Prevalenceof induced abortion and associated

factors east shewa zone, Oromia Region

BY:
 Yadeta Ayana
 Yilma Abdissa
 Teshome Abdisa
 Omer Hussen
 Merian Abdirkadir

ADVISORS:

 Prof. Getu Degu

 Dr. Belaynewu Wassie

A RESEARCH PROPOSAL TO BE SUBMITTED TO ETHIOPIAN PUBLIC HEALTH

ASSOCIATION (EPHA)

DECEMBER, 2015
Adama, ETHIOPIA

i
Prevalenceof induced abortion and associated
factors east shewa zone, Oromia Region

BY:
 Yadeta Ayana
 Yilma Abdissa
 Teshome Abdisa
 Omer Hussen
 Merian Abdirkadir

ADVISORS:

 Prof. Getu Degu

 Dr. Belaynewu Wassie

DECEMBER, 2015
Adama, ETHIOPIA

i
Acknowledgement
We very grateful to our advisors Prof.Getu Degu and Dr. Belaynewu Wassei for all their
unreserved guidance and constructive suggestions and comments about the development of
research proposal.

Also I would like to express my thanks to EPHA for providing us this golden opportunity to
prepare this proposal.

ii
Abbreviations and Acronyms

iii
Table of Contents
Acknowledgement.......................................................................................................................................ii
Abbreviations and Acronyms.....................................................................................................................iii
List of Tables...............................................................................................................................................v
List of figures..............................................................................................................................................vi
Summary....................................................................................................................................................vii
1. Introduction.............................................................................................................................................1
1.2. Statement of the problem..................................................................................................................1
2. Literature Review....................................................................................................................................3
2.1. Magnitude of induced abortion.........................................................................................................3
2.3 Justification of study..........................................................................................................................8
3. Objectives................................................................................................................................................9
3.1. General objective............................................................................................................................9
3.2. Specific objectives..........................................................................................................................9
4. Methods and Materials.........................................................................................................................10
4.1 Study setting....................................................................................................................................10
4.2 Study design and period...................................................................................................................10
4.3. Study population.............................................................................................................................10
4.4. Source population...........................................................................................................................10
4.5. Inclusion and exclusion criteria......................................................................................................10
4.5.1. Inclusion..................................................................................................................................10
4.7. Sample size determination..............................................................................................................11
4.8. Sampling technique and procedure.................................................................................................11
4.9. Study Variables..............................................................................................................................13
4.9.1. Dependent Variable:................................................................................................................13
4.9.2. Independent Variables:............................................................................................................13
4.10. Operational definitions.................................................................................................................13
4.11. Data collection..............................................................................................................................15
4.12. Data quality control (Validity and Reliability)..............................................................................15
4.13. Data processing and analysis........................................................................................................15
4.14. Ethical consideration....................................................................................................................16
4.15. Dissemination of results................................................................................................................16

iv
5:Work plan of the study...........................................................................................................................17
6. Budget Breakdown................................................................................................................................20
References.................................................................................................................................................22
Annex -1 –English version Questionnaire.................................................................................................24
Annex -1 –Verbal consent.........................................................................................................................30

v
List of Tables

Table 1: Tentative Work Plan for Prevalence of Induced abortion and its associated factors in
East Shoa Zone Oromia Region, in 2015.....................................................................................29
Table 2: Budget Break Down Plan for Prevalence of Induced abortion and its associated factors
in East Shoa Zone Oromia Region, in 2015.................................................................................32

List of figures

vi
Figure 1Fig.1. Conceptual Framework for the prevalence and associated factors of induced
abortion among females of 15 to 49 years of age in East Shoa zone, Oromia Region................19
Figure 2: Schematic presentation of sampling procedure for studying Prevalence of Induced
abortion and its associated factors in East Shoa Zone Oromia Region, in 2015...........................23

vii
Summary
Background:
The term abortion is defined as termination of pregnancy before the fetus is viable or capable of
survival outside uterus. World Health Organization (WHO) defines unsafe abortion as a
procedure for terminating unwanted pregnancy either by people lacking the necessary skills or in
an environment lacking minimal medical standards or both. According Global and regional
incidence of induced abortion report by WHO, worldwide an estimated 43.8 million induced
abortion were in 2008. From this unsafe abortions were estimated to be 21.6 (56%) million,
which is almost all in developing countries. Each year, throughout the world, approximately out
of five pregnancies one ends in induced abortion
Objective: To assess the magnitude of induced abortion and its associated factors among women
aged 15 to 49 years in East Shoa zone of Oromia region

Methods: A community-based cross-sectional study design will be employed on 968 women 15-49
years old will be selected using multi-stage random sampling technique. A structured questionnaire will
be used for data collection. The collected data will be entered in the computer using EPI INFO 7.1.3.10
software then exported to SPSS version 22 program for analysis. Descriptive analysis will be used to
describe study variables. Multiple logistic regression analyses will be fitted to identify factors associated
with induced abortion. Confidence interval at 95% and p-value at significance level of 0.05 will be
considered to identify major predictor variables. The statistical significance of individual
regression coefficients (i.e., βs), will be tested using the Wald chi-square statistic.

Budget: 350,912 Ethiopian birr will be used to conduct this research.

Keywords: Induced abortion,

viii
ix
1. Introduction

1.2. Statement of the problem

The term abortion is defined as termination of pregnancy before the fetus is viable or capable of
survival outside uterus. World Health Organization (WHO) defines unsafe abortion as a
procedure for terminating unwanted pregnancy either by people lacking the necessary skills or in
an environment lacking minimal medical standards or both. According Global and regional
incidence of induced abortion report by WHO, worldwide an estimated 43.8 million induced
abortion were in 2008. From this unsafe abortions were estimated to be 21.6 (56%) million,
which is almost all in developing countries. Each year, throughout the world, approximately out
of five pregnancies one ends in induced abortion [1, 2].

In Ethiopia studies on induced abortion among women of reproductive age at the community
levels are few, with a lot of studies done at the health facility level. This point out to the need of
more community-based studies, because most of the maternal deaths due to abortion
complications occur outside the formal health system. The problem of induced abortion at the
community is very big but much underreported; Women are not open to discuss on the sensitive
issue of abortion. So this study will provide information on the real situation at the community
level. Several studies have been conducted to determine factors contributing to induced abortion
in Sub Saharan Africa including Ethiopia. In 2005; Ethiopia expanded its abortion law, which
had previously allowed the procedure only to save the life of a woman or protect her physical
health. [3]

Currently abortion is legal in Ethiopia under certain preconditions that include cases of rape,
incest or fetal impairment, if the pregnancy endangers her or her child’s life, or if continuing the
pregnancy or giving birth endangers her life. A woman may also terminate a pregnancy if she is
unable to bring up the child. Different study suggests that unsafe abortion is usually associated
with higher rates of complications [1,4].The annual number of induced abortion in Africa rose
between 2003 and 2008 from 5.6 million to 6.4 million. The most abortion occurs in Eastern
Africa 2.5 million followed by Western Africa which is 1.8 million. Of 6.4 million abortions
carried out 2008 only 3% were performed under safe condition while the left 97% were unsafe
[5].

1
Although unsafe abortions are preventable, they continue to pose undue risks to a woman’s
health. Millennium Development Goal (MDG) 5, announced in 2001, is an internationally
agreed-upon imperative to reduce maternal mortality by three fourth from its 1990 level by the
year 2015. As a significant proportion of mortality is due to unsafe abortion, this goal probably
cannot be met without specific and direct programmatic efforts to reduce the impact of unsafe
abortion [6].Unsafe abortion accounts for 13% of maternal deaths worldwide; of women who
survive unsafe abortion 5 million will suffer long term health complication [7].

Over 40% of the total deaths due to unsafe abortion have occurred in Africa making it the
leading cause of maternal mortality in the region [8]. In 2008 there were 382,000 induced
abortions performed in Ethiopia; about 42% of pregnancies were unintended and the rate of
abortion was 101 per 1,000 women. A cross-sectional study in Amhara region reveals that
31.3%of women aged 15 to 49 were committing induced abortion due to fear of family and the
community, and 14.1%were due to economic problem [9].The maternal mortality ratio (MMR)
in Ethiopia was estimated at 676 deaths per 100,000 live births in the year 2011 [10]. It is
estimated that there are 3.27 million pregnancies in Ethiopia every year, of which approximately
500,000 end in either spontaneous or induced abortion [4] Therefore, assessing theprevalence
and associated factors of induced abortion is important for setting interventions to reduce
theproportion of induced abortions and therebysaving the life of mothers from abortion-related
morbidityand mortality.

2
2. Literature Review

2.1. Magnitude of induced abortion

Different relevant literatures that have been done in different area (nationally and globally) are
reviewed in developing this research document. The findings of some of them are a bit similar
and that of others are different. WHO research report revealed that, unsafe abortion result in
approximately 70,000 maternal death and 5 million hospital admissions per year
globally”WHO”. Furthermore, an estimated 44 million abortions are performed globally each
year, with slightly under half of those performed unsafely. The report further states that, as
access to family planning education and Contraceptive services increased, the incidence of
abortion has declining by 40% globally and stabilized in recent years. This implies that, lack of
access to family planning, education and Contraceptive services is causal factor for loss of such
large number of female population.

As PRB findings, about one in 10 pregnancies ends with unsafe abortion globally. In low-
income countries, women have an average of one unsafe abortion during their reproductive lives
(18). According to population Reference Bureau Report, of 2011, Around 80 million pregnancies
each year are unintended and more than one-half result in induced abortion of which about 1/3
(26.5 million) of unintended pregnancies each year result from incorrect use or failure of
contraceptives (18).

Study finding from Ghana through Cross-sectional study design to assess factors influencing
contraceptive uptake among women within the age range of 15 -49 years presenting with
abortion (using systematic sampling technique and data analyzed using SPSS version 16), the
majority 60% of 420 women who had induced abortion were younger than 30, single,
unemployed with low education and socio-economic status. Although the majority (80.7%)
of the study group had the desire to use contraceptives gender inequality, economical factors,
social prescripts and poor service delivery were barriers to their contraceptive use (15).

A cross sectional study carried out in Nepal enrolling 58 women who were waiting in the
dressing room for safe abortion services in Paropkar Maternity Hospital, came up with 48%
of these women discontinue their contraceptive uptake due Side effects (11). In other African
country_ Nigeria, among 2934 women seeking abortion within the one-year study period,

3
675(23%) presented for repeat induced abortion where about 70% of those women did not use
any contraception because of fear of side effects and lack of adequate
information/misinformation about contraception. Likewise, about 10% of the women did not use
contraception as a result of objection from partner and family members (13), which is inversely /
against the findings Ghana.

Similarly in, a community-based cross-sectional study (95%+CI,+p<0.05) in rural and urban

citizens of Sudan showed, the Prevalence of an intended pregnancy was high as 30.2% which a
number of abortion is expected. Besides, unintended pregnancy increases as the level of
education is getting increase (28). In rivers to this, finding from 32 studies in 27 from all
worldwide countries evidenced that, the strongest factor associated with the decision to have an
abortion was being single (OR 39.1; 23.8−64.2), followed by being aged 19 years or below (OR
29.6; 13.4−65.5), having two children or more (OR 7.05; 5.29−9.39) and being unskilled (OR
2.48; 1.49−4.10), student (OR 2.29; 1.52−3.43) or unemployed (OR 1.65; 1.11−2.46) (32).

According to Ethiopia Central Statistical Agency and ICF International 2012, Unintended
pregnancies is higher among women who were unmarried, lower economic status, at an early or
late age of reproductive life, among those not using contraceptives consistently and attending
formal education (14). The Ethiopian DHS report of 2011 showed that 16.2% and 18.7% of
women reported that their last pregnancy was unwanted and mistimed, respectively 1). In
another study it is showed that more than 40% of pregnancies are unintended and only 14 % of
Ethiopian women of reproductive age use birth control methods (16). Unintended pregnancies is
higher among women who were unmarried, lower economic status, at an early or late age of
reproductive life, among those not using contraceptives consistently and attending formal
education(14). It also describes as many of the mistimed pregnancies in Ethiopia occurred among
women less than 30 years of age (17).

Another population based study done on unintended pregnancy among married women which
carried out in a district of Southern Nation and nationality of Ethiopia showed that, Of713
women surveyed, 302(42.4%) reported that their most recent pregnancies were unintended. The
study finding come up with, lack of knowledge, disapproval by husband, difficulty to get method
and method failure were the major reasons mentioned for failure to avoid unintended pregnancy

4
(18). Similarly a cross sectional study conducted in Adigrat zonal hospital (Tigra - Ethiopia)
revealed that, among the 907 patients seeking abortion services nearly 70 percent of the
pregnancies were unintended of which High incidences of complication in patients with
unwanted pregnancies were also reported in this study (25).

A Research carried out in Addis Ababa showed that, total of 50(50%) study population had
had unwanted pregnancy and induced abortion at some point in their lives where their main
reason for termination of pregnancy was being in school 83(37.2%). In addition, females aged
20-24 years were more likely to have unwanted pregnancy compared to 25-29 years (26).
The research would have been able to address why they fail to use any method of prevention of
pregnancy instead of being pregnant and tend to abort.

Although the Ethiopian nationwide survey that conducted at 5-6years interval revealed a
decreasing trend in the percentage of unwanted pregnancies: 17 %, 16% and 9% in 2000,
2005 and 2011 respectively (18), Studies done in the different regions of Ethiopia revealed
unintended pregnancy rate in the range between 27.9% and 42.4% (27,30). This enforce for
further findings.

In the previous and the current five years national and Regional Health sector strategic plan a
special attention given and implementing towards maternal Mortality and Morbidity.Although
not as expected, this brings good progress in decreasing maternal Mortality and morbidity which
is mainly due improvement in physical health coverage, ANC, skilled delivery …etc. However,
the number of female in 15 – 24 years of age who are seeking for abortion is yet above the
expected number. Although vary from zone to zone and town to town (above 61% in towns and
more than 5% in rural) averagely it was 7.5% abortion case was reported in the last two years in
Oromia.

Among these reported cases, more than 85% were women of less than 24 Years of age i.e
productive and fire age group. Besides, currently there are a number of factories that have huge
number of young age groups found in Oromia. Similarly, there are different universities with a
large number of young students are found around those big towns of the Region.

5
Generally, through searching for a number of several relevant studies, we are not lucky to find a
research studies that exactly respond for the issues we raised specific to our Region. This is
mainly due to much of them were done in foreign countries and it has been a long time since it
done.

6
Conceptual framework of the prevalence of induced abortion and associated factors

 Socio-demographic factors

 Marital status Wanted Pregnancy

 Level of education

 Occupation

 Religion

 Area of residence

 Level of income
Unwanted
 Socio cultural and sexual Pregnancy
factors :

 Relationship with a partner

 Number of sexual partners

 Age at first sexual intercourse

 Exposure to FP information

 Contraceptive use Induced Abortion

 Interviewee's reproductive health
history:

 Current pregnancy(wanted
versus unwanted)

 Previous abortion

Figure 1Fig.1. Conceptual Framework for the prevalence and associated factors of induced
abortion among females of 15 to 49 years of age in East Shoa zone, Oromia Region

7
2.3 Justification of study
According to WHO and other health report majority of induced abortion which is unsafe by
nature occur in developing countries which claim the lives of 67,000 women as a result of related
complication.
The problem of induced abortion at the community is very big, but much underreported. This is
due to the fact that majority of people mainly because of the social and cultural norms are not
open to discuss on the sensitive issue of abortion and unplanned pregnancies.

An understanding of the magnitude of induced abortion as well as the factors that are associated
with them at the community level is very crucial in designing and implementing interventions
that could be tailored to women needs there by contributing in the attainment of the MDG
5(Reduction in maternal mortality)

Therefore this study is aimed at investigating the prevalence of induced abortion and associated
factors which will be useful in developing or reviewing the national policy and guidelines
regarding the prevention of induced abortion.

8
3. Objectives

3.1. General objective

• To assess the magnitude of induced abortion and its associated factors among women
aged 15 to 49 years in East Shoa zone of Oromia region

3.2. Specific objectives

 To describe the status of abortion among women aged 15 to 49 years.
 To determine factors associated with induced abortion among women aged 15 to 49
years.

9
4. Methods and Materials

4.1 Study setting

East Shoa zone is one of the 18 zones of Oromia region and it is located at the center of the
region. The zonal town is Adama and it is located at a distance of 100 km away from Addis
Ababa in the east. The total population of the zone is 1,511,137 with male to female ratio of 1:1.
The reproductive age group of women aged 15 to 49 are estimated to be 334,415. The zone has
ten rural Woredas (districts) (Ada’a, Adama, Adami Tulu, Bora, Boset, Dugda, Fentale,
Gimbichu, Liben and Lume) and 5 towns (Adama, Bishoftu, Modjo, Batu and Metehara).

4.2 Study design and period

Community based multi-stage cross-sectional design will be used to estimate the prevalence of
abortion among women aged 15 to 49 years in East Shoa zone of Oromia region. The study will
be conducted from February 1, 2016 to March 31, 2016.

4.3. Study population

The study population will be all women of reproductive age group (15 to 49) residing in the East
Shoa zone of Oromia region.

4.4. Source population

The source population will be women in child bearing age of 15 to 49 years, residing in the
selected Woredas/towns of the zone.

4.5. Inclusion and exclusion criteria

4.5.1. Inclusion
Women 15 to 49 years and who resided in the area for more than six months will be included
from the study.

10
4.7. Sample size determination
Sample size is determined using the formula of sample size determination for one population
proportion:

( )
2
Z∝
2
n=P (1−P ) 2
E
Where:
n is the sample size,
p is the proportion of women who had abortion = 0.22 (Rwanda[2012]),
Zα/2 is the critical value = 1.96 (i.e., statistical significance level α = 0.05,
E is the precision (margin of error) = 0.05,
Therefore, the sample size n = 440, and considering design effect of 2 and 10% non-response rate,
the total sample size required will be 968.
NB: Using Epi Info version 7.1.3.10 StatCalc for population survey, the same sample size has been
calculated.

4.8. Sampling technique and procedure

There are 10 Woredas and 5 towns in East Shoa zone. Using lottery method, 3 Woredas (Ada’a,
Dugda and Fentale) and two towns (Adama and Batu) were selected, and then from of them,
Kebeles were selected to include study participants. Ada’a, Dugda and Fentale Woredas have 23, 36
and 19 Kebeles respectively, and Adama and Batu towns have 18 and 2 kebeles respectively. From
Ada’a Woreda, 4 kebeles (Godino, Golbo, Wajitu and Yerer Silassie); from Dugda Woreda, 6
kebeles (Abuno Gebriel, Dongorota Gusa, Hafa Kamale, Kotto Bulti Lamati, Mukiye 2 and Tuchi
Dembel); and from Fentale Woreda, 4 kebeles (Banti, Debiti, Elala and Sara Weyiba) were selected
using simple random sampling method. Additionally, from Adama town, 4 kebeles (Kebele 1, 3, 5
and 9); and fro Batu town, kebele 1 were selected using simple random sampling method. In each of
the above steps, Probability proportional to size (PPS) sampling technique was employed to
determine the number of study participants to be included in the study from each level based on
their relative size. Finally, using the house number in each kebele, systematic random sampling will
be used to select to include study participants.

11
Figure 2: Schematic presentation of sampling procedure for studying Prevalence of
Induced abortion and its associated factors in East Shoa Zone Oromia Region, in 2015

12
4.9. Study Variables

4.9.1. Dependent Variable:

 Induced abortion

4.9.2. Independent Variables:

The following are identified as an independent in this specific study topic:

• Socio-demographic variables: - Age, Marital status, Education, Income, Residence, …

• Socio-cultural and sexual factors: (relationship with the partners, number of sexual
partners, age at first sexual intercourse,

• Reproductive health history: exposure to family planning information, contraceptive use,

13
4.10. Operational definitions

14
4.11. Data collection
A structured questionnaire is prepared to interview study participants and collect data. It is
prepared in English, will be translated into Oromiffaa and then will be translated back into
English by independent bodies to check for consistency. It consists of two sections. Section-I
comprised the socio-demographic characteristics, and Section-II consists of factors that influence
women for having abortion.

4.12. Data quality control (Validity and Reliability)

Data collectors and supervisors with a minimum qualification of diploma will be recruited and
trained on the data collection procedures. Pre-testing of the questionnaire will be conducted at
Bishoftu town, where 5% from the total sample would be considered to check for clarity of the
questions. Data will be checked on daily basis for completeness.

4.13. Data processing and analysis

Data will be coded and entered into Epi Info version 7.1.3.10, and will be exported to SPSS V.23
for analysis. The exported data will be cleaned to check for outliers, distributions, problems with
coding, missing values, impossible values and others. Descriptive statistics will be applied to
summarize and organize the data. The association between induced abortion and several
independent variables will be assessed using Multiple Logistic Regression Model. Confidence
interval at 95% and p-value at significance level of 0.05 will be considered to identify major
predictor variables. The statistical significance of individual regression coefficients (i.e., βs), will
be tested using the Wald chi-square statistic. Hosmer and Lemeshow test will be used to assess
the fit of a logistic model against actual outcomes, and if it yields a X 2 result not significant (p >
0.05), it suggests that the model is better fit to the data. Additionally, ROC test will be used to
assess goodness-of-fit of the model.

15
4.14. Ethical consideration
Ethical approval and ethical clearance letter of the research proposal will be obtained from the
Institutional Review Board of Oromia Regional Health Bureau. A consent form will be attached
to each questionnaire which explains about the purpose of the study, confidentiality, and the
respondent's full right to take part or not in the study. A support letter will also be obtained from
Oromia Regional Health Bureau before conducting the study and deliver to the selected
Woredas/towns/kebeles. Confidentiality and anonymity will be ensured throughout the execution
of the study without any consequence. The data will be kept confidential to ensure and protect
from unauthorized access.

4.15. Dissemination of results

The report of the findings from this study will be submitted to the funding organization and
Oromia regional health bureau. The findings will also be disseminated through workshops,
annual conferences, through various meetings and to organizations which are interested to use
the findings. It will also be published in a renowned international journal.

16
5:Work plan of the study
Table 1: Tentative Work Plan for Prevalence of Induced abortion and its associated
factors in East Shewa Zone Oromia Region, in 2015

Gantt chart/Work plan

Year-2016

Sr.n Project Responsibi

o. Tasks lity Dec Jan. Feb. March April May
selection
Topic

1 Inv.
of
Preparati

project

2 Inv.
on
Finalizin

write up & research

3 Inv.
& of proposal g
Completion

4 Inv.
& discussing
Securing
of budget

5 Inv.
Preparati

tools

6 Inv.
on
Translati

question

7 Inv.
ng
question
Printing

niare

8 Inv.

17
 #
#
#
#
#
#
#
#
#
9
Dissemi Data Data Training of Selecting Travel to Prepare Securing Submissi
Report
nation of entry, collectio data data data for field ethical on of
writing
findings cleaning, n collectors collector collectio Work clearanc project

DC

Inv.
Inv.
Inv.
Inv.
Inv.
Inv.
Inv.
Inv.
Inv.

Sup.

DEC
&
&

18
 #
Presenting
findings at
different
Inv.

19
6. Budget Breakdown

Table 2: Budget Break Down Plan for Prevalence of Induced abortion and its associated
factors in East Shewa Zone Oromia Region, in 2015

Sr.N Unit Cost Multiplying factor Total Cost

o Budget category (Birr)
per diem Number of staff
days (Number of
staff x Number of
A Personnel working days)
Trainers 750 4 x7 21000
Facilitators 750 2x 7 10500
Supervisors 750 2x 20 30000
Data collectors 500 10 x20 100000
Guide 200 10x10 20000
Data entry clerk 250 1x 10 2500
Secretarial work 250 1x10 2500
Sub total Personnel Total 186500

B Transport Cost per/day Number

Car rent 1500 Birr/car/day 3 x 1500 x 20= 90000

Fuel 1000Birr/car/day 3x1000x20 60000

Sub total Transport Total 150000
C Supplies Cost per Item Number
Clip board 20 12 240
Flip chart paper 30 3 90
Pen 5 12 60
Pencil 2 12 24
Eraser 2 12 24
Sharper 2 12 24

20
 Printing paper 120 15 1800
Editing 100 Birr/page 100x50 5000
Binding 30 Birr/paper 30x5 150
Supplies Total 7412
D Training Cost per item Number of days

Hall rent 1000 2x1000 2000

Refreshment 100 Birr/person/day 100x2x25 5000

Training Total 7000

Grand Total 350912

References
1. WHO, Safe and Unsafe Induced Abortion Global and Regional Levels in 2008, and
Trends during 1995–2008, World Health Organization, Geneva, Switzerland

21
 2. https://www.guttmacher.org/about/2008/06/ 25/2007AnnualReport.pdf Guttmacher
institute 2007
3. Facts on Unintended pregnanacy and abortion in Ethiopia,IPAS,
Guttmacherinstitute,New york,NY,USA,2010
4. Technical and Procedural Guidelines For Safe Abortion Services in Ethiopia, Ministry of
Health, Addis Ababa, Ethiopia, 2006
5. www.Who.int/iris/bitstream /10665/75174/1/who_RHR_12.02_eng.pdf
6. WHO, Unsafe Abortion Global and Regional Estimates of the Incidence of Unsafe
Abortion and Associated Mortality in 2008,World Health Organization, Geneva,
Switzerland, 6th edition,2011.
7. www.ncb.nim.nih.gov/pmc/article/PMC2709326/
8. WHO, Unsafe Abortion, Global and Regional Estimates of Incidence of Mortality Due to
Unsafe Abortion with a Listing of Available Country Data, World Health Organization,
Geneva, Switzerland, 2004.
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factoprs of induced abortion in Northwet Ethiopia,” Ethiopian Journal of Health
Development, vol. 19, no. 1, pp. 37–44, 2005.
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11. KATHMANDU UNIVERSITY MEDICAL JOURNAL, 2011
12. (Induced Abortion and Associated Factors in Health Facilities of Guraghe Zone, Southern
Ethiopia,2014) ezahegn Tesfaye1, Mitiku Teshome Hambisa1,and Agumasie1 Semahegn2
(1.Department of Public Health, College of Health and Medical Sciences, Haramaya University,
P.O. Box 235, Harar, Ethiopia. 2 School of Nursing and Midwifery, College of Health and Medical
Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia.
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Abortion in Western Nigeria (by Mustafa Adelaja Lamina) 2014.)
14. Ethiopia Central Statistical Agency and ICF International 2012, 2011 Ethiopia
Demographic and Health Survey: Key Findings. Calverton, Maryland, USA: CSA and

ICF International.

22
15. Global Educational Research Journal: ISSN-2360-7963, Vol. 2(12): pp 209-242, December,
2014. By Helena Agyei Department of Community Health, College of Health Sciences, Kwame
Nkrumah University of Science and Technology, Ghana

16. Hubbacher D MIME. unintended pregnancy in sub Saharan Africa: magnitude of the

problem and potential role of contraceptives implants to alleviate it’. Children,

Youth and Unsafe abortion http: /www.iwhc. Org/resources. 2008;78:73-8.

17. Kersa DHO: Health Service Coverage. Kersa District Health Office Eastern Hararge
Oromia Ethiopia; 2011.

18.Deborah Mesce, Media Training; and Donna Clifton,(Population Reference Bureau), 2011

19.Ethiopian Demographic and Health Survey 2011.

20. Geda NR LT. A population based study on unintended pregnancy among married women in
a district in Southern Ethiopia. Journal Geography and Regional Planning 2011;4(7): 417-27.

21. Statistical Agency (2005) Ethiopia Demographic and Health Survey.Central Statistical

Agency, Addis Ababa, Ethiopia ORC Macro Calverton,Maryland, USA.

22. Gessessew A. "Abortion and unwanted pregnancy in Adigrat Zonal Hospital,

Tigray, North Ethiopia."African Journal of Reproductive Health. 2010;14 (3):183

23. Prevalency of unintended pregnancy and associated factors among women in reproductive
age group at selected Health facilities in Addis Ababacity< Ethiopia. By: Teshale Mulatu(Bsc)
2014

24.Worku S, Fantahun M (2007) Unintended pregnancy and induced

abortion in a town with accessible family planning services: The case of

Harar in eastern Ethiopia. Ethiopian Journal of Health Development

20(2): 79-83.

23
25. Kassa N, Berhane Y, Worku A (2010) Predictors of unintended

pregnancy in Kersa, Eastern Ethiopia. Reproductive Health 9(1): 1-7.

26. Hamdela B, Tilahun T (2012) Unwanted Pregnancy and Associated

Factors among Pregnant Married Women in Hosanna Town, Southern

Ethiopia. PLOS ONE 7(6): e39074. doi:10.1371/journal.pone.0039074.

27. Geda NR, Lako TK (2011) A population based study on unintended

pregnancy among married women in a district in Southern Ethiopia.

Journal Geography and Regional Planning 4(7): 417-427.

28. Prevalence& and factors associated with unintended pregnancy among

Married women in an urban and rural community, Khartoum state, Sudan

& Majdi& Mohammed& Sabahelzain

1,Sawsan&Mustafa& Abdalla 2*,& Syed& Ahmed& Meraj,& ElsadigYousif& Mohamed

29. Factors associated with Induced Abortion in 27 Countries. By akinrinola Bankole, Susheela
Sinagh and Taylor Haas, 1999

Annex -1 –English version Questionnaire

Questionnaires
Sr.No
. Part I. Demographic questionnaire
1 What is your age in years?
2 What is your primary language?

24
 1. Oromifa
2. Amharic
3. Tigregna
4. Sidama
5. Sumale
6. Others
3 What is the highest level of education you have completed?
1. Illetrate
1. Primary
2. Secondary
3. Vocational/technical
4. Diploma
5. Bachelor's degree
6 . Other
4 What is your current marital status?
1. Single
2. Married
3. Divorced
4. Separated
5. Widowed
5 What is your occupation?
1. Student
2. Teacher
3. Health professional
4. Unemployed
5. Housewife
6. Daily laborer
7. Other
6 What is your current income?
1. Under 300 Birr
2. 300-600 Birr

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 3.600-900
4. 900-1200
5. 1200-2000
6.2000-3000
7. >3000
7 Which of the following best describes the area you live in?
1.Urban
2. Suburban
3. Rural
8 What is your religion
1. Orthodox chistian
2. Muslim
3. Protestant
4. Others(specify)
9 The organization you work for is in which of the following:
1. Public sector
2. Private sector
3. NGO
4. Not-f0r-profit
5. Don't know
6. Other
Part ii. Sexual actity, contraception and pregnancy
10 Have you sexual intercourse?
1. Yes
2. No
11 Age at first sexual intercourse in years---------.
12 Have you ever heard of cntraceptives?
1. Yes
2. No
13 Have you ever used contraceptives?
1. Tyes

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 2. No
14 Type(s) of contraception
1.Pills
2.Condom
3. Injectables
4. Withdrawal
5.Norplant
6.Other)sprcify)
15 Have you ever been pregnant?
1. Yes
2. No
16 Number of pregnancies
1.1-3
2. 4-6
3. 7-9
4. 10+
17 Number of live deliveries
1. 1-3
2. 4-6
3. 7-9
4. 10+
18 Number of still births
1. 1
2. 2
3. 3
4. 4+
19 Was the pregnancy planned?
1. Yes
2. No
20 Have you ever had abortion?
1. Yes

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 2. No
21 Type of abortion was::
1. Spontaneous
2. Induced abortion
22 Number of abortion
1. 0
2. 1
3. 2
4. 3
5. >
23 Reasons for induced abortion?
1. Health problem
2. Pregnancy
3. School attendance
4. Lack of money to up bring children
5. Fear of parents & public
6. Others
24 Methods used during induced abortion?
1. Plastics
2. Oral medication
3. Others
25 Who conducted the induced abortion?
1. Myself
2. Health assistant
3. Nurse
4. Physician
5. Traditional healer
6. Others
26 Place where induced abortion was carried out
1. In the house the person who did the abortion
2. My own house

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 3. Others
27 Do you know complications associated with induced abortion?
1. Yes
2.No
28 Complications/consequences
1.Death could happen
2. Bleeding
3. Infection
4. Others(specify)
Did you visit a health facility due to problems related to the
29 induced abortion you had?
1. Yes
2. No
Did you visit a traditional healer due to problems related to the
30 induced abortion you had?
1. Yes
2. No

Annex -1 –Verbal consent

Consent

PURPOSE OF THE STUDY

29
We are planning to conduct a research study to determine the factors associated with Induced
abortion by women in East Shoa zone. The findings of the study will contribute towards guiding
the policy makers to plan approaches to help to work towards induced abortion by women.

STUDY PROCEDURES

We would like to conduct individual interviews with you as well as follow up after one months.
We will ask you if you have had induced abortion, factors that enforce you have induced
abortion, your intention of using contraception after abortion, choice of contraception method,
your knowledge about modern methods of contraceptives, and preferred choice of
contraceptive after abortion. After we explain about the study verbally, we will give you this
consent form to review. We will ask you to provide consent by signing the consent form if you
decide to participate in the study. You can also come to us within a week to provide consent and
participate in the study, if you cannot do so now. The researcher will ask you a series of
questions about terminated pregnancy, contraceptives use and related.

We will record your answers in a questionnaire so we are certain not to miss any of the valuable
information you share. All information you provide will be kept confidential. The questionnaire
and your responses will be typed into computer along with the information you will provide on
the follow up interview. Your name and other identifying information will not appear on the
computer. We will destroy the page with your identifiable information by April, 2016.

LENGTH OF YOUR PARTICIPATION IN THE STUDY

Your participation in the study /responding to those questions may take between 15-20 minutes
of your time.

RISKS, STRESS, OR DISCOMFORT

You may feel uncomfortable answering some personal questions, as these are sensitive and
personal issues. An example of a sensitive question might if we ask you the reason for
performing /induced abortion and about your intention to use contraceptive after abortion.
You may stop interview at any time and review your answers to delete any portions you are not
comfortable with.

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BENEFITS OF THE STUDY

You may not benefit directly from this study; the goal is to study the factors associated
with induced abortion in E/Shoa zone.

COMPENSATION

There is no compensation for this study.

CONFIDENTIALITY

Every effort will be made to keep your personal information private. Although we will make
every effort to keep your information confidential, the following groups may need to
review the study records about you. These organizations review studies to ensure that
everything is carried out safely and legally. These organizations include The Human Subjects
Ethical Review Board of the Regional Health Bureau, The National Health and Research
Council, and other research regulatory institutions.

The information you give us will be kept private to the extent allowed by law. All records related
to your involvement in this study will be stored in a locked secure cabinet. All digital records
indicating your participation will be kept on a password protected computer in an encrypted file.

RIGHTS TO PARTICIPANTS

Your participation is entirely voluntary. The research is not related with the clinical care you
receive; this is purely a research study. If you decide not to participate in the study, your
decision will not affect the care you receive at any Health Facilities in the future in any way. You
can choose to discontinue with interview in the study at any time without any penalty. You can
also choose which questions you want or don’t want to answer, and we can stop the interview at
any time. If you experience any kind of psychological distress as a result of participating in the
study, the research team can refer you to appropriate care. If you have any questions or
concerns, please contact the researcher, ______ at ___________ (telephone) or
_________email. If you contact the Research team by email, please note that we cannot
guarantee the confidentiality of the correspondence sent by email.

Subject’s Statement

31
This study has been explained to me. I volunteer to take part in this research. I have had a chance
to ask questions. If I have questions about the research, I can contact one of the researchers
listed above.

If I have questions about my rights as a research subject, I can call the Human Subjects _____at
the Oromia Health Bureau at _______ (telephone) or the Head of this Research Council,
Research Officer _______ at __________(Mobile) or ________ (email). I will receive a copy
of this written consent form.

Printed name of subject Signature of subject or thumb print Date Phone number of the subject:
Printed name of Researcher Signature of Researcher Date In case of subjects who cannot read
or write, Printed name of Witness Signature of Witness

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New References (only introduction part)
1. WHO, Safe and Unsafe Induced Abortion Global and Regional Levels in 2008, and
Trends during 1995–2008, World Health Organization, Geneva, Switzerland.
2. www.Who.int/iris/bitstream /10665/75174/1/who_RHR_12.02_eng.pdf
3. WHO, Unsafe Abortion Global and Regional Estimates of the Incidence of Unsafe
Abortion and Associated Mortality in 2008, World Health Organization, Geneva,
Switzerland, 6th edition,2011.
4. www.ncb.nim.nih.gov/pmc/article/PMC2709326/
5. WHO, Unsafe Abortion, Global and Regional Estimates of Incidence of Mortality Due to
Unsafe Abortion with a Listing of Available Country Data, World Health Organization,
Geneva, Switzerland, 2004.
6. CSA and ORCMacro, Ethiopia Demographic and Health Survey 2011, Central Statistical
Agency and ORC Macro, Addis Ababa, Ethiopia and Calverton, Md, USA, 2012.
7. Technical and Procedural Guidelines For Safe Abortion Services in Ethiopia, Ministry of
Health, Addis Ababa, Ethiopia, 2006.

36