joanna Briggs Institute (JBI) tool. Heterogeneity among studies was evaluated with the I2 statistic, and publication bias was assessed using funnel plots and Egger’s test. A random-effects model was employed to estimate the pooled prevalence and adjusted odds ratios (AOR) with 95% confidence intervals (CI). Ten studies involving a total of 5,559 women were included. The pooled prevalence of late requests for safe abortion was 35.20% (95% CI: 26.21, 44.19). Significant determinants identified were delayed pregnancy diagnosis (AOR: 3.23; 95% CI: 2.52, 4.13), irregular menstrual cycles (AOR: 2.36; 95% CI: 1.86, 3.00), rural residence (AOR: 2.89; 95% CI: 2.34, 3.58), unmarried status (AOR: 2.86; 95% CI: 2.13, 3.86), and age under 19 years (AOR: 4.01; 95% CI: 2.41, 6.67). Late requests for safe abortion are common in Ethiopia and are influenced by factors such as rural residence, young age, delayed recognition of pregnancy, and irregular menstrual cycles. Enhancing access to reproductive health services especially for rural and adolescent populations is essential to reduce maternal complications and promote timely care. CRD42024603467.