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Background: Although most induced abortions in Ethiopia are performed in the first trimester, many women will still require second trimester abortions. While access to abortion in Ethiopia is limited, few data are being available concerning the demand for and associated outcomes of second trimester abortions. This knowledge is important for planning the health service response to abortion. Objective: The main objective of this study was to determine the proportion and associated factors of second trimester abortion among women presenting for abortion care services at Debre Markos Referral Hospital, Debre Markos, Northwest Ethiopia. Methods: An institution-based cross-sectional study was conducted at Debre Markos Referral Hospital on a sample of 262 calculated using the single population proportion formula. Women who sought abortion services were interviewed consecutively from 12 February 2017 to 14 March 2017. Data were collected in a face-to-face exit interview and document review and analyzed using SPSS version 24.0 software. Bivariate and multivariable analyses were undertaken to identify factors. Result: Of the women who presented for abortion care services in Debre Markos Referral Hospital, 73 (29.6%) had induced second trimester abortion. Unmarried women (adjusted odds ratio = 4.93, 95% confidence interval = 1.41–17.16) and women employed at private business (adjusted odds ratio = 6.17, 95% confidence interval = 1.16–32.76) were associated with induced second trimester abortion. Conclusion: This study revealed that almost one-third of women who presented for abortion care services at Debre Markos Referral Hospital had induced second trimester abortions. Raising awareness of the health consequence of second trimester abortion at community levels and counseling to avoid further occurrences are helpful to minimize the problem. Furthermore, early management of induced second trimester abortion is very crucial to prevent further complications.
An institution-based cross-sectional study of women seeking abortion care was conducted from 12 February 2017 to 14 March 2017, at Debre Markos Referral Hospital. This hospital is located 300 and 265 km from Addis Ababa and Bahar Dar, the capitals of Ethiopia and the Amhara Regional State, respectively. The hospital is situated in Debre Markos town and provides comprehensive maternal and child-related services to an estimated catchment population of 3.5 million. During data collection, there were approximately 998 patients receiving abortion services in Debre Markos Referral Hospital in the previous 6 months. At the time of the study, there were 192 nurses, 25 midwives, 28 general practitioners, three emergency surgeons, 10 specialists, three gynecologists, and obstetricians. The hospital has 20 outpatient clinics including one for gynecology and one for obstetrics and one gynecology and obstetrics ward.31 In Ethiopia, mothers delivered at health facility were 34%,32 and 620,300 induced abortions were performed,33 whereas in Debre Markos Referral Hospital, 1 month prior to study conducted, the number of deliveries was 1300 and induced abortion cases were 270. The sample size was calculated using the formula for a single population proportion by taking the proportion of induced second trimester abortion as 19.2%,34 a confidence level of 95%, and degree of precision of 5%, in addition, a 10% of non-response rate, yielded a total sample size of 262. However, the total population was too small during the study period. As a result, all of them were included in the study (census method). Female patients who presented for abortion care services were interviewed from 12 February 2017 to 14 March 2017. Data were collected by interview using structured questionnaire and document review by three trained diploma graduate midwives. Data collection took 30 days, and the principal investigator followed the process daily. To ensure data quality, the questionnaire was pretested on 5% of the populations at Finote Selam Hospital, 1 week before the study commenced. In response to this, several modifications were made to the questionnaire and the interview protocol. Facilitators were trained and given information about the importance of the study. Data were reviewed and checked for completeness before data entry. Data were entered into EpiData version 3.1 and exported to SPSS version 24.0. Frequencies, percentages, and means were used to describe demographic and associated health characteristics. The outcome variable was illustrated by demographics and health-related characteristics using cross tabulations. P-values (P 0.05) which proved the model was good. Ethical approval was obtained from the Debre Markos University Ethical Clearance Committee with reference number of HSC/R/C/Ser/Co/141/11/10. Permission to gather data was provided by the manager of Debre Markos Referral Hospital. All women receiving induced second trimester abortion were informed about the study in order to obtain their verbal consent. Verbal consent was also obtained from each client and introduced the objective of the study that it contributes to set interventions and strategies to improve services. Any client who was not willing to participate in the study had the right to refuse at any time of interviewing. Data were collected after full informed consent is obtained and confidentiality of the information was maintained by excluding names as identification in the questionnaire and keeping their privacy during the interview by interviewing them alone.
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