1

CHAPTER ONE

Introduction

Background to the Study

One of the salient responsibilities of women as ordained by God is

procreation. However, there are conditions to be met before a woman could start
procreating. In African context, the act of procreation is a responsibility of
grown-up young adults who have been found to be physically, psychologically,
emotionally and at large economically independent to cater for their family, that
is why marriage act is solemn, contracted and celebrated in our present
societies. Regrettably, the observed situation prevalent in both developed and
underdeveloped world is such that there are girls between the age of thirteen
and nineteen years that are getting pregnant at an alarming rate due to increased
involvement in unprotected sexual activities.

Exposure to sexual content on television, sexuality in the media,

pornographic and sex chart rooms by teenagers, could most likely tune them to
engage in sexual activities (Park, 2008). Acceptance of gifts for sex, rape and
some adult deliberately taking advantage of poor teenagers and encouraging
them into having sex were noted as factors responsible for teenage pregnancy
(United Nations, 2001). A major consequence of these increase sexual activities
among teenagers is out of wedlock pregnancies that may result in abortion,
childbirth or even death (Alabi & Oni, 2017). According to Ariba (2000), many
teenagers are reckless with sexual practice resulting in unwanted pregnancies
which are terminated in unsafe ways.

Unplanned or unwanted pregnancy leads to abortion. Correia, Maia and

Cavalcante (2009) posited that abortion in teens is an indicator of unplanned
pregnancy. Young people terminate unplanned pregnancies for various reasons;
 2

these include fear of expulsion from school, unstable relationships, financial

instability and lack of support from the partner.

The practice of abortion, although a global issue has remained an

important topic of discussion particularly in regards to reproductive health and
family productivity which has been surrounded with controversial criticism that
dates several years back into human history. This is because the issue has been
approached from many different views bothering on religion, welfare and
sometimes mere sentiments (Onuzulike, 2002). Most culture and religious sects
are opposed to the concept of abortion on the ground that it is the termination of
human life which amounts to murder. In Nigeria, abortion is threated as that
topic or issue that cannot and must not be discussed due to religious and moral
reasons. According to Sudhinaraset (2008), Nigeria is predominantly made up
of Christians and Muslims whose doctrines frown at pre-marital sex and
abortion. Yakubu (2002) remarked emphatically that abortion in Nigeria is
regarded from all aspect as the killing of an unborn child which is criminal
homicide or murder. Okoye (2006) supported this that abortion in Nigeria is
considered an illegal and immoral act by law, religious bodies and even our
cultural institutions. This makes it even harder for teens who have procured
abortion in the past not to talk about it, and those who want to procure it go to
places where no one will recognize them and want it done as quickly as possible
to avoid stigmatization and mockery (Paluku, Mabuza, Ndimande & Maduna,
2010).

Medical Science recognizes the fact that abortion is necessary under

certain circumstances particularly when the life of a woman is in danger and
only abortion can save it, and there is a reasonable chance that the baby will be
severely deformed (Onuzulike, 2002). As a result of strong opposition to this
issue, legalization or permission of abortion by law exists only in a few
countries of the world.
 3

Abortion according to Roper (2010) is the abrupt termination of

pregnancy before the end of 28th week. It is also the expulsion from the uterus of
product of conception before it is viable (Ibisomi & Odimegwu, 2008).
Abortion can occur spontaneously as miscarriage or be artificially induced
through chemical, surgical or other means. Induced abortion is the intentional
termination of a pregnancy before the fetus can live independently; it may be
therapeutic (to preserve the health or save the life of a pregnant woman) or
elective (based on a woman’s personal choice). Abortion is observed to be done
at any stage of pregnancy. Most people carry it out at the first trimester, others
at the second trimester and a few even at the late trimester notwithstanding the
dangers that could result from such act.

It has been estimated that about 46 million abortions are performed each
year (Correia et al, 2009). Recent statistics have indicated that out of the twenty
two million (22 million) unsafe abortions that were conducted in 2011 the world
over, three million two hundred (3.2 million) were among the teenagers, with
Africa recording the highest number of unsafe abortion among teenagers
(WHO, 2012). According to Conservative estimates, more than three thousand
(3,000) women die annually in Nigeria as a result of unsafe abortion. Of the
women obtaining abortion eighty five percentage (85%) were younger than 25
years (Sudhinaraset, 2008). Abortion threatens the health and social life of
female teenagers, its contribution to maternal death is a major case in point.

Abortions performed under unsafe conditions apart from claiming the

lives of women, often leaves most of them with chronic irreversible health
problems; such health problems includes, physical health problems (cervical
laceration, uterine perforation, infertility, septicemia, hemorrhage, anaemia,
death) (Population Reference Bureau (2011), there are instances of severe pain
and bleeding, infection, future miscarriages, complications in pregnancy and
barrenness among other problems arising from abortion done unprofessionally
 4

that may result to death most times (Kpolovie & Oguwike, 2017). Other health
consequences include emotional health problems (anger, guilt, shame, regret,
aggrieviances/grief, etc), mental health problems (anxiety, depression, suicidal
thought, sleep disorders, post-abortion syndrome, etc) and social health
problems (stigma, alcohol and drug abuse, sexual promiscuity, economic loss,
etc). With the afore mentioned it is beyond all reasonable doubt that unsafe
abortion is a key obstacle in meeting the millennium development goal of
reducing maternal mortality and improvement of the reproductive health
services of women.

Statement of the Problem

Nasty stories of immoral behaviors like sexual harassment, promiscuity,

unwanted pregnancy and abortion among teenagers are the order of the day. A
close observation of the incidence of abortion in Nigeria shows that abortion is
very rampant. It is a common practice among female undergraduate and
secondary school students, evidence which is seen in towns and villages as
underdeveloped neonates are discovered around bush paths, behind maternity
premises, market places, and gutters, beside university hostels, school toilets
and public borrow-pits (Kpolovie & Oguwike, 2017). A situation where female
teens indulge in promiscuity and having unprotected sex even in the bush or fall
victim of rape, or sexual harassment; cases of which have led to unwanted
pregnancy and abortion which may or may not gain the support of their parents
or individuals who got them impregnated not minding its health implications.
Female teenagers in Oguta Local Government Area are no exception when it
comes to unwanted pregnancies and unsafe abortion as this is evident from the
number of girls aged less than 20 years admitted to the maternity ward for
delivery and also the high number of cases attended to for abortion
complications. Induced abortion exposes the individual to health risks such as
hemorrhage, genital injuries, sepsis, and deaths (Mbonye, 2011; Mirembe,
 5

2010). For instance, in Port Harcourt on October 28, 2017; a girl of 17 years old
in one secondary school died as a result of complications from abortion of a
pregnancy of about three months old (Kpolovie, & Ogwuike, 2017).

Psychological and emotional problems such as depression, guilt trauma,

not forgiving oneself and transfer of aggression, maladjusted behaviour and
social problems that affect the home and society at large are also long-term
effects of abortion. In view of the above, the researchers are poised to determine
the perceived health implications of abortion among female teenagers in Oguta
Local Government Area of Imo State.

Purpose of the Study

The purpose of the study was to determine the perceived health implications
of abortion among female teenagers in Oguta Local Government Area of Imo
state. In specific terms, the objectives of the study were:

1. To determine the perceived physical health implications of abortion

among female teenagers in Oguta Local Government Area.
2. To ascertain the perceived emotional health implications of abortion
among female teenagers in Oguta Local Government Area.
3. To determine the perceived mental health implications of abortion among
female teenagers in Oguta Local Government Area.
4. To ascertain the perceived social health implications of abortion among
female teenagers in Oguta Local Government Area.
5. To determine the perceived health implications of abortion among female
teenagers in Oguta Local Government Area based on their age.
6. To determine the perceived health implications of abortion among female
teenagers in Oguta Local Government Area based on their level of
education.
 6

Research Questions

1. What are the perceived physical health implications of abortion among

female teenagers in Oguta L.G.A.?
2. What are the perceived emotional health implications of abortion among
female teenagers in Oguta Local Government Area?
3. What are the perceived mental health implications of abortion among
female teenagers in Oguta Local Government Area?
4. What are the perceived social health implications of abortion among
female teenagers in Oguta Local Government Area?
5. What are the perceived health implications of abortion among female
teenagers in Oguta Local Government Area based on their age?
6. What are the perceived health implications of abortion among female
teenagers in Oguta Local Government Area based on their education?

Hypothesis

Based on the objectives and research questions of the study, the following
research hypothesis were postulated:

1) There is no significant difference in the perceived health implications of

abortion among female teenagers in Oguta Local Government Area based
on age.
2) There is no significant difference in the perceived health implications of
abortion among female teenagers in Oguta Local Government Area based
on level of education.

Significance of the Study

The study is considered important in the following ways:

The findings of the study are hoped to provide evidences for policy
makers regarding efforts to reduce risks associated with abortion among female
 7

teenagers in Oguta Local Government Area. It would help the teenagers in

Oguta Local Government Area to establish and confirm health implications of
abortion and how to avoid unwanted pregnancy and abortion.

The results of the study would be useful in helping the government at all
levels especially the Federal and State Ministry of Health to embark on more
anti-abortion campaigns in different parts of the country towards reducing
maternal mortality and morbidity. The data generated would also spur the
Federal and State Ministries of health to improve, promote and intensify the
provision of family planning and contraceptive services in the Federation to
ensure greater and correct use of contraceptive methods which would to a
greater extent, prevent female teenagers (women) from unplanned and
unwanted pregnancies that often make them opt for abortion.

The findings of the study would be of importance to female teens and

adolescents as well as parents. It would help them to be more serious with the
sexuality education of the girl-child by exposing them early and regular sound
sexuality education right from childhood to prevent the girl-child from falling
victims to abortions in the future.

The results of the study would assist the religious groups to intensify their
involvement in the fight against abortions in our society by organizing more
anti-abortion and pro-life programmes. Counsellors would equally benefit from
the findings of the study as it would assist and encourage them to go into family
life and reproductive health counselling and adolescence sexuality education as
a way of combating abortion.

Social health workers in government and non-governmental organizations

that are interested in women’s health and welfare would derive benefit from the
study towards improving welfare services, especially in the aspect of
accommodating teenage and adolescent girls who got pregnant, drop-out of
 8

school and are rejected by their parents and guardians. The study also would
serve as a source of reference to researchers interested in similar studies in
future; as well as a guide for similar research works.

Scope of the Study

The study was delimited to the perceived health implications of abortion

among teenagers in Oguta Local Government Area of Imo State. The study was
delimited to dependent variables of physical, emotional, mental and social
health implications of abortion. It was also delimited to independent variable of
age. Furthermore, it was delimited to the use of structured questionnaire for data
collection. Finally, it was delimited to the use of descriptive statistics of
frequency and percentage as well as inferential statistics of Chi-square for
analysis at 0.05 level of significance.
 9

CHAPTER TWO

REVIEW OF RELATED LITERATURE

This chapter reviewed related literature under the following headings:

Conceptual Framework
Concept of Perception
Concept of Teenager
Concept of Abortion
Health Implications of Abortion
Theoretical Framework
Heath Belief Model
Empirical Framework
Pattern and Outcome of Induced Abortion
Knowledge, Attitude and Practice of Abortion among Female Students of
Two Public Senior Secondary Schools
Knowledge and Attitude of School Girls about Illegal Abortions
Emotional and Psychological Effects of Induced Abortion in Young
Women

Abortion in Young Women and Subsequent Mental Health

Social Implications of Abortion among Female Teenagers

Summary of Literature Reviewed

Conceptual Framework

Concept of perception: Perception refers to how people think, believe

and the way they view and understand things. Ejifugha and Ibhafidon (2014)
defined perception as the process by which people translate sensory impressions
into coherent and unified information. Perception is equated with reality for
most practical purposes which guides human behaviour in general. In
 10

perception, it is sometimes difficult to separate the information from the action.

Thus, it is basically a process of gaining mental understanding.

Perceptions help make up our conscious experience and allow us to

interact with people and objects around us. Thus, it helps us to gather data from
our surrounding, process the data and make sense out of it. It also guides the
perceiver in harnessing, processing and channeling relevant information
towards fulfilling the perceiver’s requirements. Perception is largely guided by
knowledge (Murima, 2013). Through knowledge gained, perceptions enable an
individual to choose what is to be interpreted and how it is to be interpreted. For
the purposes of this study, perceptions refer to the ways in which teenagers
regard, understand and interpret health implications of teenage abortion within
their lived experiences. Understanding perceptions is vital as perceptions
influence uptake of healthy behaviour practices (Murima, 2013).

Concept of Teenager: Teenagers or teens are young persons chose age

falls within the range from thirteen to nineteen years (13 – 19 years). They are
called teenagers because their age number end in “teen”. It is the period when
most of the secondary sex characteristics appear. Alibi and Oni (2017)
described this period as the second decade of life. They observed that it is the
most important and sensitive period of one’s life when a person is in the second
genital stage of psychological development.

According to Onuzulike (2002), teens years is a bridge between the life as

a child and as an adult, which gives the individual the opportunity to drop
childhood behaviours and learn the adult life style. Alibi and Oni (2017)
described the teen years as a period of transition from childhood to adulthood
characterized by heightened social awareness and accelerated physical growth
 11

as well as the onset of puberty and biological maturity. According to Melgosi

(2001), it is a stage in life which is crucial in the life of an individual because
many key social, economic and demographic events occurs that set the stage for
adulthood.

Teenagers are characterized by looking into some factors such as age

factors, motivation factors and parental factors (Gadsby, 2010). Teenagers
behave differently in attending different ages as well as the way they learn.
Teenagers in the age of 13 to 15 years learn faster than those from 16 to 19
years because during this period their brain is more flexible than the later.
Motivation plays a special and significant role in everything they do. A teenager
whose needs are not provided by the parents will certainly behave rudely or in
unacceptable manner. Parental relationships deemed to become more difficult as
teens try to find a way to increase their level of independence and parents who
worry about their future will struggle to teach them the last of information
before they are grown.

The teenager period is filled with challenges such as changes in need to

develop self-esteem, independence, pressures from studies and peers. According
to Onuzulike (2003), female teenagers face a wide range of issues everyday
relating to their psychological, physiological, emotional and socio-cultural
concerns. The average teen struggle to figure out how to fit in with different
peer groupings that exist in his/her environment, how to afford and own the
latest cloth styles that peers mates are wearing and a strong desire to belong to
the high social group. Materialism has attacked teens through the status of
owning a cell phone, money, expensive shoes and hip clothing for different
occasions and outings which comes with emotional distress (Kumar, Hessini &
 12

Mitchell, 2009). These has led most of female teens for instance into having
older men/boy friends, premarital sex, promiscuity, night clubbing, alcohol
drinking and smoking which exposes them to risk of rape, sexually transmitted
infections, unwanted pregnancies and abortions.

Concept of Abortion: Life begins at conception since all the inherited

features of an individual are already set at conception. However, the destruction
of life at conception which is referred to as abortion is a popular practice all
over the world. According to Davis (2011), abortion is the spontaneous or
induced termination of pregnancy before the fetus reaches a viable age. Okoye
(2006), explained that the age of viability of an embryo or fetus in many
countries including Nigeria is accepted to be 28 weeks of gestation which is the
9th month of pregnancy. In consonance, Ramalingam (2000), viewed abortion as
the premature termination of pregnancy. Abortion is considered as deliberate
and willful act of expelling an embryo or fetus from the uterus by artificial
means and so prohibiting the development of an embryo (Agbakwuru &
Ekechukwu, 2009). Put differently, Kpolovie (2017) described abortion as a
method employed in preventing the birth of unwanted child by destroying the
embryo.

A critical examination of the definitions in the preceding paragraph

reveals that abortion is induced. Okoye (2006) affirms that induced abortion is
the most common of the three types which include induced abortion,
spontaneous abortion and therapeutic abortion. Spontaneous abortion which is
also known as miscarriage is an abortion that occurs naturally on its accord.
Therapeutic abortion is the termination of pregnancy performed to save a life of
a woman, either from a complication of pregnancy or other illness while
 13

induced abortion is an artificial and intentional termination of a pregnancy

against the law in Nigeria.

Monnaf (2013) classified abortion into two major types, spontaneous abortion
and induced abortion.

Spontaneous abortion includes threatened abortion, inevitable abortion,

complete abortion, incomplete abortion, missed abortion, septic abortion,
recurrent spontaneous abortion or habitual abortion. While induced abortion
include therapeutic (legal) abortion and illegal (criminal) abortion.

Threatened abortion: It is a clinical entity where the process of abortion

has started but has not progressed to a state from which recovery is impossible
(Monnaf, 2013). The bleeding is usually slight and bright red in colour. On rare
occasion, the bleeding may be brisk and sharp especially in the second trimester
suggestive of low implantation of placenta. The bleeding usually stops
spontaneously. According to Williams (2013), the condition is usually painless,
but there may be mild backache, dull pain in the lower abdomen. The decision
whether abortion is only threatened or is inevitable is important but often certain
cases of threatened or is inevitable is important but often certain cases of
threatened abortion should always be regarded seriously, since at any time
profuse bleeding may occur and the abortion will then become inevitable.

Inevitable abortion: In this type of abortion where the changes have

progressed to a state from where continuation of pregnancy is impossible
(Monnaf, 2013). This type of abortion is unavoidable, it is usually present with
a myriad of pains, vaginal bleeding, amenorrhea (absence of menstruation) and
products of conception are sometimes felt through the dilated internal Os of the
 14

cervix. Inevitable abortion therefore is one which has advance to a stage where
termination of pregnancy cannot be prevented.

Incomplete abortion: An incomplete abortion described the situation

where the entire products of conception are not expelled instead, a part of it is
left inside the uterine cavity. Usually, there is a history of amenorrhea,
expulsion of product of conception per vagina, lower abdominal pain, varying
amount of bleeding, uterus smaller than the vagina of amenorrhea and the
cervical orifice often admitting tip of the finger.

Complete abortion: It is a condition where products of conception are

expelled completely. According to Shut (2011), examination of patients with
complete abortion shows that pain is absent, bleeding slight and smaller uterus.

Missed abortion: This is an in uterus death of the embryo or fetus before

the 20th week of gestation with retained conception products (Zeqiri, Pacarada &
Kongjeli, 2010). There is usually a history of amenorrhea, bleeding or brownish
discharge, subsidence of pregnancy symptoms; fetal heart sound not audible
with Doppler, cervix feels, pregnancy test negative and blood coagulation
disorder during complications.

Septic abortion: This is an infection of the placenta and fetus (products

of conception) of a previable pregnancy. Infection is centered in the placenta
and there is risk of spreading to the uterus, causing pelvic infection or becoming
systematic to cause sepsis and potential damage to distant vital organs
(Eschenbach, 2015). It is usually comes with high fever, chills, severe
abdominal pain, heavy bleeding that suddenly stops and does not resume, or
heavy vaginal bleeding, foul smelling, vaginal discharge ad backache.
 15

Recurrent spontaneous abortion: Recurrent miscarriage is synonymously

used with recurrent spontaneous abortion, habitual abortion or habitual
miscarriage is defined as the loss of 3 or more consecutive pregnancies before
the 24th week of gestation (Meka & Reddy, 2006).

Therapeutic abortion: This is the type of abortion following a diagnosis

of medical necessity. Such abortions are carried out in order to avoid risk of
substantial harm to the mother or in cases of fetal unviability (Wikipedia, 2018).
In many countries, therapeutic abortion is legal, including some where elective
abortion is illegal.

Illegal abortion: This refer to any abortion which is contrary to the laws
of the jurisdiction in which it is carried out or sometimes the laws of the country
of origin of the participants. Or when performed by unskilled or skilled health
personal without a significant health reasons or in non-medical settings
(Wikipedia, 2018).

Unsafe abortion: An unsafe abortion is the termination of pregnancy by

people lacking the necessary skills or in an environment lacking minimal
medical standard or both (WHO, 2003; WHO, 2007 and Rosenthal, 2007).

Abortion is carried out at various different stages of a pregnancy which

could be in the first trimester, which is considered early abortion, while the
second and third trimester are considered late abortion. Kpolovie (2017)
observed that majority of women have abortion before 12 weeks of gestation
being the first trimesters and few others seeks abortion from 16 – 28 weeks of
gestation, that is within the second and third trimesters. Thus, the periods
 16

(second and third trimesters) requires excellent skills which most providers do
not have, thereby increasing the risk and complications of abortion.

Several methods have been employed to induce abortion ranging from

procuring and drinking self prescribed abortion drugs or pills such as
misoprostol, cytotec, oxytocin, mifepristone. Others include some traditional or
herbal preparations and concoctions such as lime, lipton, nescafe, native herbs,
gin and mechanical manipulations with sharp solid objects which are
collectively considered as crude, unscientific and unhygienic methods of
abortion (Kpolovie, 2017).

Abortion can be performed by a medical expert, Welch (2010) identified

some medical and surgical methods of induced abortion which include dilation
and currettage, manual/electric vacuum aspiration, suction termination of
pregnancy (STOP), distillation and evacuation and so on. however, the stage of
the pregnancy determines the methods employed.
 17

Factors Associated with Unsafe Abortion among Female Teenagers

(Sources: Shah, 2009; Grimes, 2006)

The conceptual framework shows factors that are associated with

unwanted pregnancies among adolescent girls; it further stipulates reasons why
adolescents may want to terminate an unwanted. Due to the fact that teenagers
may have limited knowledge and access to safe abortion services they may
resort to unconventional methods of abortion thereby resulting in an unsafe
abortion.

Masthoff (2017) opined that there are several questions running in the
mind of the girl who became pregnant from unsolicited means and the answers
 18

to these questions are influenced by a variety of factors including but not

limited to where she lives, the religion she follows, her relationship status, the
relations with her parents, influences of her peers and availability of and access
to contraceptive services.

There are various reasons why teenage girls resort to abortions. One of
the most common reasons teenage girls give for terminating pregnancy is being
single. A study conducted by Guttmacher Institute in Nigeria reveals that 31%
of the adolescents 15 – 19 year old cited being single as the main reason
wanting to procure abortion. While 30% revealed that they are too young to
carry the responsibility of child bearing or they are in schools (Sedgh, 2006).
Another reason is the financial difficulties in raising the kids while continuing
with their education (Ibrahim, 2011). Most of these young girls are in schools
and it will be difficult for them to take care of themselves and the kids without
any financial assistance and because of that they prefer to abort the pregnancy.

For the young girls in schools, the fear of expulsion from school is one of
the reasons they resort to abortion. In Nigeria, once the school authority finds
out that a student is pregnant, she will automatically be expelled from that
school. And most of the time, there is no provision for her to go back to school
to complete her education after delivery (Okonofua, 2009). And for the young
girls the only guarantee to the future is education especially in southern Nigeria
where girl child education is highly valued. Because of this fear and wanting to
secure a better future, the young unmarried girl opts to abortion in order to
continue with her education (Koster, 2010, Okonofua, 2009).

Fear of the parents to find out about the pregnancy and disapprove the
young girl is another reason for pregnancy termination. Most of the time, a
 19

young girl who is pregnant will try to conceal the pregnancy so that the parents
will not find out because of fear they might disapprove her for bringing shame
to the family (Okonofua, 2009). And sometimes the parents will refuse to
continue paying for her school fees. In some instances she will be forced to
marry the father of the baby even if it against her wish, so as to save the dignity
of the child and the family.

Rape or incest is another reason for pregnancy termination in Nigeria.

Teens can become pregnant as result of sexual abuse or rape. Between 43 and
62 percent of teens acknowledge that they were impregnated by an adult male.
Also studies have found that between 11 and 20 percent of pregnancies in
teenagers were as a result of rape, while about 60 percent of teenage girls had
unwanted sexual experiences (abuse) preceding their pregnancy (Alabi & Oni,
2017). According to report of the IPAS National Health Service director
Nigeria, most of the rape victims will everything possible to abort the
pregnancy if conceived not daring the consequences (Orisaremi, 2012, Okoro-
Eweka, 2014).

In some parts of Southern Nigeria, the young girl has to prove her fertility
before being considered as a wife. In this way a lot of young girls were lured
into sexual activities by men with the promise to marry them but were turned
down after becoming pregnant and at the end of the day they have to abort the
pregnancy (Koster, 2010). Young girls also have their share of the blame, as
most of them will do everything possible to lure rich men into sexual activities
to get pregnant so that they can tie them to marriage end if they refused, the
pregnancy has to be aborted.
 20

Social stigma associated with teenage pregnancy is another reason why

most teenagers terminate their pregnancies particularly when the teenager is
unmarried and became pregnant due to a passing affair. Thus, making teenage
pregnancies unacceptable in our society. Girls who decide to keep their babies
become a subject of constant mockery and pity (Abbas, 2014).

To avoid thus social pressure many teenager choose to abort their babies.

Health Implication of Abortion: The World Health Organization

(WHO) in the year 1948 defined health as a state of complete physical, mental
and social well-being of an individual and not merely the absence of disease of
infirmity. Health is the extent to which an individual or group is able to realize
aspirations and satisfy needs and to change or cope with the environment.
Health is a resource for everyday life and nor only for objective of living; it is a
positive concept emphasizing on social and personal resources as well as
physical capacities. Also, health is referred to as the ability to maintain
homeostasis. According to Ewuzie (2016), health is a state of perfect harmony
between the organs and the systems in the body.

Health is relative, it has many indices such as vigour, vitality and

endurance capacity (Onuzulike, 2007). The determinants of health which are
mental, intellectual, emotional and social health is referred to as a person’s
ability to handle stress, to acquire skills, to maintain relationships, all to which
forms resources for resiliency and independent living (Denovan & McDowell,
2009). In response to the reconceptualization to disease and health, the
definition and meaning of health has expanded to include wellness, as the
positive end of the health continuum. Last (2007), opined that wellness is a
word used by behavioural scientist to describe a state of dynamic physical,
 21

mental, social and cultural wellbeing that enable a person to achieve full
potentials and an enjoyable life.

Implication is also known as the consequence, according to Webster

(2014), implication means a possible effect or result. Schore (2009) explained
that consequences of certain problems suggested a drastic effects on health
either by act of omission or commission on health. Health effects as seen by
Godfrey (2009) are as a result of the factors in the environment which impinge
on the physical, social and mental health of an individual. Abortion and its
health consequences have been so serious and alarming among the population
of female teenagers which affect both the individual’s family and society at
large.

Physical Health Consequences of Abortion: Physical health problems

emanating from abortion include the damage of cervical and uterine muscles,
which may later result in the perforation of the uterus, infectious, hemorrhage,
blood clothing disorder, inability to conceive an bear children in future
(bareness) and ectopic pregnancy (Agbakwuru & Ekechukwu, 2009). According
to Okoye (2006) death, pains, prolong bleeding, splitting or tearing of the
cervix, perforation and infection are some of the immediate physical problems
associated with induce abortion. Other possible effects of induced abortion
include 17.5% chance of the future miscarriages, 24.3% chance of
complications during future pregnancies, cervical and breast cancer, menstrual
disorder, fever, insomnia, loss of appetite, weight loss, tiredness, vomiting,
gastro-intestinal disorders, frigidity and decreased work capacity (Federal
Ministry of Health, 2016).
 22

Risk of Cervical Laceration and Uterine Perforation: Splitting of the

cervix and formation of perforations in the uterus are some of the commonly
seen complications related to induce abortion.

Generally, induced abortion are done using suction aspiration, most

importantly, the doctor is not able to see what is going inside. According to
Reardon (2007), this process might lead to injuries to the cervical and uterine
walls and in the case of future pregnancies those old wound might lead to
various type of infection which later resulted in labour complications and
premature death. In some case, instrument related injuries have also been
reported that damaged the other organs of the body or the intestines. Teens are
upto twice as likely to have dangerous experience during abortion compared to
older women, probably because they have smaller cervixes which are more
difficult to dilate or grasp with instruments. Calhoun (2012) stressed that
abortion is associated with cervical and uterine damage which may increase the
risk of premature delivery, complications of labour and abnormal development
of the placenta in later pregnancies.

Risk of Serious Infection (Sepsis): Serious infection is an infection that

has spread into blood (sepsis) a women is more likely to have a serious infection
if the abortion was done later than 3 or 4 months from the last monthly bleeding
if there was an injury to the womb during the abortion (Health Guild, 2018).
Sepsis is very dangerous and is the commonest early complication of unsafe
abortion. It normally manifests itself with high-grade fever and purulent
offensive vaginal discharge. It mostly arises due to use of unsterilized
instruments by quacks or by the women themselves (Abbas, 2014). According
to Hesprian Health Guild (2018) infection can happen because an unclean hand
 23

or object was put inside the womb, pieces of the pregnancy left inside the womb
and they have become infected, the woman already had an infection when she
had the abortion or a hole was made in the wall of the womb. It accounts for 50
– 80% of all complications from illegal abortion in the country. The findings is
in line with a study conducted in Niger-Delta in 2011, which shows that genital
sepsis carried 88.9% of all the complications of unsafe abortions followed by
retained products of conception 82.5% (Ibrahim, Jeremiah, Abasi & Adda,
2011). Sepsis is considered as the main cause of maternal mortality and if the
woman survives she might end up with long term health consequences (Abbas,
2014).

Heavy Bleeding from the Vagina: Heavy bleeding is the most problem
after an abortion. It usually casued by pieces of the pregnancy that are left in the
womb. The womb cannot squeeze itself shut and keeps bleeding. This is called
an incomplete abortion (Hesprian Health Guild, 2018). If the pieces are
removed, often the bleeding will stop. Sometimes the bleeding is caused by a
torn cervix which must be stitched for the bleeding to stop. A women is
bleeding too much if she soaks more than 2 heavy pads or cloths in one hour or
two hours in a row (Abbas, 2014).

A slow, steady trickle of bright red blood is also dangerous. When this happens,
a woman may quickly lose a dangerous amount of blood leading to aneamic or
shock a life threatening condition which can kill (Hesprian Health Guild, 2018).

Risk of secondary infertility: Secondary infertility is one of the serious

complications of unsafe abortions worldwide. According to WHO estimate, 20
– 30% of unsafe abortion cause reproductive tract infections and 20 – 40% of
which is responsible for the upper genital tract infection and secondary
 24

infertility (Grimes, Benon, Singh, Romero, Ganatra, Okonofua & Shah, 2006).
Furthermore, the report revealed that 2% of women of childbearing age 15 – 49
years are infertile as a result of unsafe abortion (Grime et al. 2006). In spite of
the high fertility in Nigeria (5.7 children per woman) (Federal Ministry of
Health (FMOH), 2016), infertility is still very high and varies among the ethnic
groups. It ranges from 10.5 in the north to 14.6 in the southwest and to as high
19.1 among the Igbos in the Southeastern Nigeria (Araoye, 2003; Abbas, 2018).

Infertility is defined as failure of couple to establish pregnancy within one

year of unprotected regular sexual intercourse (Shah, 2009). In the case of
primary infertility, there has not been any pregnancy, but in secondary infertility
there is a history of pregnancy in the past, either delivered or aborted (Shah,
2009). The growing rate of secondary infertility due to abortion has been trained
and untrained illegal abortionist, such as inserting different instruments in the
uterus. Other are cervical dilation, introducing chemicals or traditional remedies
to induce abortions. Sometimes foreign bodies such as needles, bones and tree’s
back are inserted. These result in multiple injuries to the reproductive organs
especially the vagina, tubes and the uterus. Such injuries result to various forms
of long term complications from vaginal atresia, uterine synecae, cervical
incompetence and cervical fibrosis to complete tubal blockage that
consequently lead to secondary infertility (Eyo, Epuyi & Ukpong, 2012).
Sometimes infertility results because of complete removal of the uterus to treat
complications of unsafe abortions (Abbas, 2018; Okonofua, 2009).

Maternal mortality: Maternal mortality is the death of a woman while

pregnant or within forty two days of termination of the pregnancy, irrespective
of the site or duration of the pregnancy, from causes that are directly related or
 25

aggravated by the pregnancy or its management, but not from accidental or

incidental causes (WHO, 2014). Maternal mortality from unsafe abortion is a
serious problem that continues to threaten the lives of many women. According
to WHO, every eight minutes, a woman is dying of unsafe abortion at the rate of
367 maternal deaths per 100,000 unsafe abortion (Grimes et al., 2006). And
more than 97% are in the developing countries with restricted abortion laws and
poorly organized healthcare services. Among those that survive the early
complications: over 5 million will suffer serious long-term complications
(Haddad, 2009).

Unsafe abortion is responsible for about 30 – 40% of maternal mortality in

Nigeria and the estimate is likely to be higher considering those dying at home
and before reaching the health facilities (Abbas, 2014). Another study
conducted in some of the hospitals in the country shows that unsafe abortion is
responsible for up to 51% of maternal deaths. That study shows that unsafe
abortion is one of the leading caused of all maternal mortality in the country.
The case of fatality rate ranges between 1.0% and 1.5%, which means that for
every 100 illegal abortions performed, one women will die. This is three times
higher than the global estimate; when compared to pregnant women who had
their babies pregnant women who aborted were 3.5 times more likely to die
(WHO, 2014). Iniaghe (2009) reported that 50% of maternal death in Africa is
attributed to abortion, with over 20,000 Nigerian women death as a result of
abortion annually.

Emotional health consequences of abortion: Emotions has to do with

psychological feelings, one may have experiences or developed about a
situation. Welch (2010) identifies self condemnation, anger, aggressiveness,
 26

regret, sadness, deep feeling of shame and hopelessness, grief and guilt, low
self-esteem, hatred or unforgiveness of self and partner, secret torture and hunt
of the irreparable past and thought of the would be birth of the aborted fetus as
some of the negative emotional problems experienced by women after
procuring abortion. According to Reardon (2001), emotional effects of induced
abortion includes sad mood, sudden and uncontrollable crying episodes,
deterioration of self-concept and guilt.

Feelings of guilt: Feelings of guilt are among the most common

immediate as well as delayed reactions to abortion. Guilt is a normal reaction
that usually surfaces after the women recognizes that abortion is wrong and that
she is responsible for terminating her own pregnancy. Guilt is what we feel
when we have violated our moral (Coleman, 2007). For the woman who comes
to believe at some point after the abortion that she has consented to the killing
of her pre-born child, the burden of guilt is relentless, there is little or no
consolation to offer the woman who has transgressed one of nature’s strongest
instincts: the mother’s protection of her young. According to Ree and Reardon
(2001), thus inner voice of self condemnation begins playing a repeating tape in
the mind that accuses; you are defective, how could you have done this thing,
you are desperately wicked person.

Feeling of anger: The woman will often express her guilt and shame
through anger at herself and other involved in the abortion decision such as her
parents, friends, doctor, the baby’s father and men in general (NugentPam,
2016). She may also be angry with her future children, which often results in
abuse. Studies indicate that child abuse is more frequent among mothers who
 27

previously had an abortion. His due to the guilt and depression hindering the
mother’s ability to bond with her children (Coleman, 2007).

Feeling of regret: Occasionally after having an abortion, a woman can

sometime think that she made the wrong choice, she may wish she had not
terminated the pregnancy. Regret is an emotion that a woman can experience
more often when the decision to terminate is extremely difficult to make or was
influenced by pressure from a partner or other family member (Children by
Choice Association Incorporated, 2016). The women might have felt misled by
others or had not given herself enough time to make an informed decision.
Sometimes regret is expressed by asking “if only I had know I would have not
do it”.

Feeling of shame: Public shaming seems to be popular way to treat

omen who find themselves in this situation. Despite years of advances in regard
to women’s rights, when it comes to an unexpected pregnancy blame continues
to be placed primarily on the women. This can make a woman feel worthless,
humiliated and alienated from any form of support (NugentPam, 2016).

Feelings of loneliness: Many people who go through trauma and feel that
it is their fault will re-labelled themselves as bad and withdraw themselves from
the company of people who they feel are better than them (Coleman et al,
2009). In some cases, the public shaming of an abortion will create a social
stigma around the woman or girl adding to her loneliness. In other cases, she
makes the choice herself deciding she is unworthy. In many cases, this means
socially separating themselves from people who can be good influences because
they see themselves as so much worse than those other people. This can create
 28

social isolation or compel a woman befriend people who put her into risky or
unfulfilling situations. Often this will only compound the loss of self-esteem.

Mental health consequences of abortion: There is a largely body of

international research which demonstrates that abortion carriers risk of mental
health problem. Interestingly, abortion is sometime used as a solution for mental
health problem, even though the research also tells us quite convincingly that if
you have had or have a mental health problem at any time, that you are at a
substantially increased risk of mental health problems after abortion. According
to Coleman (2011), women who had undergone an abortion experiences an 81%
increased risk of mental health problems. These problems can range from mild
depression to severe anxiety disorders. In 1 2006 study conducted in New
Zealand, it was found that in all comparisons those becoming pregnant and
seeking abortion had significantly higher rates of disorder than the not pregnant
groups and with the exception of anxiety disorder, significantly higher rates of
disorder than the pregnant no abortion group. Researchers concluded that
exposure to abortion is a traumatic life event which increases longer term
susceptibility to common mental disorder (Fergusson, Horwood & Ridder,
2006).

When compared to women who have given birth, women who have had
an abortion also have significantly higher rates of admission to hospital for
psychiatric reasons (Reardon, Cougle, Rue, Shuping, Coleman & Ney, 2003). In
a 2003 study sponsored by the Ontario College of physicians and surgeons, it
was found that women who had an induced abortion had a five times higher rate
of admission to hospital for psychiatric reasons in the following three months
 29

than women who had not undergone induced abortion (Ostbye, Wenghofer,
Woodward, Gold & Craighead, 2003).

Women with a past history of abuse or mental problems as well as

women with a lack of support, conflicting belief systems or those in their teen
years are at an even higher risk for developing psychological problems
following an abortion. Women who are pressured or coerced into having an
abortion are also likely to experience more distress around the decision.
Reardon (2007), identified clinical depression, anxiety attacks, phobias,
personality disorders, addictions, hallucination as some of the mental problems
of abortion. Also the Canadian Mental Association (2018) outlined anxiety,
depression, post-traumatic stress (post abortion stress) disorder, nightmares and
suicidal ideation as common psychological health problems linked to induced
abortion.

Feelings of depression and sense of loss: Women who had an abortion

were at a higher risk for major depression compared to women who has not
become pregnant (Rees & Sabia, 2007; Dingle, Alati & Clavarino, 2008;
Pedersen, 2008). Depression is a mood filled with sadness, guilt and feelings of
hopelessness (Reardon, 2001). According to Ferguson et al (2006) women who
reported induced abortion were 65% more likely to score in the high-risk range
for clinical depression than women whose pregnancies resulted in birth.
Approximately 20% of post-abortive women experience some form of mild
depression , while 10% of post abortive women will experience persistent
depression (Planned Parenthood Federation of America, 2007). Those who
report a sense of loss describe a number related reactions such as the inability to
 30

look at other babies or pregnant mothers or a jealousy of mothers. Many

consciously seek a replacement pregnancy (Reardon & Sobie, 2011).

Risk of anxiety attacks: Women who undergo abortion show higher

levels of generalize anxiety when compared to women who carry to term.
Anxiety is an unpleasant emotional and physical state of apprehension (Cougle,
Reardon & Coleman, 2005). Post-abortive women with anxiety may experience
any of the following tension (inability to relax, irritability), physical responses
(dizziness, pounding heart, upset stomach, headache, etc), worry about the
future and disturbed sleep. The conflict between a young woman’s moral
standard and her decision to abort generates much of this anxiety. Very often,
she will not relate her anxiety to a past abortion and yet she will unconsciously
begin to avoid anything having to do with babies. She may make excuses for
not attending a baby shower and so on.

Risk of post abortion syndrome (PAS): Approximately one out of every

10 women is affected by an anxiety disorder known as Post Abortion Syndrome
(PAS) which is akin to Post Traumatic Stress Disorders (PTSD). Symptoms
include guilt, anxiety, depression, thoughts of suicide, drug or alcohol abuse,
eating disorders and flash backs. This type of disorder is typically caused by a
psychologically traumatic event which can include seeing another person
harmed or killed. According to Korenromp (2004) at least 19% of women who
had undergone abortions suffered from PTSD and 13.8% of women experienced
some kind of psychological distress.

Reardon (2001) described teenagers who have abortions a s vulnerable to

PAS because they are at the critical development of their life; even though teens
are likely to be most deeply affected by abortions they are likely to be least
 31

expressive about their doubts and/pains. Thus, they are encouraged to mature
through infantile destruction instead of maturing through responsibilities of
parenthood.

Sleep disorder: Adolescents with an abortion history when compared to

adolescents who continued an unplanned pregnancy to delivery were 4 times
more likely to report frequent sleep problems (Coleman, 2006). In a study,
conducted by Elliot Institute, 36% of women who had undergone an abortion
were experiencing sleep disturbances eight weeks after the abortion (Elliot
Institute, 2000). According to Reardon (2001), severe cases of this condition
occurs when the woman experience nightmares and hallucinations – hearing
voices or babies crying seeing child at would be age.

Suicidal thoughts: feelings of rejection, low self-esteem, guilt and

depression are all ingredients for suicide. According to a recent study, women
who have had abortions are nine times likely to attempt suicide than women in
general population (Reardon, 2001). In a similar development, teenagers aged
15 – 18 years who underwent an abortion were twice as likely to experience
suicidal ideation when compared to teens of the same age who had never been
pregnant teens who has been pregnant or teens who have been pregnant but
chose not to have an abortion (Ferguson et al., 2006).

Pregnancy resulting in birth is associated with a lower suicide risk while

pregnancy resulting in abortion is associated with increased risk (Reardon, Ney,
Scheuren, Cougle, Coleman & Strahan, 2002). In another study, it was found
that girls aborted were 10 times more likely to commit suicide if she had
undergone an abortion within the preceding 6 months than if she had not (Sabia
& Rees, 2013). The study concluded that girls with a lifetime history of abortion
 32

were about 6 times more likely to have attempted suicide compared with those
who had no history.

Social health consequences of abortion: Social health includes good

relationship with others, a supportive culture, successful adaptation to the
environment, acceptance, tolerance, friendliness and co-operation (Onuzulike,
2007). The social effects of abortion stem from the perspective that abortion
violates the fundamental human right of the unborn to life, restrictive legal,
political, cultural and religious norms which regards abortion as the killing
(murder) of an innocent child. also implicated include some deviant behaviours
expressed by individuals who engaged in abortion practices which occurs as a
result of psychological and emotional trauma experienced by the woman that
eventually affect her personality and relationships with others.

Social stigma: Induced abortion is stigmatized in many parts of the

world, regardless of the laws governing the procedure (Bakole et al, 2006).
Kumar, Hessini & Mitchell (2009) defined abortion stigma as a negative
attribute ascribed to women who seek to terminate a pregnancy that makes
them internally or externally inferior to the ideal of womanhood. While
definitions of womanhood varies across cultures and countries, there are
normative constructs that are commonly associated with the concept: sexuality
for procreation; motherhood, biological destiny, protection, sustenance of an
deference to others (Shellenberg, Moore, Bankole, Juarez, Omideyi, Palomino,
Sathar, Singh & Tsui, 2011). Women who choose to have an abortion is often
directly transgressing these norms, and as a result, she may perceive
stigmatization.
 33

Social stigma is conceptualized to have three separate domains: i)

perceived stigma; ii) experienced stigma and iii) internalized stigma
(Shellenberg et al, 2011). This frame work can utilized to further define and
understand abortion stigma. Perceived stigma is defined as the extent to which
an individual believes that most other devalue or discriminate against any
specific individual or group for possessing a certain attribute or engaging in
certain behaviours (Kumar et al., 2009). Applied to abortion, this refers to an
individual’s perception of how other people feel about abortion or how others
might react to knowing that she had an abortion, such as family rejection, loss
of friends, being avoided or mistreated public ridicule or experiencing any type
of abuse related to having had an abortion. Experience stigma is the actual
experience(s) of being discriminated against or treated negatively by other and
having that discriminating or negative treatment be directly related to the
stigmatized condition (Shellenberg et al., 2011). For women who disclose that
they had an abortion or are planning to have one, experiences of stigma may
include rejection by their family, friends and peers, physical, verbal or
emotional abuse; being devalued, being mistreated in the home and/or seen such
women as deviant (promiscuous, careless, selfish and lack compassion for
human life). Such woman feels embarrassed, shamed, guilt and fear of
disclosure. Finally, internalized stigma is defined as the extent to which the
stigmatized individual incorporates negative perceptions, beliefs and
experiences inti her own self (Fife & Wright, 2000). The internalization of
perceived or experienced abortion related stigma can manifest itself as feelings
of guilt or shame.
 34

Stigma may appear at the community or institutional level. Stigmatizing

behaviour at the level of the family or community may extend to the healthcare
system as well as, thereby increasing the risk of morbidity and mortality among
those who had obtained unsafe abortion and had complications (Levandowski,
2012). For instance, the negative attitude of health workers leads to poor quality
of care, including further delays in attending to women seeking post-abortive
care. Thus, endangering her health and fertility (Moore et al, 2011).

Alcohol and drug abuse: Induced abortion has been linked to increased
rates of substance abuse, especially among young women. According to
Ferguson (2004), young women who aborted had significantly high rate of drug
dependence than young women who had never been pregnant and pregnant
young women who carried to term. A study, found that young women with an
abortion history had almost 3 times greater risk of experiencing a lifetime. Illicit
drug use disorder and twice the risk for an alcohol problem (Dingle, 2008).
Another study revealed that women who had undergone an abortion were 2.8
times more likely to have alcohol problems, 4.6 times more likely to use
marijuana, 5.0 times more likely to have nicotine dependence, 7.7 time more
likely to use other illicit drugs (Pederson, 2008). Women who have undergone
abortion also tend to smoke more frequently or 6 times more likely to use
marijuana which may account for the increased lung cancer and personality
disorder (Coleman, 2006).

Broken relationship: Abortion performed with hope of saving

relationship seldom succeeded. According to Reardon (2006), almost every
relationship between single people broke up either before or after the abortion.
Abortion grief/trauma frequently destroys relationship and shatters families both
 35

present and future. Partner conflict may enter into abortion decision making
where there are difference in opinion regarding how the pregnancy should be
resolved. Post abortion psychological effects on one or both parties may
conceivably add to either conflicts and/or new relationship problem could
emerge following the procedure (Coleman, Rue & Coyle, 2007).

Adverse psychological and behavioural effects of abortion may elevate

the risk for withdrawn, antagonist or aggressive partner-directed behaviour and
increase risk for involvement in less emotionally taxing, uncommitted
relationships (Coleman, Rue & Coyle, 2009).

Sexual promiscuity : Sexual promiscuity refers to engagement to sexual

activities with different partners and that behaviour can have undesirable effects
such as HIV/AIDS and other sexual transmitted infections (gonorrhea, syphilis,
candida, herpes) and repeated abortions (Leclerc-Madlala, 2013). When
compared to women without a history of abortion, women with abortion history
were hypothesized to report more frequent sexual partners, more frequent sex
with acquaintances and friends and more frequent engagement in impersonal
sexual behaviours (sex during casual encounter) (Coleman et al., 2007). Linking
abortion experience to sexual attitude and behaviour may be attributed to the
association based on the feelings of decreased self-esteem, fear of intimacy,
feelings of not deserving to be loved/value, self-destructive tendencies, and s
desire to escape from feelings of depression and anxiety and pregnancy
replacement tendencies. These may develop into compliant personality which is
perceived to be the display of a behaviour and attitude associated with getting
along with others, including strangers (Schultz & Schultz, 2013).
 36

Various adverse health risk behaviours may include compulsive re-

enactment of the sexual experience to gain some mastery over the abortion
trauma, impersonal sex as punishment for the abortion and attempts to undo the
abortion by becoming pregnant again from random or casual sexual encounters
(Angelo, 2004; Coleman et al., 2007).

Theoretical Framework

Theory in broad sense of the word is construction and interpretation of

the field or aspect of cognition. In other words, theory is a set of related
propositions which should be able to describe, explain, predict or control the
phenomena (Jones & Barlett, 2010). According to Ross and Mico (2009),
theories provides strategies for understanding individual behaviours and those
factors that influence such behaviours and those factors that influence such
behaviour enabling programmes to be developed in order to provide solution
and basis for planning appropriate interventions.

A model on the other hand, is often describe as a symbolic depiction of

reality. It provides a schematic representation of reality. It provides a schematic
representation of some relationships among phenomena and uses symbols and
diagrams to represent an idea. It also helps to organize the study, examine a
problem, gather and analyze data (Jones & Bartlett, 2010). Theories and models
are usually adopted in studies to provide clear explanation of how the important
variables are linkes so that the hypotheses and instruments developed would
capture concepts being studied.
 37

Health Belief Model (HBM)

Human behaviour is grounded on both knowledge and attitudes, which

are commonly established early in life and are in many aspects the strategically
most important group to reach. However, despite good knowledge or favourable
attitudes the outcome of behaviour may change due to the influence of
numerous surrounding factors.

The health Belief Model is one of the most widely used theories of health
behaviour; it offers a conceptual framework that identifies factors affecting
human behaviour in relation to (personal) health. The HBM has been used in
health education and health promotion (Glanz, Rimer & Lewis, 2002). It
enables a socio-physiological theory the focuses on an individual’s perceptions,
attitudes and beliefs in trying to explain human behaviour. This model is driven
by the premise that knowledge is important and essential in performing a
motivational role for promoting adoption of behaviour change. On its own,
knowledge cannot bring sustainable health behaviour adoption. Nevertheless, it
is an important starting point in behaviour change cycle (Hayden, 2009).
Perceptions about a disease also play an important role in determining health
behaviour.

The Health Belief Model was developed in the 1950s by American

Psychologists. Godfrey Hochbaum, Irwin Rosentock and Stephen Regels to
explain the widespread facture of tuberculosis screening (Glanz et al., 2002).
The model provides a tool for identifying clients perception of disease and the
decision making process the person uses in seeking health services (Rosenstock,
1994). The HBM assumes that individuals take precautionary measures (risk
reduction) when they perceive themselves susceptible to a disease or condition,
 38

acknowledge consequences of a condition as severe, accept that taking

precautionary measures will be beneficial in reducing risk, and that benefits of
taking action will overcome perceived barriers (Melkote & Steeves, 2001;
Rosenstock et al, 1994).

The HBM assumes that an individual’s health behaviour is influenced by

size key constructs namely: 1) perceived susceptibility; 2) perceived severity; 3)
perceived benefits; 4) perceived barriers; 5) cues to action and 6) self efficacy.

Fig. 2.2: The Health Belief Model

(Source: Glanzl et al., 2002)

Perceived Susceptibility: Perceived susceptibility refers to a person’s

likelihood of getting a condition or a disease (Glanz et al., 2008). Perceived risk
of contracting a disease refers to individual’s personal awareness of their
vulnerability to the disease. Perceived susceptibility has been found to be
 39

predictive of certain health behaviours. Sexually active female teenagers who

engaged in procuring abortion services when pregnant must believe that they
are at risk of contracting infection such as HIV/AIDS, sepsis or damaging their
womb which will affect their physical, emotional, mental and social lives
thereby adopting preventative actions such as use of contraceptives when
having sex, avoiding premarital sex and seeking antenatal and post abortion care
when pregnant. It is when the female teen realizes the magnitude of the
negative consequences of procuring abortion due to unplanned pregnancy that
she will take the necessary actions to avoid becoming pregnant or seeking for
post abortion care.

Similarly teenagers who believe that they are not at risk of developing
complications due to abortion will not attend post abortion care services
provided at the health clinics/hospital or have their pregnancy terminated by
unskilled personnels. Thus, efforts should be made through sex education and
awareness to rise the level of perceive severity of abortion among female teens.

Perceived severity: Perceived severity is defined as an individual’s perception

of the seriousness of contracting the disease or condition (Champion & Skinner,
2008). Perceived severity takes into account personal feelings of the graveness
of a condition based on the subject awareness of the consequences of that
condition (Hall, White, Reame & Westhoff, 2010).for instance, a pregnant
female teen is more likely to take action if they believe that the negative
physical, social and psychological effects of an abortion such as severe pains,
bleeding, anaemia, shock, infertility or even death associated with abortion are
likely to seek care to avoid endangering her health condition.
 40

On the other hand, female teenager with low perceived severity are less
likely to take preventative measures. This study uses the teenagers’ perceived
severity of induced abortion to inform the communication intervention around
contraceptive use, delaying sexual debut, promotion of secondary abstinence
and responsive uptake of post- abortion care services to avoid undue
complications.

Perceived Benefits: An individual’s belief or opinion on the positive effects of

a particular health action. Rosentock (1974) defines perceived benefits as the
steps an individual takes to prevent effects of certain conditions. For behaviour
change to take place, there is need to belief that the preventative behaviour
effectively prevents the condition (Hayden, 2012).For instance female teens
who believe that there are benefits of seeking care in other to avoid unnecessary
complications which may arise due to abortion will seek for care. similarly,
female teenagers who do not have the conviction that seeking care will protect
them will not bother taking appropriate healthy steps.In this case will not attend
antenatal and post abortion care.

Perceived benefits may be influenced by the availability of information

regarding that particular condition (Hall et al., 2010). Perceived benefits are also
important for the adoption of secondary prevention behaviour.Thus, there is
need to help pregnant teen see the importance of seeking care throughout her
gestation period to reduce maternal morbidity and mortality associated with
abortion.

Perceived Barriers: Perceived barriers prevent an individual from adopting

certain behaviour. Perceived barriers constitute factors that hinder one’s ability
to perform a particular health action (Champion & Skinner, 2008). These
 41

barriers may include cost, social support for the particular health action, pain,
and inconvenience. The value outcome of the HBM is represented when
individuals evaluate the positive and negative aspects that accompany
behaviour. Perceived barriers for young women seek post-abortion care include
stigma attached to abortion, people associate abortion with murder which
violates the rights to life, cultural and religious inclinations in the society. Thus,
individuals may be wary to seek treatment for fear of being stigmatized (Ndoro,
2009).

The HBM assumes that the absence of perceived barriers motivates

individuals to seeks treatment and maintain health behaviours. Where behaviour
cost outweigh perceived benefits then positive behaviour is not adopted.For
example,teenagers have indicated that fear of rejection by the family,stigma and
cost of treatment interferes with the decision of seeking care. Thus, fear, stigma
and cost of treatment becomes a barrier to abortion care services.

In order for a new risk reducing action to be adopted, an individual to accept

that the benefits of changing health behaviour outweigh the consequences of the
old behaviour. Pregnant teen should accept the benefits of attending to antenatal
care regularly or carrying the pregnancy to term than to abort the baby.
Perceived barriers act as the single most powerful predictor for decision making
(Sharma & Romas, 2008).

Cues to Action: Cues to action are circumstances, event or people that

motivate an individual to change (Hall et al., 2010). Cues to action can give a
disease or condition a human face and make people aware of the disease
(Rosenstock, Stretcher & Becker, 1998; Murima, 2013). Cues to action can be
either internal or external stimuli.
 42

Internal stimuli may include guilt of killing an innocent child or

damaging her womb through abortion for a teenage girl who become pregnant
in an unsolicited way. External stimuli may include seeing a peer mate who
suffered a severe complications or death after procuring abortion. Cues to action
have a causal relationship with perceived susceptibility, where perceived
susceptibility is low; there is a need for intense cues to action as they will
stimulate interest in pursuing new behaviour (Murima, 2013).

Self Efficacy: This is the strength of an individual’s belief in one’s own ability
to respond to novel or difficult situations and to deal with any associated
obstacles or set-backs. Self-efficacy is one’s ability to successfully take action.
An individual will not try any behaviour or action if the confidence that they
can perform the said behaviour is absent (Hayden, 2009). For instance, the
pregnant female teen despite the challenges she may face in attempt in seeking
care should develop and sustain confidence in seeking help from parents, health
workers, church leaders, teachers, guidance and counsellors towards helping her
overcome her situation.

Self-efficacy is important for the adoption of a new health/action, for

example, an individual who believes that seeking for care is useful (perceived
benefits) but does not believe they able to use them (perceived barriers); will
not adopt the new behavior because of low self-efficacy.
 43

Empirical Framework

Several studies were reviewed which are related to health implications of

abortion as follows.

In a study carried out by Ikeako, Onoh, Ezegwui, and Ezeonu (2014) on the
pattern and outcome of induced abortion in Abakaliki, Southeast of Nigeria.
The aim of the study was to determine the pattern of unsafe abortion and the
extent to which unsafe abortion contributes to maternal morbidity and mortality
in our settings as well as assess the impact of post- abortion care. A descriptive
survey was conducted among 1,562 women who were on gynecological
admission following complication of induced abortion between January 1, 2001
and December 31, 2008 at the Federal Medical Center, Abakaliki. The study
sample consists of 83 patients with age distribution ranging from 15 to 34 years
out of which adolescents, 15 – 34 years constituted 32.5% (27/83) while 47.0%
(39/83) and 21.7% (18/83) were secondary school students and undergraduates
respectively. The data was obtained from the clinical case records of patients
from the records department and was analyzed using the Epi-info 2007 software
version 3.4.1.

The study revealed that death (15.7%), septicemia (59.0%), abdominal

pain (28.9%), haemorrhages (34.9%) and uterine perforation (30.1%) were the
major complications arising from induced abortion. The researchers concluded
that unsafe abortion remains one of the most neglected sexual and reproductive
health problems in developing countries today despite its significant
contribution to maternal morbidity and mortality they were of the opinion that
prevention of unplanned and unwanted pregnancies by sex education and access
 44

to safe and sustainable family planning methods is a key element in reducing

cases and complications due to induced abortion.

A study carried out by Paluku, Mabuza, Maduna, and Ndimande (2010)

on the knowledge and attitude of abortion in Goma, Democratic republic of
Congo with the aim of determining the knowledge of school girls in Goma,
DRC about the health consequences of illegal abortions and to assess their
attitude towards these abortions. A descriptive cross-sectional study was
conducted among a randomly selected sample of 328 high school girls out of
2,250 girls aged 16-20 years. A pre-tested self-administered questionnaire was
used for data collection. Nine out of 55 (11 public and 44 private) secondary
schools were randomly selected for inclusion in the study. The Epi-info 2000
computer program was used for data capturing and analysis. The different
sources of information were the radio (66.2%, 217), friends (31.7%, 104),
parents (1.5%, 5) and the church (0.5%, 2).

The study revealed that the majority of the participants were 18 years old
(32.6%, 107/328), 19 years old (30.80%, 101/328), 17 years old (23.8%,
78/328), 16 years old (9.8%, 32/328) and 20 years old (3.0%, 10/328). Paluku,
Mabuza, Maduna, and Ndimande (2010)The knowledge level of health
consequences of abortion among the girls increased according to their age
categories 28.1% (9/32) among the 16 year-olds, 80.8% (63/78 among the 17
year-olds, 87.9% (94/107) among the 18 year-olds, 96.0% (97/101) among the
19 year-olds and 90.0% (9/10) among the 20 year-olds. The study also revealed
that most participant (83.2%) knew some health consequences mentioned were
death (79.1%, 233), infertility (14.0%, 46), infection (2.5%, 8) and bleeding
(1.4%, 5). The conclusion shows that girls in secondary school in Goma had a
 45

good knowledge of illegal abortion and its consequences. The researchers

recommended that the Democratic Republic of Congo government may need to
consider legalizing abortion to secure a healthy future for affected girls.

In a similar study carried out by Abiola, Oke, Balogun, Olatona and

Adegbesan-Omilabu (2018) on the knowledge, attitude and practice of abortion
among female students of two public senior secondary schools in Lagos
Mainland Local Government Area, Lagos state. a cross-sectional descriptive
study was aimed at determining the knowledge, attitude and practice of abortion
and factors associated with it among female students of two public senior
secondary schools in Mainland Local Government Area, Lagos State. The
sample size consist of 210 respondents selected using a multi-stage sampling
method. Data were collected with self-administered questionnaire and analyzed
using the Epi-info software.

The results show that the response rates was 98%. The mean age of the
respondents was 15.1±1.3 years. The majority (83.3%) of the respondents had
good knowledge of abortion and its complications and there was a statistically
significant association between the level of education of the respondents and
their knowledge of abortion. Bleeding 168 (81.6%), infection 157 (76.2%),
infertility 159 (77.2%) and death 199 (96.9%) were most abortion complication
mentioned. The researchers concluded that the respondents showed good
knowledge of abortion and its complications, therefore, there is need to improve
and sustain the existing knowledge and attitudes towards abortion so as to
reduce the practice among students of the two schools.

In another study carried out by Obertinca, Dangellia, Pacarada, beha,

Gallopeni, Kongjeli, Gashi and Blakaj (2016) on the emotional and
 46

psychological effects of induced abortion on young women at the clinic for

Gynecology and Obstetrics, University of Clinical Center of Kosova. A cross-
sectional survey conducted among 122 women which consisted the sample size
out of the total population of 9,783 women who underwent abortion in clinic for
Gynecological and Obstetrics from January to December of 2015. Data
collection was based on two questionnaire; Beck Anxiety Questionnaire and
Edinburgh. Postnatal Depression Scale Questionnaire which were analysed
using statistical version 20.0 for windows.

The results revealed that anger (36.06%), feelings of guilt and shame
(27.4%), feelings of loneliness (29.5%), sleep disorders (22.13%), anxiety
(30.32%) and depression (27.86%) were major emotional and psychological
effects of induced abortion on women. These emotional effects can have
negative effect on planning pregnancy and holding other pregnancies.

In a similar study carried out by Ferguson, Horwood, and Ridder (2006)

on abortion in young women and subsequent mental health. The aim of the
longitudinal study was to examine the linkages between having an abortion and
mental health outcomes over the interval from age 15 – 25 years. The sample
sizes used in the analysis range between 506 and 520 depending on the timing
of assessment of pregnancy history and mental health. The sample represent
between 80% and 83% of the original cohort of 630 females. Data collection
was done using questionnaire based on the Diagnostic Interview Schedule for
Children (DISC) at age 16 years and the Composite International Diagnostic
Interview (CIDI) at ages 18 – 25 years.

The results shows that major depression (78.6%), anxiety disorder

(64.3%), suicidal ideation (50.0%), alcohol dependence (53.7%), illicit drug
 47

dependence (57.3%) and other mental health problems (1.93%). The researcher
concluded that abortion in young women may be associated with increased risks
of mental health problems.

A study carried out by Okoro, Okonkwo, Okoh and Oham (2015) on the
social health implications of abortion among female teenagers in Ikeduru Local
Government Area of Imo State. a descriptive survey conducted among the
sample size of 360 respondents out of 6,000 teenagers. The instrument used for
data collection was self-structure questionnaire. The data collected was analysed
using descriptive statistics of frequency counts and percentage grand mean. The
results showed that social stigma 244 (62.22%), illicit drug use 190 (52.78%),
promiscuity (the act of many sexual partners) 199 (55.27%) are social effects of
abortion. The researchers concluded that abortion carries a lot of social
problems in the society.

Summary of Literature Reviewed

The literature reviewed show the conceptual, theoretical and empirical

frameworks of the study. The conceptual framework described the concepts of
perception, teenagers, abortion, health and health consequences as well as the
physical health effects (such as bleeding, death, cervical laceration, uterine
perforation, infertility and sepsis); emotional health effects (such as anger, guilt,
feelings of loneliness and regret), mental health problems (such as anxiety,
depression, suicidal thoughts) and social effects (stigma, substance abuse,
promiscuity and economic loss) of abortion among teenagers in Oguta L.G.A.

The theoretical framework was based on the Health Belief Model

propounded by an American psychologist; Godfrey Hochbaum, Irwin
 48

Rosenstock and Stephen Regels in 1950’s to test the failed tuberculosis

screening programme. The HBM has six constructs; namely perceived barriers,
cues to action and self efficacy that explains how an individual respond to
disease or conditions by adopting new health actions that are beneficial and
sustainable in spite of numerous challenges. This model is applied to health
behaviour like unwanted and unplanned pregnancy and abortion practices.

Finally, the empirical studies reviewed previous studies carried out by

other researcher and their findings on health consequences and attitudes towards
abortion which were relevant to the present study on perceived health
implications of abortion among female teenagers in Oguta Local Government
Area, Imo State. From the studies reviewed, none of such study was carried out
in Oguta L.G.A. of Imo State. This necessitated the present study.
 49

CHAPTER THREE

RESEARCH METHODOLOGY

This chapter described the research procedure that will be employed in

conducting this study. Therefore, it will comprise of the following sub-
headings:

Research Design
Area of the Study
Population of the Study
Sample and Sampling Technique
Instrument for Data Collection
Validity of the instrument
Reliability of the instrument
Method of Data Collection
Method of Data Analysis

Research Design

The research design adopted for the study was the descriptive survey
research design. Ejifiugha (2014) opined that, this design permits the
investigation of the current status of the phenomenon from who should supply
the relevant data and to whom the data are generalizable. The use of this design
is considered appropriate for the study, because it helps to describe, record,
analyze and interpret the condition that exist on the study. Paluku, Mabuzza,
Madunna & Ndimande (2010), used descriptive survey research design to carry
out research on the knowledge and attitudes of school girls towards health
 50

consequences of abortion. Also, the successful application of this design by

Okoro, Okonkwo, Okoh and Oham (2014) in studying the health consequences
of abortion among teenagers. Suggest a possible success in use for the present
study. It is therefore considered appropriate for the present study.

Area of the Study

The study was carried out in Oguta L.G.A. of Imo State. Oguta L.G.A. is
one of the twenty-seven (27) Local Government Areas in Imo State, with its
administrative headquater at Oguta town. It has an area of 1483km 2 and density
of 405.8km2, with an estimated population of about 142,340 as reported from
2006 Census (National Population Commission, 2006). The city of Oguta is
divided into two townships; Oguta 1 and Oguta 2 separated by its popular Oguta
lake from where its name was derived. Also, Njaba River is a major tributary of
the Lake. Oguta L.G.A. which was one of the territories used by the british to
advance into the Igbo hinterland shares boundaries with Ihiala L.G.A in
Anambra State in the north, Oru-West L.G.A and Oru-East L.G.A in Imo State
in the north east, Ohaji/Egbema LGA in Imo State in the south, Mbaitoli LGA
in Imo State, in the east, Owerri West LGA in Imo State in the South east and
Delta state in the west.

Oguta L.G.A. has a huge oil and gas deposit known as the golden belt. It
is also, a home of commercial fishing with a vast fertile area of lands for
farming activities that produce staple foods such as yam, cassava, corn,
vegetables, palm oil. Other commercial activities engaged by the rural dwellers
includes blacksmithing, crafts, canoe building as well as rearing of domestic
animals like goat, sheep, poultry and so on.
 51

Oguta is known for its rich cultural heritage and diversity with Eze-Igwes
as the traditional paramount ruler of the various autonomous communities in
Oguta L.G.A. The people of the area speaks Igbo as their major language as
well as English which is their official language, also, Oguta people observes
the four traditional market days such as Eke, Orie, Afor and Nkwo markets
days. Over 80% of the inhabitants are Christians while some practice traditional
religion and believe system.

Oguta is a home to many government and private institutions such as

Oguta Lake and Resort Centre, Dongurella, an Itallian Catholic outreach project
for the handicapped children, many primary and secondary schools, markets,
hospitals, health centres as well as the proposed Imo State Maritime University
at Osse-motor with a lot of good road networks across the major cities in the
area.

Oguta is blessed with men and women of high repute in different field of
human endeavours. Such personalities includes Late Justice Chukwudifu Oputa,
Senator Arthur Nzeribe, Mrs Flora Nwankpa, among others. There are fourteen
(14) towns that made up Oguta L.G.A., they are: Oguta 1, Oguta II, Osemotor,
Orsu-obodo, Egwe, Nnebukwu, Egbuoma, Awa, Akabor, Ejemekwuru,
Mgbelle, Ezi-orsu, Nkwusi and Izombe. The issue of teenage abortion is no
longer a new thing in any society such like Oguta L.G.A. Various reasons has
been adduced for its existence, but the basic problem is the persistency and
geometric progression of its expansion despite all effort that has been made by
the government, schools, religious bodies and non-governmental agencies at
resolving some identified factors leading to this decadence in Oguta L.G.A.
coupled with high rate of maternal morbidity and mortality among female
 52

teenagers in Oguta L.G.A. as a result of unwanted pregnancies and cases of

incessant procurement of abortion. From the studies reviewed, none of such
studies on perceived health implications of abortion has been carried out in
Oguta L.G.A. Thus the present study is apt to bridge this gap.

Population of the Study

The population of the study consisted of all female teenagers in Oguta

L.G.A. This population consists of about 21,900 female teenagers between the
ages of 13 – 19 years (National Population Commission, 2006).

Table 1: Distribution of Population

S/N Town/City Population

1 Oguta 1 1,900
2 Oguta II 1,450
3 Osemotor 1,750
4 Orsu-obodo 1,500
5 Egwe 1,600
6 Nnebukwu 1,500
7 Egbuoma 1,600
8 Awa 1,300
9 Akabor 1,400
10 Ejemekwuru 1,700
11 Mgbelle 1,550
12 Ezi-orsu 1,600
13 Nkwusi 1,250
14 Izombe 1,800
Total 21,900

Source: (National Population Commission, 2006)

 53

Sample and Sampling Technique

A sample size of 350 female teens were drawn from a total of 21,900
female teenagers in Oguta L.G.A. Two stage sampling technique was used to
determine the sample size.

Stage one: The purposive sampling technique was used to select 7 towns from
14 towns in the L.G.A.

Stage two: A simple random sampling technique was used to select 50 female
teenagers each from the selected seven (7) towns to arrive at 350 as the sample
size.

Table 2: Distribution of Sample Size

S/N Selected Town/City Population Sample size

1 Egwe 1,600 50
2 Nnebukwu 1,400 50
3 Egbuoma 1,600 50
4 Awa 1,700 50
5 Akabor 1,400 50
6 Ezi-orsu 1,600 50
7 Izombe 1,800 50
Total 350

Instrument for Data Collection

The research instrument for this study was the researchers self-structured
questionnaire that was titled “Perceived Health Implications of Abortion among
Female Teenagers (PHIAFTQ) Questionnaire”. The questionnaire consisted of
five sections, the first section (Section A) was on personal data, the second
section (Section B) consisted of 5 items inquiring on perceived physical health
implications of abortion.
 54

The third section (Section C) consisted of 5 items inquiring on perceived

emotional health implications of abortion, the fourth section (section D)

consisted of 5 items inquiring on perceived mental health implications of

abortion while the last section (section E) consisted of 5 items inquiring about

the perceived social health implications of abortion among female teenagers in

Oguta L.G.A. The respondents were expected to respond to the options

provided. Questions answered were structured in modified Likert format: SA-

Strongly Agree, D- Disagree, SD- Strongly Disagree:

SA A D SD
4 3 2 1

Validity of the instrument

The content and face validity of the instrument was established through
the expert judgment of three lecturers selected from the Department of Health
Education, Alvan Ikoku Federal College of Education, Owerri in affiliation with
University of Nigeria, Nsukka. Based on their corrections and inputs the final
copy of the instrument for data collection was drawn.

Reliability of the instrument

The researchers conducted a test re-test method of reliability to ascertain

the reliability of the instrument for the study. Twenty (20) copies of the
validated questionnaire were administered to 20 female teenagers of the
proposed population which were not part of the selected villages in Oguta
L.G.A. After two (2) weeks interval, the instrument were re-administered to the
same respondents. The first score (x) and the second score (y) was correlated
 55

using Spearman’s Rank order of Coefficient Correlation (rho) which is 0.76,

this shows that there is very high degree of correlation existing between test x
and y scores. Therefore, the instrument is reliable.

Method of Data Collection

The questionnaire was administered to three hundred and fifty (350)

respondents from the seven (7) selected towns on face to face basis. To gain
access and obtain co-operation from the respondents, a letter of introduction
from the Project Supervisor which introduced the researchers to the Clan heads
as well as the Youth Leaders in the selected towns in Oguta Local Government
Area. The youth leaders of various churches and towns selected assisted the
investigators to reach the youths during their meetings. This enabled the
administration of instrument to the youths. The researchers ensured that all the
questionnaire were correctly filled, completed and returned to avoid any lost
and improper filling of the questionnaire.

Method of Data Analysis

The data generated from the questionnaire distributed were analyzed

using descriptive statistics of frequency tables, percentage and mean to answer
the research questions. A criterion mean of 2.5 was used to accept or reject the
research questions. Mean scores equal or above 2.5 was regarded accepted,
below 2.5 was regarded as rejected. While the inferential statistics of Chi-

Square (χ2) was used to test the hypothesis proposed for the study at 0.05 level

of significance and at appropriate degree of freedom.

 56

CHAPTER FOUR
DATA PRESENTATION AND ANALYSIS
This chapter dealt with the presentation and analysis of data and findings
on perceived health implications of abortion among female teenagers in Oguta
L.G.A., Imo state. A total of four hundred (400) questionnaire was distributed to
400 nursing mothers in Okigwe L.G.A. out of which 320 copies were properly
filled and returned. That is 91% of the questionnaire were returned. It is on the
basis of this that the results of the findings were presented based on the research
questions and hypotheses that were postulated for the study.
Research Question 1
To determine the maternal-related factors militating against the practices of
exclusive breast-feeding among nursing mothers in Okigwe Local Government
Area of Imo State
Table 3: Responses on the perceived physical health implications of abortion
S/ Items SA A D SD
N f % f % f % f %
1 Abortion carries Risk of cervical laceration 132 41 110 35 58 18 20 6

2 Abortion can lead to uterine perforation 87 27 120 38 75 23 38 12

3 Severe haemorrhage (heavy bleeding) 198 62 102 32 20 6 0 0

4 Increases the risk of acquiring serious 86 27 180 56 50 16 4 1

infection (sepsis)

5 Abortion can cause infertility 103 32 129 40 64 20 24 8

(barrenness)in the future

6 Abortion can lead to death due to 91 28 208 65 18 6 3 1

complications
Overall 116 36.3 142 44.3 48 14.8 15 4.7

Data in table 3 show the perceived physical health implications of

abortion among female teenagers. The table shows that 132 (4%) of the
respondents strongly agreed that abortion carries risk of cervical
laceration;110(35%) of the respondent agreed; 58(18%) disagreed; while
 57

20(6%) strongly disagreed with a mean of 3.5 which is greater than the criterion
mean of 2.5.The table also shows that 120 (38%) of the respondents agreed that
abortion can lead to uterine perforation; 87(27%) of the respondents strongly
agreed; 75(23%) disagreed and 38(12%) strongly disagreed with a mean of 2.8
which is greater than the criterion mean of 2.5. Furthermore, the table shows
that 198 (62%) of the respondents strongly agreed that there is risk of severe
haemorrhage (heavy bleeding) following an abortion; 102(32%) of the
respondents agreed and 20(6%) disagreed while 0(0%) strongly disagreed with
a mean of 3.6 which is greater than the criterion mean of 2.5. Μoreso,
180(56%) of the respondents agreed that abortion may expose one to risk of
acquiring serious infection (sepsis); 86(27%) of the respondents strongly
agreed; 50(16%) disagreed while 4(1%) strongly disagreed with of 3.0 which is
greater than the criterion mean of 2.5. Also, 129(40%) of the respondents
agreed that abortion can cause infertility in future; 103(32%) strongly agreed;
64(20%) disagreed and 24(8%) strongly disagreed with a mean of 2.9 which is
greater than the criterion mean of 2.5.
The Table further showed that 208(65%) of the respondents agreed that
abortion can lead to death due to complications; 91(28%) strongly agreed;
18(6%) disagreed while 3(1%) strongly disagreed with a mean of 3.2 which is
greater than the criterion mean of 2.5. The overall shows that 116(36.3%) of the
respondents strongly agreed; 142(44.3%) agreed; 48(14.8%) disagreed while
15(4.7%) strongly disagreed to the items as perceived physical health
implications of abortion with a mean of 3.1 which is greater than the criterion
mean of 2.5. This implies that the female teenagers perceived the items as
physical health implications of abortion.
 58

Research Question 2
What are the perceived emotional health implication of abortion among female
teenagers in Oguta L.G.A.?

Table 4: Responses on the perceived emotional health implications of abortion

S/ Items SA A D SD x
N F % f % f % f %
1 Abortion can lead to loss of happiness 112 35 154 48 32 10 22 7 3.1
(anger)
2 There is always expression of shame 124 39 146 46 36 11 14 4 3.1
following abortion
3 Feelings of guilt after abortion 167 52 88 28 36 11 29 9 3.2
4 There is always feelings of regret following 121 38 110 34 50 16 39 12 2.9
induced abortion
5 Young girls who procure abortion tend to 15 5 142 44 112 35 51 16 2.3
isolate themselves from peer group as a
result of shame
Overall 108 33.8 128 40 53 16.6 31 9.6 2.9

Data in table 4 show the perceived emotional implications of abortion

among female teenagers. The table shows that 154 (48%) of the respondents
agreed that abortion can lead to loss of happiness (anger); 112(35%) of the
respondents strongly agreed; 32(10%) disagreed and 22(7%) strongly disagreed
with a mean of 3.1 which is greater than the criterion mean of 2.5. The table
also shows that 146(46%) of the respondents agreed that there is always feelings
of regret following induced abortion; 124(39%) of the respondents strongly
agreed;36(11%)disagreed and 14(4%) strongly disagreed with a mean of 3.1
which is greater than the criterion mean of 2.5.
Furthermore, the table show that 167(52%) of the respondents strongly
agreed that there is feelings of guilt after abortion;88(28%) of the respondents
agreed;36(11%) disagreed while 29(9%) strongly disagreed with a mean of 3.2
which is greater than the criterion mean of 2.5. More so, 121(38%) of the
 59

respondents strongly agreed that There is always expression of shame

following abortion;110(34%) of the respondents agreed;50(16%) disagreed and
39(12%) strongly disagreed with a mean of 2.9 which is greater than the
criterion mean of 2.5. Also, 142(44%) of the respondents agreed that young
girls who procure abortion tend to isolate themselves from peers due to shame;
112(35%) of the respondents disagreed; 51(16%) strongly disagreed while
15(5%) strongly agreed with a mean of 2.3 which is greater than the criterion
mean of 2.5. The overall shows that 108(33.8%) of the respondents strongly
agreed; 128(40%) agreed; 53(16.6%) disagreed while 31(9.6%) strongly
disagreed to the items as perceived emotional health implications of abortion
with a mean of 2.9 which is greater criterion mean of 2.5. This implies that the
female teenagers perceived the items as emotional health implications of
abortion.

Research Question 3
What are the perceived mental health implication of abortion among female
teenagers in Oguta L.G.A.?

Table 5: Responses on the perceived mental health implications of abortion

S/ Items SA A D SD x
N f % f % f % f %
 60

1 Abortion muay expose young girls to 150 47 84 26 61 19 25 8 3.1

anxiety

2 It can lead to depression(feeling of 106 33 134 42 58 18 22 7 3.0

hopelessness)

3 Abortion can lead to sleep disorders 93 29 161 50 53 17 13 4 3.0

4 Young girls experiences post-traumatic 87 27 120 38 75 23 38 12 2.8

stress after abortion.

5 Most time teenage girls who procure 89 28 146 46 75 23 10 3 2.8

abortion have suicidal thoughts and feelings
Overall 105 32.8 129 40.4 64 20 22 6.8 2.9

Data in table 5 show the perceived mental implications of abortion among

female teenagers. The table show that 150 (47%) of the respondents strongly
agree that abortion may expose young girls to anxiety; 84(26%) of the
respondents agreed; 61(19%) disagreed while 25(8%) strongly disagreed with a
mean of 3.1 which is greater than the criterion mean of 2.5. The table further
showed that 133(42%) of the respondents agreed that abortion can lead to sleep
disorder; 106(33%) of the respondents strongly agree; 58(18%) disagreed and
22(7%) strongly disagree with a mean of 3.0 which is greater than the criterion
mean of 2.5.
Furthermore, the table shows that 161(50%) of the respondents agreed
that abortion can lead to depression; 95(29%) of the respondents strongly agree;
53(17%) disagree while 13(4%) strongly disagreed with a mean of 3.0 which is
greater than the criterion mean of 2.5. More so, 120(38%) of the respondents
agreed that young girls experiences post-traumatic stress disorder after abortion;
87(27%) of the respondents strongly agree; 75(23%) disagree while 38(12%0
strongly disagree with a mean of 2.8 which is greater than the criterion mean of
2.5. Also, 146(46%) of the respondents agree that abortion can expose female
teens to have suicidal thoughts and feelings; 89(28%) of the respondents
 61

strongly agree; 75(23%) disagreed while 10(3%) strongly disagreed with a

mean of 2.8 which is greater than the criterion mean of 2.5. The overall shows
that 105(32.5%) of the respondents strongly agreed; 129(40.4%) agreed;
64(20.0%) disagreed while 22(6.8%) disagreed that abortions has mental health
implications with a mean of 2.9 which is greater than the criterion mean of 2.5.
The overall show that 105(32.8%) of the respondents strongly agreed;
129(40.4%) agreed; 64(20%) disagreed while 22(6.8%) strongly disagreed to
the items as perceived mental health implications of abortion with a mean of 2.9
which is greater than the criterion mean of 2.5. This implies that the female
teenagers perceived the items as mental health implications of abortion.

Research Question 4
What are the perceived social health implication of abortion among female
teenagers in Oguta L.G.A.?

Table 6: Responses on the perceived social health implications of abortion

S/ Items SA A D SD ¿x
N f % f % f % f %
1 Female teenagers are faced with stigma 93 23 149 47 62 19 36 11 2.8
 62

(labelling or name calling) after abortion.

2 Abortion can expose young female teens to 161 50 97 30 35 11 27 8 3.2

substance abuse (e.g alcohol and drugs)

3 Abortion can lead to promiscuity 120 38 78 24 67 21 55 17 2.8

4 Abortion may cause female teenager to lose 92 29 131 41 68 21 30 9 2.8

her friends

5 Abortion may affect the female teenagers’ 57 18 108 34 96 30 59 18 2.5

good relationship with family members
Overall 101 31.6 113 35.2 66 20.4 41 12.6 2.8

Data in table 6 show the perceived health social health implications

among female teenagers. The table shows that 149(47%) of the respondents

agreed that abortion expose young female teens to substance abuse (e.g alcohol

and drugs); 73(23%) of the respondents strongly agreed; 62(19%) disagreed

while 36(11%) strongly disagreed with a mean of 2.8 which is greater than the

criterion mean of 2.5. The table further shows that 161(50%) of the respondents

strongly agree that female teens are faced with stigma after abortion; 97(30%)

of the respondent agreed; 35(11%) disagreed and 27(8%) strongly disagreed

with a mean of 3.2 which is greater than the criterion mean of 2.5.

Furthermore, the table shows that 120 (38%) of the respondents strongly

agreed that abortion may cause female teens to lose her friends; 78(24%) of the

respondents agreed; 67(21%) disagreed and 55(17%) strongly disagreed with a

mean of 2.8 which is greater than the criterion mean of 2.5. More so, 131(41%)

of the respondents agreed that abortion can lead to promiscuity (the act of

having many sexual partners); 92(29%) of the respondents strongly agreed;

68(21%) disagreed while 30(9%) strongly disagreed with a mean of 2.8 which
 63

is greater than the criterion mean of 2.5. Also, 108(34%) of the respondents

agreed that abortion may affect the female teen’s good relationship with family

members; 96(30%) of the respondents disagreed; 59(18%) strongly disagreed

while 57(18%) strongly agree with a mean of 2.5 which is equal to the criterion

mean of 2.5. The overall shows that 101(31.6%) of the respondents strongly

agreed; 113(35.2%) agreed; 60(20.4%) disagreed while 41(12.6%) disagreed to

the items as perceived social health implications of abortion with a mean of 2.8

which is greater than the criterion mean of 2.5. This implies that the female

teenagers perceived the items as social health implications of abortion.

Research Question 5
What are the perceived health implication of abortion among female teenagers
in Oguta L.G.A. based on age?

Table 6: Responses on the perceived health implications of abortion among

female teenagers according to age groups
13-15 years 16-18 years 19 years and above Mean
Variables SA A D SD SA A D SD SA A D SD
f f f f f f f f f f f f
 64

% % % % % % % % % % % %
1 Physical 51 21 3 5 69 72 51 10 12 18 3 5 3.1
health 15.9 6.6 0.9 1.6 21.6 22.5 15.9 3.1 3.8 5.6 0.9 1.6
implications

2 Emotional 32 30 10 5 56 120 14 10 24 4 8 7 3.1

health 10 9.4 3.1 1.6 17.5 37.5 4.4 3.1 7.5 1.3 2.5 2.2
implications

3 Mental health 9 21 19 19 75 25 20 8 49 40 20 12 2.9

implications 2.8 6.6 5.9 5.9 23.4 7.5 6.3 2.5 15.3 12.5 6.3 3.8

4 Social health 45 32 10 13 65 21 16 10 20 27 40 20 2.9

implications 14.1 10 3.1 4.1 19.4 6.6 5 3.1 6.3 8.4 12.5 6.3

Overall 34 26 11 11 66 60 25 10 26 22 18 11 3.0
10.7 8.2 3.2 3.3 20.5 18.5 8.0 3.0 8.2 7.0 6.0 3.5

Data in table 7 show the responses on the perceived health implications of

abortion based on age. The table shows that 51(15.9%) of the respondents

within the age group of 13-15 years strongly agreed that abortion has physical

health implications; 21(6.6%) agreed; 3(0.9%) disagreed while 5(1.6%) strongly

disagreed. Also the table showed that 69(21.6%) of the respondents within the

age group of 16 – 18 years strongly agreed that abortion has physical health

implications; 72(22.5%) agreed; 51(15.9%) disagreed while 10(3.1%) strongly

disagreed. Also, 12(3.8%) of the respondents within the age group of 19 years

and above strongly that abortion has physical health implications; 18(5.6%)

agreed; 3(0.9%) disagreed while 5(1.6%) strongly disagreed with a mean of 3.1

which is greater than the criterion mean of 2.5.

Also the table show that 32(10%) of the respondents within the age group

of 13-15 years strongly agreed that abortion has emotional health implications;

30(9.4%) agreed; 10(3.1%) disagreed while 5(1.6%) strongly disagreed. Also,

 65

the table show that 56(17.5%) of the respondents within the age group of 16 –

18 years strongly agreed that abortion has emotional health implications;

120(37.5%) agreed; 14(4.4%) disagreed while 10(3.1%) strongly disagreed.

Also, 24(7.5%) of the respondents within the age group of 19 years and above

strongly agreed that abortion has emotional health implications; 4(1.3%) agreed;

8(2.5%) disagreed while 7(2.2%) strongly disagreed with a mean of 3.1 which

is greater than the criterion mean of 2.5.

Also the table show that 9(2.8%) of the respondents within the age group

of 13-15 years strongly agreed that abortion has mental health implications;

21(6.6%) agreed; 19(5.9%) disagreed while 19(5.9%) strongly disagreed. Also

the table show that 75(23.4%) of the respondents within the age group of 16 –

18 years strongly agreed that abortion has mental health implications; 25(7.5%)

agreed; 20(6.3%) disagreed while 8(2.5%) strongly disagreed. Also, 49(15.3%)

of the respondents within the age group of 19 years and above strongly agreed

that abortion has mental health implications; 40(12.5%) agreed; 20(6.3%)

disagreed while 12(3.8%) strongly disagreed with a mean of 2.9 which is

greater than the criterion mean of 2.5.

Also the table show that 45(14.1%) of the respondents within the age

group of 13-15 years strongly agreed that abortion has social health

implications; 32(10%) agreed; 10(3.1%) disagreed while 13(4.1%) strongly

disagreed. Also the table show that 21(6.6%) of the respondents within the age

group of 16 – 18 years strongly agreed that abortion has social health

 66

implications; 21(6.6%) agreed; 16(5.0%) disagreed while 10(3.1%) strongly

disagreed. Also, 20(6.3%) of the respondents within the age group of 19 years

and above strongly agreed that abortion has social health implications; 27(8.4%)

agreed; 40(12.5%) disagreed while 20(6.3%) strongly disagreed with a mean of

2.9 which is greater than the criterion mean of 2.5.

The overall show that 34(10.7%) of the respondents with the age group of

13 – 15 years strongly agreed; 26(8.2%) agreed; 11(3.3%) disagreed while

11(3.3%) strongly disagreed. Also, the table show that 66(18.5%) of the

respondents within age group of 16 – 18 years strongly agreed; 60(18.5%)

agreed; 25(8.0%) disagreed while 10(3.0%) strongly disagreed. Furthermore,

the table show that 26(8.2%) of the respondents within the age group of 19

years and above strongly agreed; 22(7.0%) agreed; 18(6.0%) disagreed while

11(3.3%) strongly disagreed with a mean of 3.0 which is greater than the

criterion mean of 2.5. This implies that the female teenagers perceived the items

as health implications of abortion based on age.

Research Question 6
What are the perceived health implication of abortion among female teenagers
in Oguta L.G.A. based on their level of education?

Table 7: Responses on the perceived health implications of abortion among

female teenagers according to level of education
Primary education Secondary education Tertiary education Mean
S/N Variables SA A D SD SA A D SD SA A D SD
f f f f f f f f f f f f
 67

% % % % % % % % % % % %
1 Physical health 6 33 24 9 50 35 20 15 75 20 20 15 2.9
implications 1.9 10.3 7.5 2.8 15.6 10.9 6.3 4.7 23.4 6.3 6.3 4.7

2 Emotional 65 20 21 10 45 27 32 10 21 40 13 16 2.9
health 2.8 6.3 6.6 3.1 14.1 8.4 10 3.1 6.6 12.5 4.1 5
implications

3 Mental health 9 21 20 20 75 25 20 8 50 40 20 11 2.9

implications 2.8 6.6 6.3 6.3 23.4 7.8 6.3 2.5 15.6 12.5 6.3 3.4

4 Social health 31 33 30 15 50 22 17 12 50 32 16 11 2.9

implications 9.7 10.3 9.4 4.7 15.6 6.7 5.3 3.8 15.6 10 6 3.4

Overall 28 27 24 14 55 27 22 11 49 33 17 13 2.9
8.8 8.4 7.5 4.2 17.2 8.4 6.9 3.5 15.3 10.3 5.4 4.1

Data in table 8 show the responses on the perceived health implications of

abortion based on level of education. The table show that 6(1.9%) of the
respondents with primary education strongly agreed that abortion has physical
health implications; 33(10.3%) agreed; 24(7.5%) disagreed while 9(2.8%)
strongly disagreed. The table also show that 50(15.6%) of the respondents with
secondary education strongly agreed that abortion has physical health
implications; 35(10.9%) agreed; 20(6.3%) disagreed while 15(4.3%) strongly
disagreed. Also, 75(23.4%) of the respondents with tertiary education strongly
that abortion has physical health implications; 20(6.3%) agreed; 20(6.3%)
disagreed while 15(4.7%) strongly disagreed with a mean of 2.9 which is
greater than the criterion mean of 2.5.

Also the table show that 65(20.3%) of the respondents with primary

education strongly agreed that abortion has emotional health implications;

20(6.3%) agreed; 21(6.6%) disagreed while 10(3.1%) strongly disagreed. Also,

the table show that 45(14.1%) of the respondents with secondary education

strongly agreed that abortion has emotional health implications; 27(8.4%)

 68

agreed; 32(10%) disagreed while 10(3.1%) strongly disagreed. Also, 21(6.6%)

of the respondents with tertiary education strongly agreed that abortion has

emotional health implications; 40(12.5%) agreed; 13(4.1%) disagreed while

16(5.0%) strongly disagreed with a mean of 2.9 which is greater than the

criterion mean of 2.5.

Also the table show that 9(2.8%) of the respondents with primary

education strongly agreed that abortion has mental health implications;

21(6.6%) agreed; 20(6.3%) disagreed while 20(6.3%) strongly disagreed. Also

the table show that 75(23.4%) of the respondents with secondary education

strongly agreed that abortion has mental health implications; 25(7.8%) agreed;

20(6.3%) disagreed while 8(2.5%) strongly disagreed. Also, 50(15.6%) of the

respondents with tertiary education strongly agreed that abortion has mental

health implications; 40(12.5%) agreed; 20(6.3%) disagreed while 11(3.4%)

strongly disagreed with a mean of 2.9 which is greater than the criterion mean

of 2.5.

Also the table show that 31(9.7%) of the respondents with primary

education strongly agreed that abortion has social health implications;

33(10.3%) agreed; 30(9.4%) disagreed while 15(4.7%) strongly disagreed. Also

the table show that 50(15.6%) of the respondents with secondary education

strongly agreed that abortion has social health implications; 22(6.7%) agreed;

17(5.3%) disagreed while 12(3.8%) strongly disagreed. Also, 50(15.6%) of the

respondents with tertiary education strongly agreed that abortion has social
 69

health implications; 32(10.0%) agreed; 16(6.0%) disagreed while 11(4.4%)

strongly disagreed with a mean of 2.9 which is greater than the criterion mean

of 2.5.

The overall show that 28(8.8%) of the respondents with primary

education strongly agreed; 27(8.4%) agreed; 24(7.5%) disagreed while
14(4.2%) strongly disagreed. Also, the table show that 55(17.2%) of the
respondents with secondary education strongly agreed; 27(8.4%) agreed;
22(6.9%) disagreed while 11(3.5%) strongly disagreed. Furthermore, the table
show that 49(15.3%) of the respondents with tertiary education strongly agreed;
33(10.3%) agreed; 17(5.4%) disagreed while 13(4.1%) strongly disagreed with
a mean of 2.9 which is greater than the criterion mean of 2.5. This implies that
the female teenagers perceived the items as health implications of abortion
based on their level of education.

Hypothesis 1
There is no significant difference in the perceived health implications of
abortion among female teenagers in Oguta L.G.A. based on age.

Table 8: Chi-Square analysis verifying the perceived health implications of

abortion among female teenagers based on age.
Age N Cal χ
2
Tab χ
2 Level of Df Decision
value significance
13-15 82 6.725 5.991 0.05 2 Rejected
 70

16-18 161

19 and 77
above

Data in table 8 show the Chi-Square analysis verifying the significance

difference in the perceived health implications of abortion among female
teenagers based on age. The table show that the calculated chi-square (χ2) of
6.725 is higher than the tabulated Chi-square (χ2) of 5.991 at 0.05 significant
level and degree of freedom of 2. The null hypothesis of no significance
difference in the perceived health implications of abortion among female
teenagers based on age is therefore rejected. Hence, there is significant
difference in the perceived health implications of abortion among female
teenagers in Oguta L.G.A based on age.

Hypothesis 2
There is no significant difference in the perceived health implications of
abortion among female teenagers in Oguta L.G.A. based on level of education.

Table 9: Chi-Square analysis verifying the perceived health implications of

abortion among female teenagers based on level of education.
Age N Cal χ Tab χ Level of Df Decision
2 2

value significance
Primary 93 5.2935 5.991 0.05 2 Accepted
 71

education

Secondary 115
education

Tertiary 112
education

Data in table 9 show the Chi-Square analysis verifying the significance

difference in the perceived health implications of abortion among female

teenagers based on level of education. The table show that the calculated chi-

square (χ2) of 5.2935 is less than the tabulated Chi-square (χ 2) of 5.991 at 0.05

significant level and degree of freedom of 2. The null hypothesis of no

significance difference in the perceived health implications of abortion among

female teenagers based on level of education is therefore accepted. Hence, there

is no significant difference in the perceived health implications of abortion

among female teenagers in Oguta L.G.A. based on level of education.

CHAPTER FIVE

DISCUSSION OF FINDINGS, CONCLUSION, RECOMMENDATIONS

AND SUMMARY

Discussion of Findings
 72

The study generated information on the perceived health implications of

abortion female teenagers in Oguta L.G.A., Imo state The findings are discussed

below:

The finding in table 3 revealed the responses on perceived physical health

implications of abortion among female teenagers. The table revealed that the
respondents agreed that abortion carries the risk of cervical laceration; abortion
can lead to uterine perforation; severe haemorrhage; abortion increase the risk
of acquiring serious infection (sepsis); abortion can cause infertility in the future
and that abortion can lead to death due to complications. The findings is
expected and not surprisingly because it is in agreement with the findings of
Agbakwuru and Ekechukwu (2009), who revealed that physical health
problems emanating from abortion include the damage of cervical and uterine
muscles, which may later result in the perforation of the uterus, infectious,
hemorrhage, blood clothing disorder, inability to conceive an bear children in
future (bareness) and ectopic pregnancy. In addition, the findings agrees with
that of Okoye (2006), who asserted that death, pains, prolong bleeding, splitting
or tearing of the cervix, perforation and infection are some of the immediate
physical problems associated with induce abortion. Also, it agrees with Calhoun
(2012) who stressed that abortion is associated with cervical and uterine damage
which may increase the risk of premature delivery, complications of labour and
abnormal development of the placenta in later pregnancies. Grimes et al., (2006)
in their own study, revealed that every eight minutes, a woman is dying of
unsafe abortion at the rate of 367 maternal deaths per 100,000 unsafe abortion.

In another study, Abbas (2014) opined that unsafe abortion is responsible

for about 30 – 40% of maternal mortality in Nigeria and the estimate is likely to
 73

be higher considering those dying at home and before reaching the health
facilities. Also, Iniaghe (2009) in his findings, reported that 50% of maternal
death in Africa is attributed to abortion, with over 20,000 Nigerian women
death as a result of abortion annually. WHO (2014) in their own study revealed
that when compared to pregnant women who had their babies, pregnant women
who aborted were 3.5 times more likely to die. Similarly, Ikeako et al., (2014)
in their findings revealed that death, septicemia, abdominal pain, haemorrhages
and uterine perforation were the major complications arising from induced
abortion. They concluded that unsafe abortion remains one of the most
neglected sexual and reproductive health problems in developing countries
today despite its significant contribution to maternal morbidity and mortality
they were of the opinion that prevention of unplanned and unwanted
pregnancies by sex education and access to safe and sustainable family planning
methods is a key element in reducing cases and complications due to induced
abortion.

The finding in table 4 revealed the responses on perceived emotional

health implications of abortion among female teenagers. The table revealed that

the respondents agreed that abortion can lead to loss of happiness (anger); there

is always expression of shame following abortion; there is feeling of guilt after

abortion; there is always feelings of regret following induced abortion and that

young girls who procure abortion tend to isolate themselves from peer group as

a result of shame. The findings is expected and not surprisingly because it is in

agreement with the findings of with Welch (2010), who in his study identified

self condemnation, anger, aggressiveness, regret, sadness, deep feeling of shame

 74

and hopelessness, grief and guilt, low self-esteem, hatred or unforgiveness of

self and partner, secret torture and hunt of the irreparable past and thought of

the would be birth of the aborted fetus as some of the negative emotional

problems experienced by women after procuring abortion. Also, it agrees with

Obertinca et al., (2016) who revealed that anger, feelings of guilt and shame,

feelings of loneliness, sleep disorders, anxiety and depression were major

emotional and psychological effects of induced abortion on women. These

emotional effects can have negative effect on planning pregnancy and holding

other pregnancies.

The finding in table 5 revealed the responses on perceived mental health

implications of abortion among female teenagers. The table revealed that the
respondents agreed that abortion may expose young girls to anxiety; it can lead
to depression (feeling of hopelessness); abortion can lead to sleep disorders;
young girls experiences post-traumatic stress after abortion and most times
teenage girls who procure abortion who suicidal thought and feelings. The
findings is expected and not surprisingly because it is in agreement with the
findings of Coleman (2011), who revealed that women who had undergone an
abortion experiences are at increased risk of mental health problems. These
problems can range from mild depression to severe anxiety disorders. The
findings agrees with that of Ferguson et al., (2006), who found that in all
comparisons those becoming pregnant and seeking abortion had significantly
higher rates of disorder than the not pregnant groups and with the exception of
anxiety disorder, significantly higher rates of disorder than the pregnant no
abortion group. Researchers concluded that exposure to abortion is a traumatic
 75

life event which increases longer term susceptibility to common mental

disorder. Also, it agrees with Reardon et al (2003) findings who reported that
when compared to women who have given birth, women who have had an
abortion also have significantly higher rates of admission to hospital for
psychiatric reasons. Similarly, the findings is line with Ostbye et al., (2003) who
found that women who had an induced abortion had a five times higher rate of
admission to hospital for psychiatric reasons in the following three months than
women who had not undergone induced abortion.

Furthermore, the findings agrees with Reardon (2007) who in his study,
identified clinical depression, anxiety attacks, phobias, personality disorders,
addictions, hallucination as some of the mental problems of abortion. More so,
the findings is line with Canadian Mental Association (2018) that identified
anxiety, depression, post-traumatic stress (post abortion stress) disorder,
nightmares and suicidal ideation as common psychological health problems
linked to induced abortion. The findings also agrees with Ferguson et al., (2006)
who revealed that teenagers aged 15 – 18 years who underwent an abortion
were twice as likely to experience suicidal ideation when compared to teens of
the same age who had never been pregnant teens who has been pregnant or
teens who have been pregnant but chose not to have an abortion.

In another study, Sabia and Rees (2013) agrees with the findings of the

study, when they found that girls’ who aborted were 10 times more likely to

commit suicide if she had undergone an abortion within the preceding 6 months

than if she had not. They concluded that girls with a lifetime history of abortion

were about 6 times more likely to have attempted suicide compared with those
 76

who had no history. Furthermore, the findings agrees with Ferguson et al.,

(2006) revealed that abortion is associated with major depression, anxiety

disorder, suicidal ideation, and other mental health problems. The researchers

concluded that abortion in young women may be associated with increased risks

of mental health problems.

The finding in table 6 revealed the responses on perceived social health

implications of abortion among female teenagers. The table revealed that the
respondents agreed that female teenagers are faced with stigma (labelling or
name calling) after abortion; abortion can expose young female teens to
substance abuse e.g (alcohol and drugs); abortion can lead to promiscuity;
abortion may cause a female teenager to lose her friend and abortion may the
female teenagers’ good relationship with family members. The findings is
expected and not surprisingly because it is in agreement with Bankole et al.,
(2006), who stressed that women who choose to have an abortion are often
directly transgressing the norms, and as a result, they may perceive
stigmatization. Also, it agrees with Shellenberg et al, (2011) who asserted that
for women who disclose that they had an abortion or are planning to have one,
may experience the stigma in form of rejection by their family, friends and
peers, physical, verbal or emotional abuse; being devalued, being mistreated in
the home and/or seen such women as deviant (promiscuous, careless, selfish
and lack compassion for human life). Such woman feels embarrassed, shamed,
guilt and fear of disclosure.

Furthermore, the findings agrees with Ferguson (2004) study, who

asserted that young women who aborted had significantly high rate of drug
 77

dependence than young women who had never been pregnant and pregnant

young women who carried to term. This is also in line with Dingle (2008) who

found that young women with an abortion history had almost 3 times greater

risk of experiencing a lifetime illicit drug use disorder and twice the risk for an

alcohol problem. In another study, Pederson (2008) revealed that women who

had undergone an abortion were 2.8 times more likely to have alcohol problems,

4.6 times more likely to use marijuana, 5.0 times more likely to have nicotine

dependence, 7.7 times more likely to use other illicit drugs. Also, Coleman

(2006) in her findings revealed that women who have undergone abortion also

tend to smoke more frequently or 6 times more likely to use marijuana which

may account for the increased lung cancer and personality disorder.

Furthermore, Coleman et al., (2007) found that when compared to women

without a history of abortion, women with abortion history were hypothesized

to report more frequent sexual partners, more frequent sex with acquaintances

and friends and more frequent engagement in impersonal sexual behaviours (sex

during casual encounter). Okoro et al (2015) also revealed that the results

showed that social stigma, illicit drug use, promiscuity (the act of many sexual

partners) are social effects of abortion. The researchers concluded that abortion

carries a lot of social problems in the society.

The findings in table 7 revealed the responses on the perceived health

implications among female teenagers based on age. The table revealed that the

respondents based by their age groups; 13 – 15 year group had (18.9%), 16 – 18

 78

years had (39.0%) while 19 years and above had (15.2%), perceived that

abortion has health implications. This is in contrast to Paluku, et al. (2010)

findings, who revealed that the knowledge level of health consequences of

abortion among the girls increased according to their age categories. The

researchers concluded that girls in secondary schools had a good knowledge of

illegal abortion and its consequences.

The findings in table 8 revealed the responses on the perceived health

implications among female teenagers based on level of education. The table

revealed that respondents based on their educational level; primary education

had (17.2%), secondary education had (25.6%) while tertiary had (25.6%),

perceived that abortion has health implications. This is in agreement with

Abiola et al, (2018), who in their findings revealed majority of the respondents

had good knowledge of abortion and its complications and there was a

statistically significant association between the level of education of the

respondents and their knowledge of abortion.

Conclusion
On the basis of the findings and discussion, the following conclusions were

made:
 79

1) From the responses, it was revealed that majority of the respondents

agreed that the items in table 3 are perceived physical health implications

of abortion. This answers research question one.

2) From the responses, it was revealed that majority of the respondents

agreed that the items in table 4 are perceived emotional health

implications of abortion. This answers research question two.

3) From the responses, it was revealed that majority of the respondents

agreed that the items in table 5 are perceived mental health implications

of abortion. This answers research question three.

4) From the responses, it was revealed that majority of the respondents

agreed that the items in table 6 are perceived social health implications of

abortion. This answers research question four.

5) There is significant difference in the perceived health implications of

abortion among female teenagers in Oguta L.G.A. based on age. This

answers research question five.

6) There is no significant difference in the perceived health implications of

abortion among female teenagers in Oguta L.G.A. based on level of

education. This answers research question six.

Summary
 80

The study was carried out to determine the perceived health implications

of abortion among female teenagers in Oguta L.G.A. To direct the study, the

researchers formulated six (6) objectives, six (6) research questions and two (2)

hypotheses. The study was delimited to dependent variables of health

implications of abortion and independent variables of age and levels of

education. Appropriate literature were reviewed and presented under four (4)

headings which conceptual framework, theoretical framework, empirical

framework and summary of literature review. The research design adopted for

the study was descriptive survey design. The population of the study was twenty

one thousand, nine hundred (21,900) female teenagers in Oguta L.G.A. The

sample size of 350 female teenagers in Oguta L.G.A was randomly selected

using two staged sampling technique. The instrument for data collection was the

researchers’ developed valid and reliable structured questionnaire. Data

collected were presented into contingency tables and analyzed using descriptive

statistics of frequency counts, percentages and mean as well as inferential

statistics of Chi-square (χ2) at 0.05 level of significance. The result revealed that

greater percentage of the female teenagers in Oguta L.G.A. perceived that

abortion has health implications.

The following results were obtained:

 81

1) From the responses, it was revealed that majority of the respondents

agreed that the items in table 3 are perceived physical health implications

of abortion. This answers research question one.

2) From the responses, it was revealed that majority of the respondents

agreed that the items in table 4 are perceived emotional health

implications of abortion. This answers research question two.

3) From the responses, it was revealed that majority of the respondents

agreed that the items in table 5 are perceived mental health implications

of abortion. This answers research question three.

4) From the responses, it was revealed that majority of the respondents

agreed that the items in table 6 are perceived social health implications of

abortion. This answers research question four.

5) There is significant difference in the perceived health implications of

abortion among female teenagers in Oguta L.G.A. based on age. This

answers research question five.

6) There is no significant difference in the perceived health implications of

abortion among female teenagers in Oguta L.G.A. based on level of

education. This answers research question six.

Recommendations
 82

Based on the findings of the study, the following recommendations were made:

1) There should be extensive enlightenment campaign through the print and

electronic media to educate female teenagers on the dangers of abortion.

Such enlightenment campaign should sponsored by government and non-

governmental organizations.

2) There is need for parents, teachers, as well as religious bodies to take an

active role in educating teenagers about sex, pregnancy, abortion as well

as its dangers.

3) Government and health policy makers should allocate adequate resources

to fund programmes which offer comprehensive health information and

services including abortion. Excellent programmes can greatly reduce the

need for abortion by assisting young women to use their choice of

contraception consistently and effectively.

4) Government through the Ministry of Health should improve women’s

access to contraceptive information, counselling as well as wide range of

modern contraceptive methods. They should ensure that these services are

available to all women, regardless of their age, marital status, religion,

ethnicity and sexual orientation. The goal is to reduce unintended and

unwanted pregnancies as well as reduced incidence of abortion.

5) Curriculum planners should develop sex and family life education

programme that will stand test of time and to ensure its effective

implementation.
 83

6) The school health programme should be intensified to include the

education of the adolescent/teenagers towards abortion and its related

dangers. School education will best equipped youth to make appropriate

choices about delaying the initiation of sex and about protecting

themselves and their partners when to choose to have sex.

7) Health professionals should display non-judgmental attitude towards

teenagers seeking reproductive health care services. Confidential

counselling and emergency contraception should be available to female

teens in need.

8) Government should enact public health laws and ensure its effective

implementation to check-mate the incessant upspring of homes where

illegal abortions services are carried out.

Implication of the Study

The study was on perceived health implications of abortion among female

teenagers in Oguta L.G.A. The findings of the study revealed that majority of

female teenagers in Oguta L.G.A. have high perception of abortion. Therefore,

there is need to for parents, teachers to teach teenagers about abortion.

Government of all levels and relevant inter-governmental and non-

governmental organizations should strengthen their commitment to women’s

health and to deal with the health aspect of unsafe abortion as major public
 84

health concern as this will help to reduce the morbidity and mortality associated

with unsafe abortion in this country.

The result of this study will further sensitize health and allied educators

towards intensifying their efforts in teaching sex education and family health

issues related to health implications of abortion. There is also need for

government to improve women’s access to a broad range of effective

contraceptive methods regardless of their age and religion affiliation.

Suggestion for Further Studies

The following researches can be carried out in order to provide insight on

some of the areas not covered in the present study.
1) Knowledge and attitude of male teenagers towards health consequences
of abortion.
2) Investigation on the cause of illegal abortion among adolescents
3) A quantitative study on out-of-school adolescent girls attitude towards
unsafe abortion.

References

Abbas, Y.G., (2014). Causes and impact of unsafe abortion in Nigeria. 50th
 85

International Course in Health Development, Sept 16, 2013 – Sept 5,

2014. KIT (Royal Tropical Institute) Development Policy & Practice,
Urije Universiteit Amsterdam, 1(1): 10-15.

Abiola, A.H.O., Balogun, M.R., Olatona, T.A. & Adegbesan-Omilabu, M.A.

(2016). Knowledge, attitude and practice of abortion among female
students of two public senior secondary schools in Lagos MainLand
Government Area, Lagos State. J. Clin. Sc; 1(3):82-7.

Agbakwuru, C. & Ekechukwu, R. (2009). Sexuality education and

reproductive health counseling. Owerri: Career Publishers.

Alibi, O.T. & Oni, I. O. (2017). Teenagers pregnancy in Nigeria: Causes, effect
and control. Int. J. Aca. Research in Bus and Soc. Sci., 7(2): 17-32.

Angelo, J. (2004). The psychological aftermath of three decades of abortion. In

E. Bachiochi (Ed), the Cost of Choice: Women evaluate the impact of
abortion. San Francisco, CA: Encounter Books.

Araoye, M.O. (2003). Epidemiology of infertility: Social Problems of the

infertile couples. West African Journal of Medicine, 22(2): 190 -196.

Ariba, A. (2000). Family life and sexuality education: An overview of Nigerian

School. Health Journal, 12(1): 1-10.

Bandura, A. (2004). Health promotion by social cognitive means. Health

Education and Behaviour; 31(2): 143 – 164.

Bankole, A., Adewole, I.F., Hussain, R., Awolude, O., Singh, S. & Akinyemi,
J.O. (2015). The Incidence of abortion in Nigeria. Int Perspect. Sex
Reprod. Health, 41(4): 170 – 181.

Berer, M. (2002). Making abortion safe: a matter of good health policy and
practice. Reproductive Health Matters. 10 (9), 31-43. Retrieved from
http://www.who.int/bulletin/archives/78(5)580.pdf.

Bhana, A & Peterson, I. (2010). HIV and Youth: behavioural perspective In:
Rohleder, P., Swartz, L., Kalichman, S.C. and Simbayi, L.C. (Eds).
HIV/AIDS in South Africa 25 years on: Psychosocial perspectives. New
York: Springer.
Calhoun, B.C. (2012). Preterm birth update, 79. The Linacane Quarterly,
231.
 86

Champion, V.L. & Skinner, C.S. (2008). The Health Belief Model In: Glanz, K.,
Rimer, B.K. and Viswanath, K.V., (Eds). Health Behaviour and Health
Education: Theory, Research and practice. 4th ed. San Francisco: Jossey-
Bass Inc.

Children by Choice Association Incorporated (2016). Misunderstanding

abortion regret. https://www.childrenbychoice.org and for women after
abortion.

Coleman, P.K. (2011). Abortion and mental health: Quarterly synthesis and
analysis of research published 1995 – 2009. Brit J. Psychiatry, 19(9): 180
– 186.

Coleman, P. K. (2006). Resolution of unwanted pregnancy during adolescence

through abortion versus childbirth: Individual and family predictors
and psychological consequences. Journal Youth Adolescence, 35(2):
903-911.

Coleman. P.K., Rue, V.M. & Coyle, C.T. (2009). Induced abortion and intimate
relationship quality in the Chicago Health and Social Life Survey. Public
Health Journal, 45(3): 45-55.

Coleman, P.K., Rue, V.M. & Coyle, C.T. (2007). Abortion and sexual lives
of men and women: Is casual sexual behaviour more appealing and more
common after abortion: International Journal of Clinical and Health
Psychology, 8(1): 77-91.

Correia, D.C., Cavalcante, J.C. & Maia, E.M. (2009). Induced abortion: Risk
factors for adolescent female students, a Brazilian study. Scientific World
Journal, 9(5): 1374-81.

Cougle. J., Reardon, D.C. Coleman, P.K. & Rue, V.M. (2005). Generalized
anxiety associated with unintended pregnancy: a cohort study of the 1995
National Survey of family growth. J. Anxiety Disord, 1(9): 137 – 142.

Davis, F.A. (2011). Taber’s Medical Dictionary: Abortion Taber’s Cyclopedic

Medical Dictionary. Archived from the original on 15th June, 2011.
Retrieved 18 July, 2018.

Denovan, & McDowell (2009). Citizenship and same sex relationships.

Journal of Social Policy, 28(4): 649 -709.
 87

Dingle, K., Plati, R. & Clavarino, A. (2008). Pregnancy loss and psychiatric
disorders in young women: an Australian Birth control study. The British
Journal of Psychiatry 19(3): 455-460.

Ejifugha, A.U. (2014). Fundamentals of research in health education. Luso

Publishers, Owerri.

Ejifugha, A.U., & Ibhafidon, A. (2014). Students’ perception of acquisition of

personal health skills among adolescent in Imo State through the school
health programme. Academic Journal Interdisciplinary Studies, 3(7).

Elliot Institute (2000). A list of major pyschological sequelae of abortion. Fact

sheet.

Eschenbach, D, (2015). Treating spontaneous and induced septic abortions.

Obstetrics and Gynecology. 125(5):95-110.

Ewuzie, M.A. (2016). Health and illness: Emerging dimension in fitness plan,
health psychology, determinants and interventions, complementary and
alternative modalities and emotional intelligence. Skillmark Media Ltd.

Eyo, U.E., Upuji, F.I. & Ukpong, E.I. (2012). Termination of pregnancy (top)
related infertility in women in Akwa Ibom State. Journal of Academic
Research International, 3(3): 120 – 124.

Federal Ministry of Health (FMOH). (2016). Induced Abortion: Causes of

infertility among ethnic groups in Nigeria. Quarterly fact sheet.

Ferguson, D.M., Horwood, L.J. & Ridder, E.M. (2006). Abortion in young,
women and subsequent mental health. Journal of Child Psychology and
Psychiatry. 47(1): 21-35.

Ferguson, D.M., Horwood, J.L. & Bordon, J.M. (2008). Abortion and mental
health disorders evidence from a 30 year longitudinal study. The British
Journal of Psychiatry, 19(3):444-451.

Fife, B.L, & Wright, E.R. (2000). The dimensionality of stigma: A

comparison of its impact on the self of persons with HIV-AIDS
and cancer. Journal of Health and Social Behavior, 4(1): 50–67.

Gadsby, S.U. (2010). Health consequences of teenage pregnancy in Ethiopa.

The need for controlling pregnancy. World Health Organization Bulletin.
31(2): 817-841.
 88

Glanz, K., Rimer, B.K. & Lewis, F.M. (2002). Health behaviour and health
education. Theory, Research and practice (3rd ed). San Francisco: Jossey-
Bass.

Glanz, K., Rimer, B.K., & Viswanath, K. (2008). Health behaviour and health
education. Theory, Research and practice 4th (Ed.) San Francisco: Jossey
Bass.

Godfrey, S. (2009). Delphic export consultation final report to Department of

Health victims of violence and abuse prevention programmes. Melbourne
Deakin University.

Grimes, D.A., Benson, J., Singh, S., Romero, M., Ganatra, B., Okonofua, F.E.,
& Shah, I.H. (2006). Unsafe abortion: the preventable pandemic. WHO
Sexual and reproductive health series, 4(2): 1 -13.

Haddad, L.B.(2009). Unsafe abortion: unnecessary maternal mortality. Journal

of Obstetrics and Gynecology, 2(2): 122-126.

Hall, K.S., White, K.O., Reame, N. & Westhoff, C. (2010). Studying use of oral
contraception: a system review of measurement approaches. Journal of
women’s Health, 192(12): 2203 – 2210.

Hayden, J.A. (2009). Introduction to health behaviour theory. Jones and

Barlett Publishers: Ontario Canada 102.

Henshaw, S.K. Adewole, I., Singh, S., Bankole, A., Oye-Adeniran, B. &
Hussain, R. (2008). Severity and cost of unsafe abortion complications
treated in Nigerian hospitals. Int. Fam Plan Perspect. 34(1): 40-50.

Hesprian Health Guides (2018). Where women have no doctor, accessed at

hespearian@hesperian.org.

Ibisome, L. & Odimegwu, C. (2008). Pregnancy termination in sub-Saharan

Africa: The need for refined data. International of Health Research; 1(1):
207 – 224.

Ibrahim, I.A., Jeremiah, I., Abasi, I.J. & Adda, A.O. (2011). Patterns of
complicated unsafe abortion in Niger-Delta Teaching Hospital Okolobiri,
a four year review. The Nigerian Health Journal. 11(4).
 89

Ikeako, L. Onoh, R. Ezegwui, H. & Ezeonu, P. (2014). Pattern and

outcome of induced abortion in Abakiliki; Southeast of Nigeria. Ann
Med Health Sci. Res 4(3): 442-6.

Iniaghe, K. (2007). No abortion is safe. Vanguard, p12.

Ipas, (2013). Comprehensive abortion care.

Jones & Barlett, H. theoretical concepts. Health Belief Model 31 – 36.

Retrieved from: http:www.jbleaming.com/sample/.076374383 6/chapter
%204.pdf. accessed on 2018.

Korenromp, M.J. (2004). A prospective study on parental coping 4 months after

termination of pregnancy for fetal anomalies. Prenatal diagnosis. 2(7):7-
12.

Koster, W. (2010). Linking two opposites of pregnancy lost: Induced abortion

and infertility in Yoruba society, Nigeria. Journal of social science and
Medicine. 71(4):1788-1795.

Kpolovie, P.J. & Ogwuike, A. (2017). Female students’ attitude towards

abortion. International Journal of Humanities Social Science and
Education, 4(11): 98-120.

Kumar, A., Hessini, L. & Mitchell, E.M. (2009). Conceptualising abortion

stigma. Culture, Health and Sexuality, 11(6): 625-39.

Last. J. (2007). A dictionary of Public Health, New York: Oxford University

Press.

Leclerc-Madlala, S. (2013). Why young women in southern Africa are going for
riskier older men. Exchange on HIV/AIDS Sexuality and Gender, 4(1): 5-
8.

Levandowski, B.A., Kalilani-Phiri, L, Kachale, F., Awah, P., Kangaude, G.

& Mhango, C. (2012). Investigating social consequences of unwanted
pregnancy and unsafe abortion in Malawi: the role of stigma. Int J
Gynecol Obstet; 118(2):167 –71.

Martyn, S. (2008). Survey Research Design. Retrieved Nov 10, 2017 from
explorable.com. htts//explorable.com/survey-research-design.
 90

Masthoff, K. (2017). Abortions in teenagers – Reasons and effects. Source:

shutterstock.

Mbonye, A.K. (2011). Abortion in Uganda: Magnitude and implications. Afr. J.

Repro. Health 4(2): 104 – 108.

Meka, A. & Reddy, B.M. (2006). Recurrent spontaneous abortions: An

overview of genetic and non-genetic backgrounds. Int. J. Hum Genet,
6(2): 109-117.

Melgosa, J. (2001). To adolescents and parents. Spain Marpa Artes.

Melkote, R.S. & Steeves, L.H. (2001). Communication for development in third
world: Theory and practice for empowerment. London: Sage
publications.

Mfino, Z. (2008). Teenage contraceptive needs in Urban South Africa: A case

study. International family planning perspective. Proquest Nursing
Journals, 24(4): 22-48.

Mirembe, F., Karanja, J., Hassan, E.O. & Faundes, A. (2010). Goals and
activities proposed by countries in seven regions of the world toward
prevention of unsafe abortion. Int. J. Gynecol. Obstet. 1(10): 25 – 9.

Monnaf, M.H. (2013). Abortion – Definition, type and management.

EasyMBBS, Academic Guideline for MBBS Student Seeking FCPS, MD
and other PG Admission. Accessed @ 5/1/2018.

Murima, P. (2013). Assessing teenagers’ knowledge, attitude and perceptions

towards teenage pregnancy. The case of a Durban High School. A Master
thesis, University of Kwazulu-Natal, Howard College, Durban, South
Africa.

National Population Commission (2006). Oguta L.G.A. Census Population

Figure as at 2006.

Ndoro, T.R.S. (2009). Attitudes and perceptions towards TB in Grahamstown

East in a time of HIV/AIDs. Master Thesis. Rhosed University, South
Africa.

NugentPam, M.S. (2016). The emotional side effects of abortion in psychology.

Dictionary.org http:psychologydictionary.org/article /the emotional-
sideeffects-abortion accessed June, 2018.
 91

Nwosu, A.O. (2006). State of world population 2005. The promise of equality.
San Francisco, UN.

Obertinca, B. Dangellia, A., Pacarada, M. Beha, A.B. Gallopeni, F., Kongjeli,

N., Gashi, A. & Blakaj, V. (2016). Emotional and psychological effects
on women after induced abortion. International Journal of Science and
Research, 5(3): 1785- 1788.

Okonofua, E.F., Hammed, A., Nzeribe, E., Saidu, B., Abbas, T., Adeboye,
G., Adegun, T. & Okolocha, C. (2009). Perceptions of policy makers in
Nigeria towards unsafe abortion and maternal mortality. International
perspectives on sexual and Reproductive Health, 35(4): 194-202.

Okoro, C.O., Oknokwo, R.M., Okoh, I.M. & Oham, C.J. (2014). Health
consequences of abortion among teenagers in Ikeduru L.G.A. Imo state.
(Unpublished thesis).

Okoro-Eweka, R. (2014). The magnitude and burden of rape in Nigeria. The

Nigerian observer, viewed 24 June, 2018, http:www.nigerianobserver
new.com/04092013/features/features9.htm/u6nXRRyxHFI.

Okoye, R.C. (2006). The Untold Story of Abortion. Port Harcourt: Save a Life
Foundation.

Onuzulike, N.M. (2002). Issues in Health, Owerri: McWilliams Publishers.

Onuzulike, N.M. (2003). Adolescent pregnancy: Issues and prevention

strategies. Paper presented at the Annual Conference of the Nigeria
Association of Health Education Teachers (NAHET) at Akwa.

Onuzulike, N.M. (2007). Personal Health: CON Publishers Ltd. Owerri.

Orisareme, T.C. (2012). An explorative study of abortion among the Tarok in

Central Nigeria. African Sociological Review, 16(1): 61-76.

Ostbye, T., Wenghofer, E., Woodward, C., Gold, G & Craighead, J. (2001).
Health Services utilization after induced abortions in Ontario. A
comparison between community clinics and hospitals. American Journal
of Medical Quality, 16(3): 103-112.
Paluka, L.J., Mabuzza, L.H., Madunna, P.M.H. & Ndimande, J.V. (2010).
 92

Knowledge and attitude of school girls about illegal abortions in Goma,

Democratic Republic of Congo. Afri. J. Prm Health Care Fam Med,
2(3):1 – 5.

Park, A. (2008). Sex on television increases teen pregnancy. Available from

http:www.time.com/time/nation/article/08599,1855842100.html accessed
20th June, 2018.

Pederson, W. (2008). Abortion and depression: A population based longitudinal

study of young women. Scandivian Journal of Public Health, 3(6): 424 –
428.

Planned Parenthood Federation of America (2007). The emotional effects of

induced abortion. Fact sheet.

Population Reference Bureau (2011). Abortion fact and figures.

Prada, E. Bankole, A. Oladapo, O.T. Awolude, O.A. Adewole, I.F. & Onda, T.
(2015). Maternal near-miss due to unsafe abortion and associated short-
term health and socioeconomic consequences in Nigeria. Afri. J. Rep. H,
19(2): 52-62.

Ramalingam, P. (2006). Dictionary of psychology. New Delhi Academic (India)

Publishers.

Reardon, D.C. (2007). A new strategy for ending abortion: learning the truth-
telling the truth. Retrieved from http:www.afterabortion.org.

Reardon, D.C., Cougle, J.R., Rue, V.M., Shuping, M.W., Coleman, P.K. &
Ney, P.G. (2003). Psychiatric admissions of low-income women
following abortion and childbirth. Canadian Medical Association
Journal, 168(10): 1253 – 1256.

Reardon, D.C., Ney. P.G., Scheuren, F.G., Cougle, J.R., Coleman, P.K., &
Strahan, T. (2002). Death associated with pregnancy outcome, a record
linkage study of low income women. South Med J. 95(8): 834-841.

Rees, D.I & Sabia, J.J. (2013). The effect of parental involvement on youth
suicide. Economic enquiry, 51(1): 620-636.

Rosenberg, M.J. & Waugh, M.S. (2008). Oral contraceptive discontinuation: A

 93

perspective evaluation of frequency and reasons. Am J. Obstet. Gynecol.

17(9): 577 – 582.

Rosenstock, I.M. Strecher, V.J. & Becker, M.H. (1988). Social learning theory
and the health belief model. Health Ed. Quar. 15(2): 175-184.

Rosenstock, I.M. (1974) Historical origins of the Health Belief Model. Health
Education Monographs, 2(4): 1-20.

Rosenstock, I.M., Strecher, V.J. & Becker, M.H. (1994). The Health belief
Model and HIV risk behaviour change: In DiClemente, R. (ed).
preventing AIDS: Theories and Methods of behavioural interventions.
San Francisco. Jossey-Bass Publishers.

Ross, S. & Mico, C. (2009). Theories of individual behaviour and those factors
that influence such behaviour.

Schore, A. (2009). Affect regulation and origin of the self: The neurology of
emotional development. Oceania Journal of the Native people of
Australia, 74(4); 224-235.

Schultz, D.P & Schultz, S.E. (2013). Theories of personality: (10th ed)
Wadsworth Cengage Learning: Australia.

Sedgh, G., Bankole, A., Oye-Adeniram, B., Adewole, I.F. Singh, S. & Hussain,
R. (2006). Unwanted pregnancy and Associated factors among Nigerian
women. International Family Perspectives, 32(4): 175 -184.

Shah, P.Z. (2009). On behalf of knowledge synthesis group of determinants of

preterm/LBW Births, induced termination of pregnancy and low birth
weight and preterm birth: a systematic review and meta-analysis, BJOG;
1(6):1425-1442.

Sharma, M. & Romas, J.A. (2008). Theoretical foundations of health education

and health promotion (2nd Ed). Jones and Bartlett Publishers, Ontario
Canada.

Shellenberg, K.M; Moore, A.M., Bankole, A., Juarez, F., Omideyi, A.K. &
Palomino, N. (2011). Social stigma and disclosure about induced
abortion: Results from an exploratory study. Glob. Public Health, 2(6):
111-25.

Shut, R.N. (2011). Abortion practice and attitude in cross cultural perspective.
 94

Columbia University press.

Sudhinaraset, M. (2008). Reducing unsafe abortion in Nigeria, New York:

Guttmacher Institute, p3.

United Nations (2001). Widowhood: Invisible women, secluded or excluded.

World’s women 2000. Trends and Statistics UN Publication, 18(14): 2-
10.

Webster (2014). Mariam Webster Dictionary of English language. USA Delain

http:www.merriam-webster.com/dictionary>implication.

Welch, K.J. (2010). Family life Now, Second edition. Boston Pearson education,
Inc.

Williams, S.J. (2001). A year in the life of an obstetrician gynecologist, New

York.

World Health Organization (2012): unsafe abortion in adolescents.

World Health Organization (2014). Preventing unsafe abortion. Viewed

9th July, 2018. Accessed at http://www.who.int/mediacentre/
factsheets /fs388/en/.

Yakubu. J.A. (2002). Medical law in Nigeria, Ibadan, Demyaxs Press Ltd.

Wikipedia, (2011). Epidemiology of unmarried teenage pregnancy. Retrieved

June 31, 2018 from http:www.sceintificamerica.com /articles.cpmpid.

Zeqiri, F. Pacarada, M., Kongjele, N., Zeqiri, V. & Kongjeli, G. (2010). Missed
abortion and application of misoprostol. Med. ARH; 64(3): 151-3.

APPENDIX
 95

Department of Health Education,

Alvan Ikoku Federal College of Education,
P.M.B 1033,
Owerri,
20th August, 2018

Perceived Health Implications of Abortion Among Female Teenagers in

Oguta Local Government Area

Dear Respondents,

The researchers are Health Education degree students of the above named
institution of learning. The researchers are conducting a research on the above
topic.

Please, kindly respond to the questions below as they apply to you. The
information supplied is for academic purpose and will be treated with utmost
confidentiality.

Thanks for your anticipated cooperation.

Yours faithfully,

Ogbonna, Mirian I. BD/15/72903

Ogonna, Emmanuel C. BD/15/72905
Okafor, Augusta O. BD/15/72880
Oparah, Jennifer O. BD/14/68398
(Researchers)
 96

Questionnaire
Section A
Demographic Data
Instructions: please tick () in the appropriate box that best suit your chosen
option.
1. Which of the following best explains your age?
a. 13 – 15 years
b. 16 – 18 years
c. 19 years – above
2. What is your highest level of education?
a. Tertiary
b. Secondary
c. Primary
Instructions: You are please requested to indicate your response by ticking ()
against your chosen option in these sections B, C, D and E.

SA = Strongly Agreed

A = Agreed

D = Disagreed

SD = Strongly Disagreed

Section B

S/N Items on Physical Health Implications of Abortion SA A D SD

1 Abortion carries Risk of cervical laceration
2 Abortion can lead to uterine perforation
3 Severe haemorrhage (heavy bleeding)
4 Increases the risk of acquiring serious infection (sepsis).
5 Abortion can cause infertility (barrenness)in the future.
6 Abortion can lead to death due to complications (e.g heavy
bleeding and infection)
 97

Section C

S/N Items on Emotional Health Implications of Abortion SA A D SD

1 Feelings of guilt after abortion
2 Expression of shame
3 Loss of happiness (anger)
4 There is always feelings of regret following induced abortion
5 Young girls who procure abortion tend to isolate themselves
from peer group as a result of shame

Section D

S/N Items on Mental Health Implications of Abortion SA A D SD

1 Abortion may expose young girls to anxiety
2 It can lead to depression(feeling of hopelessness)
3 Abortion can lead to sleep disorders
4 Young girls experiences post-traumatic stress after abortion.
5 Most time teenage girls who procure abortion have suicidal
thoughts and feelings
Section E

S/N Items on Social Health Implications of Abortion SA A D SD

1 Female teenagers are faced with stigma (labelling or name
calling) after abortion.
2 Abortion can expose young female teens to substance abuse
(e.g alcohol and drugs.)
3 Promiscuity (the act of having many sexual partners).
4 Abortion may cause female teenager to lose her friends.
5 Abortion may affect the female teenagers’ good relationship
with family members
 98

Appendix I
Mean x=
∑ fx
N
where x = mean
∑x = summation sign
F = frequency
x = numerical score
N = total number of respondents
4+ 3+2+1 10
4
= 4

= 2.5
 99

Appendix II

Week x Week y Rx Ry d d2
12 15 11.5 6 5.5 30.25
9 9 16.5 7.5 -1 1
9 12 16.5 11.5 5 25
15 15 5 6 -1 1
15 18 5 3.5 1.5 2.25
12 12 11.5 11.5 0 0
9 9 16.5 17.5 -1 1
9 12 16.5 11.5 5 25
12 15 11.5 6 5.5 30.25
15 12 11.5 11.5 0 0
18 21 1 1.5 0.5 0.25
6 9 19.5 17.5 2 4
12 9 16.5 17.5 1 1
15 12 5 11.5 -6.5 42.25
12 12 11.5 11.5 0 0
15 18 5 3.5 1.5 2.25
15 21 5 1.5 3.5 12.25
15 12 5 11.5 -6.5 42.25
6 6 19.5 20 -0.5 0.25
12 12 11.5 11.5 0 0
Total ∑ d 2 319.25
6 ∑ d2
rho =1-
n(n 2−1)
6(319.25)
rho =1- 2
20(20 −1)
1915.5
rho = 1- 20(400−1)
1915.5
rho =1- 20(399)

319.25
rho = 1- 1915.5
1915.5
rho = 1- 7980

rho = 1 – 0.24
rho = 0.76
 100

Appendix II

Steps and formula

Step1 formula of hypothesis
Ho H1 = H2
Ha H1  H2
(O−E)2
Step 2 E=
E
Step 3 df = (r-1)(e-1)
Step 4 Table value chi-square at 0.05 and df
Step 5 Statistical decision: accepted or rejected
ColumTotal × Row Total
Step 6 Expected frequency (f) E = Grand Total
=¿

O E O–E (O – E)2 (O – E)2

E
60 59.96 0.04 0.0016 0.00000266
22 22.04 -0.04 0.0016 0.000007259
126 117.73 8.27 68.39 0.581
35 43.27 -8.27 68.39 1.581
48 56.31 -8.31 69.05 1.2262
29 20.69 8.31 69.05 3.3373

Cal χ 6.725
2

CT × RT
E= ¿
=¿

82× 234
E1 = 320 =59.96

82× 86
E2 = 320 =22.04

161× 234
E3 = 320
=117.73
 101

161× 86
E4 = 320 =43.27

77 ×234
E5 = 320 =56.31

77 ×86
E6 = 320 =20.69

Df = (r-1) (c-1)
= (3-1) (2-1)
= (2) (1)
=2

O E O–E (O – E)2 (O – E)2

E
55 63.6 -8.6 73.96 1.1628
38 29.4 8.6 73.96 2.5156
82 78.7 3.3 10.89 0.1383
33 36.3 -3.3 10.89 0.3
82 76.7 5.3 28.09 0.3662

30 35.4 -5.3 28.09 0.7935

Cal χ 5.2935
2

93 ×219
E1 = 320 =63.6
93 ×101
E2 = 320
=29.4

115× 219
E3 = 320
=59.61

115× 101
E4 = 320
=36.3

112× 219
E5 = 320
=76.7

112×101
E6 = 320
=35.3
 102

Df = (r-1) (c-1)
= (3-1) (2-1)
= (2) (1)
=2