|Year : 2016 | Volume
| Issue : 2 | Page : 86-92
Prevalence, perceptions, consequences, and determinants of induced abortion among students of the Kaduna State University, Northwestern Nigeria
Adegboyega Omoniyi Oyefabi1, Awawu G Nmadu1, Muhammed S Yusuf2
1 Department of Community Medicine, Kaduna State University, Kaduna, Nigeria
2 Department of Community Medicine, Kaduna State University, KadunaDepartment of Community Medicine, Kaduna State University, Kaduna, Nigeria
|Date of Web Publication||13-Oct-2016|
Adegboyega Omoniyi Oyefabi
Department of Community Medicine, Kaduna State University, Kaduna
Source of Support: None, Conflict of Interest: None
Background: Induced abortion contributes significantly to maternal mortality in developing countries. Abortion has not been liberalized in Nigeria, and various studies have reported the high prevalence of unsafe abortion in countries where induced abortion has been restricted. The aim of this study was to determine the prevalence, perceptions, determinants, and consequences of induced abortion among the Kaduna State University students.
Materials and Methods: This cross-sectional study was conducted among 540 undergraduate students of the University selectedby three faculties from the University main campus through the simple random sampling technique (balloting).
Result: The mean age ofthe respondents was 21 2 years. Some (14.4%) of the respondents affirmed that abortion should be legalized in every part of the world, while 32.4% believed that a pregnant woman should be free to make decision to have abortion. About 51.7% opined that people should not discriminate against women who chose to have abortion. The prevalence of premarital sex and induced abortion was 8.38% and 6.7%, respectively. There was a signifi cant relationship between the age, religion, faculty, and academic level of the respondents and the incidence of induced abortion (P < 0.05). The most common postabortal complication was vaginal bleeding.
Conclusion: This study shows that the respondents had varied perceptions about induced abortion, which influence its prevalence among this population. The demand for pregnant women to be free to make decision to have an abortion without being discriminated against is also high among the respondents. There is a need for improved sexual health education and availability of contraceptive services for the students in this University.
Keywords: Abortion, liberalized, maternal mortality, perceptions, vaginal bleeding
|How to cite this article:|
Oyefabi AO, Nmadu AG, Yusuf MS. Prevalence, perceptions, consequences, and determinants of induced abortion among students of the Kaduna State University, Northwestern Nigeria. J Med Trop 2016;18:86-92
|How to cite this URL:|
Oyefabi AO, Nmadu AG, Yusuf MS. Prevalence, perceptions, consequences, and determinants of induced abortion among students of the Kaduna State University, Northwestern Nigeria. J Med Trop [serial online] 2016 [cited 2019 May 22];18:86-92. Available from: http://www.jmedtropics.org/text.asp?2016/18/2/86/192230
| Introduction|| |
Abortion is the removal or expulsion of an embryo or fetus from the uterus which can be spontaneous, without any external manipulation, or induced either by medical, surgical, or other unorthodox means at any point during human pregnancy for therapeutic or elective reasons.  The issue of abortion is viewed in different perspectives depending on individual characteristics and sociocultural background.  Usually, in Africa, spontaneous abortion is believed to be an unfortunate situation usually attributed to the evil deeds of an enemy, which may be a close family relative. The victim may resort to seeking psychospiritual solutions to unravel the mystery depending on her socioreligious background. 
The Nigeria laws, though patterned after the British laws, are not favorably disposed to induced abortion. The liberalized abortion law is not permitted in Nigeria.  The provisions of the Nigerian criminal codes dealing with abortion were derived from Section 58 and 59 of the offense against person Act of 1861. The Nigeria laws criminalize abortion. The country has two abortion laws, one each for Northern and Southern Nigeria. Both laws specifically allow abortions to be performed to save the life of the woman. , In addition to these laws, in the Southern Nigeria, the holding of Rex v. Bourne is applied which allows abortions to be performed for physical and mental health reasons. Induced abortion is prohibited for rape, incest, fetal impairment, or economic and other social reasons. 
Apart from these restrictive laws, the sociocultural and religious beliefs in the African society have also frown at the practice of induced abortion, considering the act as a murder.  Hence, in many settings, the incidence of induced abortion is treated clandestinely and the culprits if exposed are highly stigmatized.  These embargoes however have not stopped the requests for induced abortion. A study in Sagamu, Nigeria, in 2014 revealed that 2934 women came to a health facility to request for a repeat abortion in 2012. 
Majority of the abortions in Nigeria are being committed in secrecy by the less-qualified persons in very poor environments due to the desperation of the clients and the need to make easy money by the quack doctors.  This situation has in no doubt contributed to the increasing prevalence of unsafe abortion and consequently an increasing maternal mortality rate, with up to 40% maternal deaths in Nigeria due to induced abortion. , A study, conducted by US-based Guttmacher Institute, and IPAS, reported that at least 1. 2 million induced abortions take place in various parts of Nigeria every year.  It has also been reported that 56% of all abortions in the developing nations are unsafe, compared with just 6% in the developed countries with liberalized abortion laws. ,,
The purpose of this current study, therefore, is to determine the prevalence, perceptions, consequences, and the risk factors for induced abortion among the undergraduate students of the Kaduna State University. This study will provide information to support the University Management to organize reproductive health programs for the students to address the abortion-related reproductive health issues.
| Materials and Methods|| |
The Kaduna State University was established under the Kaduna State law promulgated in May 2004. It has the main campus located at Tafawa Balewa way in the capital city of Kaduna, while the second campus is located at Kafanchan, about 228 km from the state capital. The Kafanchan campus comprised the faculties of agriculture, architecture, and environmental science, while the faculties of arts, science, medicine, pharmaceutical sciences, and social and management science are located at the main campus. The University has an estimated population of about 6000 students.
This was a descriptive, cross-sectional study that quantitatively explored the prevalence, perception, and consequences of induced abortion among the study population.
The study was conducted among the female undergraduates from the faculties of arts and science and faculty of social and management science of the Kaduna State University. Those eligible but not available at the time of the survey were excluded from the study.
Sample Size and Sampling
This survey S involved 540 undergraduate students from the selected faculties between July and August 2015. The main campus was purposively selected for the study and three faculties were selected by the simple random sampling technique (balloting) from a list of the five faculties at the main campus of the University. In these faculties, all students in each class 100-400 Levels who were willing to participate in the study were included in the study. A pretest of the questionnaire was conducted at the Kaduna Polytechnic, with 10% of the study population. 
The Cochran's formula was used to calculate the sample size as shown below:
n = Z 2 pq/d 2
n = Desired sample size
Z = Obtained from the normal distribution table = 1.96
p = The incidence of induced abortion in a previous study was 47.2% = 0.472 
q = Complimentary probability to P = (1 − P) = 0.528
d = Degree of accuracy (precision) desired here set at 0.05
n = 1.96 2 × 0.472 × 0.528
0.05 2 = 382.95 ≈ 383 respondents.
This however was increased to 540 clients to improve the power of the study.
Data Collection Tool and Data Collection
The respondents were interviewed using a structured, self-administered questionnaire supervised by the authors assisted by five volunteer medical students from the Kaduna State University. The structured questionnaire consists of three sections: Section A included questions on sociodemographic characteristics such as age, marital status, ethnic group, religion, academic level, faculty, and respondents' program of the study. Section B had questions related to the perception of the respondents on abortion such as "Should abortion be legalized in every part of the world?" and "Is abortion a good way of solving an unwanted pregnancy?" While Section C had questions related to the practice of abortion such as "Have you ever had any cause to get an abortion done before?"
The data were collected in the large lecture halls of each faculty. Completed questionnaires were scrutinized on the spot and at the end of the daily data collection for immediate correction of erroneous entries. Data were collected over a period of 4 weeks.
The data were analyzed with Stata Statistical Software, StataCorp LP and IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Percentages and standard deviation were computed for baseline characteristics of the participants. The respondents' perceptions on abortion were analyzed using frequency tables; bivariate analysis was carried out using Chi-square test and independent t-test where appropriate, to determine the association between the respondents' demographics, their perceptions, and incidence of induced abortion. The level of statistical significance was set at P < 0.05. The unadjusted odds ratio (OR) was determined at 95% confidence interval (CI).
The ethical permission was obtained from the Deans of the surveyed faculties and the Kaduna State Ministry of Health as the school did not have an Institutional Review Board yet as at the time of this survey. The purpose and nature of the study were explained to each respondent. None of the participants' name or any form of identity was requested on the questionnaire to maintain confidentiality.
| Results|| |
The mean age of the respondents was 21 ± 2 years. The majority were Hausa (47.6%), Moslem (57%) students, unmarried (79.8%), while 5 (1%) were divorced. They were mostly from the science department (67%). A larger proportion of the students lived off campus. The prevalence of premarital sex and induced abortion were 8.38% and 6.7%, respectively [Table 1].
Some of the respondents affirmed that abortion should be legalized in every part of the world (14.4%); while 15.4% opined that an unborn baby is not a person as long as it is still inside the womb, 32.4% perceived that a pregnant woman should be free to make a decision to have an abortion. More than a half (51.7%) of the respondents was of the view that people should not discriminate against women who choose to have an abortion, while 87.1% believed that abortion is wrong no matter the circumstances. Only 12.6% noted that induced abortion is a good way of resolving the challenge of an unwanted pregnancy [Table 2].
Further analysis revealed that those who believed that induced abortion should be legalized in every part of the world and those who believed that it is a good way of resolving unwanted pregnancy were three times more likely to seek for abortion ([OR = 3.36, 95% CI = 1.54-7.36] and [OR = 3.14, 95% CI = 1.4-6.98], respectively). Likewise, those who opined that pregnant women should be free to have an abortion and those who thought that people should not discriminate against people who decided to have abortion were two times more likely to commit abortion than the other students [Table 3].
|Table 3: Association between respondents' perception and incidence of abortion|
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Regarding where abortions were performed, 58%, 17%, 11%, 8%, and 6% of the procedures took place in private clinics, health workers' houses, patent medicine stores, Government Hospitals, and other unidentified places, respectively. The major postabortal complication was vaginal bleeding (33.3%); others included emotional disorder (20%), abdominal pain (20%), vaginal discharge (13.3%), fever (6.7%), and inability to conceive (3.3%).
We found a significant association between the age (P = 0.001), religion (P = 0.003), faculty (0.04), academic level of the respondents (P = 0.022), and the prevalence of induced abortion [Table 4].
|Table 4: Sociodemographic determinants of induced abortion among the respondents|
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| Discussion|| |
The mean age of the respondents was 21 ± 2 years, with the majority age group being 15-24 years. This is the usual age group at which majority of Nigeria women are first exposed to sexual intercourse and are therefore at a greater risk of sexually transmitted diseases (STDs), exposure to complications of abortions, and other reproductive health problems.  Previous studies have shown that 14% of all unsafe abortions in low- and middle-income countries are among women aged 15-19 years.  Lamina reported a median age of 25 years among women seeking repeated induced abortion in Sagamu, Southwestern Nigeria.  This corroborates the fact that the adolescent and early adults are the major age groups at risk of induced abortion. The World Health Organization has also revealed that the age group 15-24 years in African region account for more than 50% of the global abortion-related mortalities. 
There is no significant relationship between the marital status of the respondents and occurrence of induced abortion. This implies that marital status of the respondent is not a risk factor for the incidence of induced abortion in this population. This study shows that either married or unmarried, a woman can be involved in induced abortion for varied reasons. This is similar to a previous study from Ibadan with the report that Nigeria is experiencing demographic transition; the fertility rates are falling; therefore, after a few children, there is higher probability of demand for abortion by married couple who believe that they have had enough children.  This can also explain the increased unmet demand for contraceptive use in Nigeria as more women have unplanned pregnancies, the demand for induced abortion increases. 
It was also noted in this current study that 62.4% of the respondents were sexually active. This is comparable with reports of sexual prevalence rate of 70% from the Nigeria National Demographic Health Survey, 62% from Ilorin,  77% from Benin City,  and the 60% from Lagos.  Our findings however are higher than the 40% from Southeastern Nigeria  and the 32.7% from Niger State  among similar age groups. ,,,, Several studies from other parts of the Sub-Saharan Africa have also documented very high premarital sexual activities among the adolescents. ,,
Our study showed that 6.7% of the respondents were ever pregnant and all (100%) ever had induced abortion. This is similar to the findings by Araoye and Fakeye in North-Central Nigeria with 5.7% pregnancy rate and 100% abortion prevalence rate among the sexually active females.  This is also comparable with studies by Ameh et al.,  Kaufmann et al.,  and Watcharaseranee et al.,  where ever-pregnant respondents of similar age group were reported to be 8.8%, 8.4%, and 9%. The practice of induced abortion by virtually every young girl with sexual exposure before marriage calls for increased reproductive health awareness on sex education, use of appropriate modern contraceptives, and the need for the review of the Nigeria restrictive abortion law. 
This study also discovered that 60% of the induced abortion were done in private clinics, 17% in health workers house, 8.6% in Government Hospitals, 11% in patent medicine store, while 2.1% in other unidentified places by unqualified persons most likely at the health workers' or clients' homes. This can be compared to a report from a previous study in Nigeria, where 85% of the abortions among young persons were done in private clinics.  These clinics and "Chemist shop" (patent medicine vendors) from various reports have become the havens for illegal induced abortions.  These are avenues through which a lot of quack "doctors" make easy money in developing countries.  They capitalize on the restrictive abortion law to exploit their clients and most of the time, their procedure results in damaging complications, due to the poor procedure, performed by unqualified persons clandestinely in an unhygienic environment, such as the patient medicine store or health workers home. ,
Majority of the respondents in this study believed that a woman should be obligated to bear a child she has conceived (87.4%); however, a good proportion perceived that abortion should be legalized in every part of the world (14.4%), others opined that people should not discriminate against women willing to have an abortion (51.7%) and that abortion is necessary if a person is not ready to get married yet. There was a significant positive association between incidence of induced abortion and the respondents' perceptions that abortion should be legalized, the perception that it is a good way of resolving unwanted pregnancy, and the belief that abortion is necessary if a person is not ready for marriage yet (P < 0.05). This shows that perceptions have great influence on the practice of abortion. Makinwa-Adebusoye et al. in their study highlighted the influence of perceptions on the practice of abortion in Nigeria. 
The major postabortal complications in this study were vaginal bleeding and abdominal pain. A few respondents reported inability to conceive, vagina discharge, or febrile illness. This is similar to a study from Abakaliki which reported that postabortal septicemia, anemia, peritonitis, hemorrhages, uterine perforation, and postabortal-related death as major consequences of induced abortion.  Studies from different parts of the world have also reported similar grave consequences among respondents with history of induced abortion, especially when performed by unqualified persons. , The most common reported complication in this study was vaginal bleeding, and this is in keeping with other previous studies. , This may be due to incomplete abortion and trauma to genital tract or the uterine cavity during the procedure.
Finally, our study noted that the religious beliefs, the department and the academic levels of the respondents significantly influence the practice of induced abortion (P < 0.05). A Gabon study had emphasized the influence of religion on the practice of abortion.  We observed that higher proportion of students from the faculty of art significantly practiced induced abortion compared to other faculties. This may be due to poorer awareness of the contraceptive methods compared to the science students. Ever-pregnant females had abortion significantly increases from 3.6% in 100 level to 9.1% in 200 level and above. This enormous increase can be attributed to higher social and sexual activities as students get to know the campus and make more friends as their number of years on campus increases.
| Conclusion|| |
The prevalence of abortion among the 6.7% ever-pregnant women in this study was 100%. The practice of induced abortion was noted to be associated with the respondents' age, beliefs and perceptions, length of stay in the University, and the faculties of respondents. Most of the abortions were done in private clinics, with vaginal bleeding and abdominal pain being the major postabortal complications.
Based on the outcomes of this study, the University management needs to include sexual education, knowledge of STDs, and awareness of the dangers of illegal induced abortion, and knowledge of modern contraceptive methods for the new students in their orientation program access to reproductive health services should be one of the major focuses of the University health service. Nigeria is a very religious state, to recommend liberalized abortion law may not appeal to the conscience of the general populace; however, with sex education, increased reproductive health awareness, increased access to modern contraceptives, the maternal morbidity and mortality due to induced abortion can be reduced.
Financial Support and Sponsorship
Conflicts of Interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]