Trends in and predictors of pregnancy termination among 15–24 year-old women in Nigeria: a multi-level analysis of demographic and health surveys 2003–2018

Abstract

Background Three-quarters of pregnancy terminations in Africa are carried out in unsafe conditions. Unsafe abortion is the leading cause of maternal mortality among 15–24 year-old women in Sub-Saharan Africa. Greater understanding of the wider determinants of pregnancy termination in 15–24 year-olds could inform the design and development of interventions to mitigate the harm. Previous research has described the trends in and factors associated with termination of pregnancy for women of reproductive age in Nigeria. However, the wider determinants of pregnancy termination have not been ascertained, and data for all women have been aggregated which may obscure differences by age groups. Therefore, we examined the trends in and individual and contextual-level predictors of pregnancy termination among 15–24 year-old women in Nigeria. Methods We analysed data from the 2003, 2008, 2013 and 2018 Nigerian Demographic and Health Surveys (NDHS) comprising 45,793 women aged 15–24 years. Trends in pregnancy termination across the four survey datasets were examined using bivariate analysis. Individual and contextual predictors of pregnancy termination were analysed using a three-level binary logistic regression analysis and are reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results Trends in pregnancy termination declined from 5.8% in 2003 to 4.2% in 2013 then reversed to 4.9% in 2018. The declining trend was greater for 15–24 year-old women with higher socioeconomic status. Around 17% of the total variation in pregnancy termination was attributable to community factors, and 7% to state-level factors. Of all contextual variables considered, only contraceptive prevalence (proxy for reproductive health service access by young women) at community level was significant. Living in communities with higher contraceptive prevalence increased odds of termination compared with communities with lower contraceptive prevalence (aOR = 4.2; 95% CI 2.7–6.6). At the individual-level, sexual activity before age 15 increased odds of termination (aOR = 2.3; 95% CI 1.9–2.8) compared with women who initiated sexual activity at age 18 years or older, and married women had increased odds compared with never married women (aOR = 3.0; 95% CI 2.5–3.7). Conclusion Our findings highlight the importance of disaggregating data for women across the reproductive lifecourse, and indicates where tailored interventions could be targeted to address factors associated with pregnancy termination among young women in Nigeria.

Determinants of abortion among youth 15–24 in Ethiopia: A multilevel analysis based on EDHS 2016

“…Similarly, both the married and the divorced youth mothers had an increased risk of abortion relative to the unmarried ones. The finding is consistent with other studies in Ethiopia, another Africa, and non-African countries [22,23,31]; ( Table 2).…”

“…It is consistent with a study by Van Rensburg that showed societal poverty, unemployment, and other socio-demographic factors affected youth pregnancies and might lead to abortion [28]; (Table 1). Abortion was increased with increased age so that age group 20-24 had more abortion than15-19 The finding is in agreement with that of Nigerian DHS where abortion was 2.34 higher among those aged 20-24 than youths aged 15-19 [23]. It might show that age is the risk of abortion during the younger time because of the lack of information and less self-relying decision making.…”

“…We took it from the EDHS question ‘have you ever had a pregnancy termination?’ with the response ‘yes’ if the woman ever had an abortion and otherwise ‘no’ as a binary outcome. It usually means abortion is any pregnancy outcome of a miscarriage, abortion, or stillbirth [ 23 – 25 ]. The exploratory variables are individual or group variables showing both mother and child, every socio-demographic variable used in the selected EDHS dataset.…”

Intimate partner violence against adolescent girls and young women and its association with miscarriages, stillbirths and induced abortions in sub-Saharan Africa: Evidence from demographic and health surveys

“…Majority of induced abortions, stillbirths and miscarriages occur in low-and middle-income countries (LMICs) and the sub-Saharan African region ( Bearak et al, 2020 ). Studies have also found that the risk of pregnancy termination is high among adolescent girls and young women (AGYW) compared to older women ( Leppälahti, Gissler, Mentula, & Heikinheimo, 2012 ; Onukwugha, Magadi, Sarki, & Smith, 2020 ; Sánchez-Páez & Ortega, 2019 ). One of the major risk factors for pregnancy termination is intimate partner violence (IPV) ( Durevall & Lindskog, 2015 ).…”

“…However, in SSA, only country-specific studies have been carried out in Cameroon ( Alio et al, 2011 ), Ethiopia ( Tiruye, Chojenta, Harris, Holliday, & Loxton, 2020 ), Ghana ( Tenkorang, 2019 ), Nigeria ( Bola, 2016 ) and Tanzania ( Stöckl, Filippi, Watts, & Mbwambo, 2012 ) on the association between IPV and pregnancy termination. None of these studies specifically focused on AGYW, despite previous studies recording high prevalence of pregnancy termination among this cohort of women ( Leppälahti et al, 2012 ; Onukwugha et al, 2020 ; Sánchez-Páez & Ortega, 2019 ). The current study seeks to fill this gap by examining the association between IPV and pregnancy termination among AGYW in 25 sub-Saharan African countries using recent Demographic and Health Surveys (DHS) data from 2010 to 2019.…”