Unveiling 10‐Year Dynamics of Pregnancy Termination Across Sub‐Saharan Africa: A Multilevel Study
ABSTRACT Background and Aims Sub‐Saharan African (SSA) women face significant reproductive health challenges, including unwanted pregnancies and unsafe abortions. Despite the high prevalence of pregnancy termination in the continent, multilevel determinants and recent data trends remain understudied...
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Wiley
2025-05-01
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| Online Access: | https://doi.org/10.1002/hsr2.70742 |
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| author | Getayeneh Antehunegn Tesema Sylvester R. Okeke Michael Sarfo Edward K. Ameyaw Olanrewaju Oladimeji Sanni Yaya |
| author_facet | Getayeneh Antehunegn Tesema Sylvester R. Okeke Michael Sarfo Edward K. Ameyaw Olanrewaju Oladimeji Sanni Yaya |
| author_sort | Getayeneh Antehunegn Tesema |
| collection | DOAJ |
| description | ABSTRACT Background and Aims Sub‐Saharan African (SSA) women face significant reproductive health challenges, including unwanted pregnancies and unsafe abortions. Despite the high prevalence of pregnancy termination in the continent, multilevel determinants and recent data trends remain understudied. This study addresses these gaps by leveraging recent Demographic and Health Survey (DHS) data and advanced statistical techniques. Methods This study involves secondary analysis using DHS data collected between 2010 and 2021 from 33 countries in Sub‐Saharan Africa. The analysis focused on pregnancy termination among women aged 15–49, comprising a weighted sample of 470,330 individuals. The data underwent a weighting process, considering sampling weight, primary sampling units, and strata. We utilized a multilevel binary logistic regression model to evaluate the correlation between individual and community‐level variables and the probability of pregnancy termination. Given the nested structure of the models, comparisons were made using the deviance statistic (−2 log‐likelihood ratio). All analyses were performed using STATA version 17. Variables with a p‐value ≤ 0.2 in the bivariable multilevel analysis were included in the multivariable model. The final results are presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs) to indicate the strength and statistical significance of associations. Results The overall prevalence of pregnancy termination among reproductive‐age women in SSA was 6.96% (95% CI: 6.89%, 7.03%), with the highest (13.59%) and lowest (3.83%) prevalence reported in Ghana and Ethiopia, respectively. The odds of pregnancy termination among rural resident women were 8% lower (AOR = 0.92, 95% CI: 0.89, 0.95) compared to urban residents. Women in Southern Africa had 9% decreased odds of pregnancy termination than women in Eastern Africa. Compared to women from East Africa, women in Western and Central Africa were 1.21 (AOR = 1.21, 95% CI: 1.18, 1.25) and 1.40 (AOR = 1.40, 95% CI: 1.35, 1.44) times higher odds of pregnancy termination, respectively. Conclusion The study reveals a notably high rate of pregnancy termination in SSA, which is particularly worrisome due to the legal limitations on abortion services in many SSA countries. Expanding access to contraception and comprehensive sexual health education is crucial to reducing unintended pregnancies across the region. Additionally, a reassessment of the strictness of abortion service restrictions is critical to encourage women to obtain these services from qualified professionals. |
| format | Article |
| id | doaj-art-215d2ddad0644da7be539e50ccb22d36 |
| institution | DOAJ |
| issn | 2398-8835 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Wiley |
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| series | Health Science Reports |
| spelling | doaj-art-215d2ddad0644da7be539e50ccb22d362025-08-20T02:55:06ZengWileyHealth Science Reports2398-88352025-05-0185n/an/a10.1002/hsr2.70742Unveiling 10‐Year Dynamics of Pregnancy Termination Across Sub‐Saharan Africa: A Multilevel StudyGetayeneh Antehunegn Tesema0Sylvester R. Okeke1Michael Sarfo2Edward K. Ameyaw3Olanrewaju Oladimeji4Sanni Yaya5Department of Epidemiology and Biostatistics College of Medicine and Health Sciences, University of Gondar Gondar EthiopiaCentre for Social Research in Health UNSW Sydney New South Wales AustraliaSchool of Human and Health Sciences University of Huddersfield Huddersfield UKInstitute of Policy Studies and School of Graduate Studies Lingnan University Tuen Mun Hong KongDepartment of Social Sciences, Demography and Population Studies Unit Walter Sisulu University Mthatha South AfricaThe George Institute for Global Health Imperial College London London UKABSTRACT Background and Aims Sub‐Saharan African (SSA) women face significant reproductive health challenges, including unwanted pregnancies and unsafe abortions. Despite the high prevalence of pregnancy termination in the continent, multilevel determinants and recent data trends remain understudied. This study addresses these gaps by leveraging recent Demographic and Health Survey (DHS) data and advanced statistical techniques. Methods This study involves secondary analysis using DHS data collected between 2010 and 2021 from 33 countries in Sub‐Saharan Africa. The analysis focused on pregnancy termination among women aged 15–49, comprising a weighted sample of 470,330 individuals. The data underwent a weighting process, considering sampling weight, primary sampling units, and strata. We utilized a multilevel binary logistic regression model to evaluate the correlation between individual and community‐level variables and the probability of pregnancy termination. Given the nested structure of the models, comparisons were made using the deviance statistic (−2 log‐likelihood ratio). All analyses were performed using STATA version 17. Variables with a p‐value ≤ 0.2 in the bivariable multilevel analysis were included in the multivariable model. The final results are presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs) to indicate the strength and statistical significance of associations. Results The overall prevalence of pregnancy termination among reproductive‐age women in SSA was 6.96% (95% CI: 6.89%, 7.03%), with the highest (13.59%) and lowest (3.83%) prevalence reported in Ghana and Ethiopia, respectively. The odds of pregnancy termination among rural resident women were 8% lower (AOR = 0.92, 95% CI: 0.89, 0.95) compared to urban residents. Women in Southern Africa had 9% decreased odds of pregnancy termination than women in Eastern Africa. Compared to women from East Africa, women in Western and Central Africa were 1.21 (AOR = 1.21, 95% CI: 1.18, 1.25) and 1.40 (AOR = 1.40, 95% CI: 1.35, 1.44) times higher odds of pregnancy termination, respectively. Conclusion The study reveals a notably high rate of pregnancy termination in SSA, which is particularly worrisome due to the legal limitations on abortion services in many SSA countries. Expanding access to contraception and comprehensive sexual health education is crucial to reducing unintended pregnancies across the region. Additionally, a reassessment of the strictness of abortion service restrictions is critical to encourage women to obtain these services from qualified professionals.https://doi.org/10.1002/hsr2.70742fertilityglobal healthpregnancy terminationreproductive healthsub‐Saharan Africawomen |
| spellingShingle | Getayeneh Antehunegn Tesema Sylvester R. Okeke Michael Sarfo Edward K. Ameyaw Olanrewaju Oladimeji Sanni Yaya Unveiling 10‐Year Dynamics of Pregnancy Termination Across Sub‐Saharan Africa: A Multilevel Study Health Science Reports fertility global health pregnancy termination reproductive health sub‐Saharan Africa women |
| title | Unveiling 10‐Year Dynamics of Pregnancy Termination Across Sub‐Saharan Africa: A Multilevel Study |
| title_full | Unveiling 10‐Year Dynamics of Pregnancy Termination Across Sub‐Saharan Africa: A Multilevel Study |
| title_fullStr | Unveiling 10‐Year Dynamics of Pregnancy Termination Across Sub‐Saharan Africa: A Multilevel Study |
| title_full_unstemmed | Unveiling 10‐Year Dynamics of Pregnancy Termination Across Sub‐Saharan Africa: A Multilevel Study |
| title_short | Unveiling 10‐Year Dynamics of Pregnancy Termination Across Sub‐Saharan Africa: A Multilevel Study |
| title_sort | unveiling 10 year dynamics of pregnancy termination across sub saharan africa a multilevel study |
| topic | fertility global health pregnancy termination reproductive health sub‐Saharan Africa women |
| url | https://doi.org/10.1002/hsr2.70742 |
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