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Background: Second-trimester abortions disproportionately contribute to the increased medical cost, maternal morbidity, and mortality compared to the first trimester. Therefore, the aim of the current study was to determine the magnitude and determinants of late presentation for safe abortion care at a tertiary hospital in Ethiopia. Methods: We conducted a cross-sectional study among pregnant women who requested safe abortion care from January 2019 to April 2020. Participants were selected using systematic sampling and data were collected using the interviewer-administered questionnaire. P-value adjusted odds ratios (AOR) with their 95% confidence interval (CI) were used to determine the association between variables. Results: The prevalence of second-trimester abortion was 53.4%. Young age, ≤ 19 years (AOR= 6.37, 95% CI=1.84–22.06), decision ambivalence (AOR=5.64, 95% CI=1.71–18.61), delay to suspect pregnancy (AOR= 8.56, 95% CI=2.11–34.57), delay to diagnose pregnancy (AOR=3.83, 95% CI=1.51–9.75), lack of awareness on pregnancy signs and symptoms (AOR=4.22, 95% CI=1.59–11.23), delay to get the service (AOR =4.43, 95% CI=1.43–13.67), and lack of information where to get the abortion service (AOR=3.90, 95% CI=1.53–9.96) were significantly associated with presentation in second trimester. Conclusion: More than half of women who request safe abortion at Saint Paul’s Hospital Millennium Medical College do so in the second trimester. Young age, delay in diagnosis of pregnancy, delayed decision, and lack of information where to get service were contributing factors. Therefore, comprehensive adolescent sexuality education, increasing access to contraception, and safe abortion service including self-care interventions are very imperative to avert late gestation abortion and its consequences.
We conducted a prospective hospital-based cross-sectional study at Michu clinic, SPHMMC in Addis Ababa, the capital city of Ethiopia. SPHMMC is one of the teaching and tertiary referral hospitals directly under the federal ministry of health. According to the statistics office report, the hospital gives service to 200,000 people annually. It gives service under different clinical disciplines which include Obstetrics and Gynecology. Michu clinic is under the Department of Obstetrics and Gynecology department which provides abortion and family planning-related services. Around 1500 women receive abortion care in the hospital annually. The data were collected from January 2019 to April 2020. The study population were all pregnant women requesting a safe abortion service during the study period at Michu Clinic. We included all pregnant women who requested a safe abortion service and gave written informed consent. We excluded those women who seek abortion service for indications of fetal demise, fetal anomaly, and life-threatening maternal medical disorders. Besides, those who presented after the gestational age of viability (≥28 weeks) and those who are seriously ill and unable to communicate during the data collection period were excluded. The sample size was calculated using the single population proportion formula taking a P value of 0.192 from the study done in the Amhara region which shows the prevalence of second-trimester abortion as 19.2%.10 Using the power of 80%, adding a marginal error of 5%, and a contingency rate, the estimated sample size was 246. We used systematic sampling to recruit eligible study participants. Considering 420 data collection days in the study period to recruit 246 participants we recruited every 2nd client prospectively. In cases when the 2nd patient is not eligible the patient immediately before or after the patient will be enrolled. The data were collected at the time of client presentation to Michu clinic by interviewer-administered structured questionnaires. The questionnaire was prepared in English, translated to Amharic which is a local language, and then translated back to English to check for consistency. Pretesting of the questionnaire was conducted on ten women and appropriate modification was applied. Data collectors were trained at Michu Clinic for 02 consecutive days by the principal investigator in pre-tested checklists. The operational manual for the study was prepared to assure a uniform standard for carrying out the study with good quality control. All data were collected and stored anonymously. All filled questionnaires were checked daily for completeness, accuracy, and consistency by the principal investigator. Supervision was carried out by the principal investigator throughout the data collection. Timing for seeking abortion care was the dependent variable and categorized as second trimester (≥13 weeks of gestation and < 28 weeks) and early (< 13 weeks of gestation). The independent variables were socio-demographic characteristics (age, marital status, educational status, place of residency, monthly income, religion), reproductive characteristics (gravidity, parity, abortion history, menstrual nature, gestational age, whether the pregnancy was a result of sexual assault or not), logistic factors (financial, transportation and information problems, service availability around vicinity), interpersonal and intrapersonal factors (partner or family conflict, social or religious stigma, decision ambivalence), level of awareness on reproductive health (pregnancy window period, pregnancy signs and symptoms, contraception use, alternative options for unplanned and unwanted pregnancies, abortion care centers, early and safe pregnancy duration for induced abortion, abortion complications) After data were collected, each questionnaire was given code and checked visually for completeness. The data were entered Epi-info version 3.5.1 and transported to SPSS version 20 software packages for analysis. Further, data cleaning was performed to check for outliers, missed values, and any inconsistencies before the data analysis. For any missed values and inconsistency, the principal investigator cross-checked the patient medical record using the codes and made necessary corrections. Data were analyzed using SPSS 20.0 version. Socio-demographic and reproductive characteristics of the participants and their level of awareness on reproductive health were described using descriptive statistics. Bivariable and Multivariable logistic regression was used to identify independent factors associated with the late request for safe abortion. Bivariate analysis was carried out first to observe the crude association between independent and outcome variables. The variables with P value < 0.2 in bivariate analysis, were considered as candidate variables for the multivariable model. Finally, statistically significant variables that fit the final regression model were identified using the odds ratio with a 95% confidence interval and P value < 0.05. The current study was conducted following the Declaration of Helsinki. Ethical clearance was obtained from the Institutional Review Board (IRB) of SPHMMC including informed written consent for participants under the age of 18 years. Permission to conduct the study was taken from the hospital administration. Informed consent was obtained from each study participants after the objectives of the study were explained. To ensure the confidentiality of participants, we did not collect or store any identifying information about participants. All the datasets used and/or analyzed during the current study are included in the manuscript.
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