Pooled prevalence of induced abortion and associated factors among reproductive age women in sub-Saharan Africa: a Bayesian multilevel approach

Abstract

BACKGROUND: Abortion is one of the leading causes of maternal death in developing countries, particularly in sub-Saharan Africa (sSA,). In this region, abortion is responsible for 38,000 maternal deaths, making the area with the highest rate of abortion-related mortality in the world. This study aimed to examine the prevalence and associated factors of induced abortion in 33 countries in the region. METHOD: We used data from the most current Demographic and Health Surveys (DHS) conducted in 33 sSA countries between 2012 and 2022. A total 367,881 of women were included in the analysis. The Bayesian multilevel logistic regression model was used to determine the factors associated to induced abortion because of the hierarchical nature of the DHS data. RESULTS: The overall prevalence of induced abortion was 16.50% in sSA. The random effects model revealed that about 75% of the variation in the induced abortion was caused by community and individual-level factors. Based on the Bayesian multilevel logistic regression model, women who smoke cigarettes(AOR = 1.044; 95%CI: 1.020, 1.070), 24-month and above birth interval(AOR = 5.747; 95%CI: 5.595, 5.889), rich women(AOR = 1.470, 95%CI: 1.436, 1.510), secondary and above-educated women (AOR = 2.640, 95%CI: 2.567, 2.707), being exposed to the media (AOR = 1.099, 95%CI: 1.083, 1.115), rural women (AOR = 1.025, 95%CI: 1.004, 1.047) and having pregnancy complications (AOR = 1.095, 95%CI: 1.067, 1.124) were associated with higher odds of induced abortion. But, the odds of an induced abortion were lower for women 35-49 years of age(AOR = 0.019, 95% CI: 0.018, 0.019), having 2-3 birth history(AOR = 0.105, 95%CI: 0.102, 0.107), having family size of 4-6 (AOR = 0.747; 95%CI: 0.735, 0.760), using contraception (AOR = 0.747; 95%CI: 0.735, 0.760), being married (AOR = 0.642; 95%CI: 0.628, 0.654), and being a working woman(AOR = 0.673; 95%CI: 0.658, 0.687). CONCLUSION: The prevalence of induced abortion was high in the sSA countries with a significant country-specific variations. Therefore, public health programs shall focus on sexual and reproductive health education for young women, rural women, unmarried women, and rich women, in order to address this problem. Furthermore, it is crucial to formulate policies and initiatives that consider regional disparities in the prevalence of induced abortion and to actively pursue their implementation.