CAUSES AND EFFECTS OF ABORTION AMONG WOMEN OF REPRODUCTIVE AGE

1.1 Introduction

Abortion is the spontaneous or induced termination of pregnancy before foetal viability (Elias & Sherman, 2007). Popular use of the word abortion implies a deliberate pregnancy termination and some prefer the word miscarriage to refer to spontaneous foetal loss before viability. This definition implies a legal perception of the age at which a foetus can survive out of the womb. An estimated 44 million abortions are performed globally each year, with slightly under half of those performed unsafely (Sedghet al., 2012). The overall abortion rate in Africa, where the vast majority of abortions are illegal and unsafe, showed no decline between 2003 and 2008, holding at 29 abortions per 1,000 women of childbearing age.

The Southern African sub-region, dominated by South Africa, where abortion was legalized in 1997, has the lowest abortion rate of all African sub-regions, at 15 per 1,000 women in 2008. East Africa has the highest rate, at 38, followed by Middle Africa at 36, West Africa at 28 and North Africa at 18 (WHO, 2008).

As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitation of the study and Definition of terms.

1.2 Background of Study

In Africa, abortion complications account for almost half of all maternal deaths (Hord et al., 2004). Abortion-related maternal deaths account for 13% of all maternal deaths worldwide, most of which are caused by unsafe abortions (Siraneh et al., 2019). Abortion is the termination of a pregnancy before the 28th week of gestation after the last normal menstrual period or birth weight less than 1000gm (Health, 2013). Induced abortion is described as intentional medical or surgical termination of a live fetus before it is viable, and spontaneous abortions generally referred to as miscarriages; occur when an embryo or fetus is lost due to natural causes (Cunningham et al., 2014). Globally, from 2015 to 2019, approximately 73.3 million induced abortions were performed annually, with 45% of these abortions being performed unsafely. Almost half of these unsafe abortions occurred in developing countries, including Ethiopia. Developing countries accounted for more than 98% of all unsafe abortions (Gebremedhin et al. 2018; Bearak et al. 2020). About 210 million women become pregnant per year, with one out of every ten pregnancies ending in an unsafely induced abortion worldwide (WHO, 2008; Tesfaye et al., 2014).

Every year, an estimated 68,000 women die as a result of unsafe abortions around the world, with another 5.3 million suffering temporary or permanent disability. In developing countries, unsafe abortion is a leading cause of maternal mortality and morbidity. In addition to this, the public health burden is greatest in the developing world (Warriner et al., 2006).

Around 3.27 million women became pregnant each year in Ethiopia, of which approximately half-million ends by abortion and the rate of abortion is highest in the urban area of Ethiopia, which is 92 per 1000 in Addis Ababa and 78 per 1000 in smaller regions like Harari and Dire Dewa (Oumer et al., 2019; Jamie et al., 2020). Ethiopia made some strides in 2005 by revising the abortion law, which previously only allowed procedures to save a woman's life, and making safe abortion available to many women. Following that, abortion is legal whether the pregnancy is the result of rape or incest, the continuation of the pregnancy risks the mother's or child's health, the fetal disability is severe or incurable, and the woman is in a minority that is physically and mentally unprepared for childbirth (Holcombe, 2018).

Despite the presence of technological advancement in health care, unsafe abortion remains essentially unchanged globally as well as Ethiopian women are suffering from an increased risk of abortion-related complications, due to various reasons for example unmet family planning method need, rape, early sexual practice, etc. (Gebremedhin et al. 2018; Amhare et al., 2019). Women seek induced abortion for a variety of reasons, depending on their circumstances. According to a study conducted in Denmark and Uganda, the strongest determinant of women's decision to have an abortion is being single, followed by being under the age of 19, having two or more children, being a student, or being unemployed (Rasch et al. 2008; Kaye et al., 2006). In Ethiopia, similar findings were revealed that unwanted pregnancy, single marital status, young age, low income, occupational status, the mother's level of education, is the major contributing factors to induced abortion (Tesfaye et al., 2014; Jamie et al., 2020; Tilahun et al., 2017).

Several efforts have been made to improve abortion-related services, including the construction of more health centers and the training of more mid-level healthcare providers, the expansion of abortion services to primary healthcare units, and the development and dissemination of national guidelines for providing legal and safe abortion services (Health, 2010). In 2014, the guideline was revised to update the gestational age limits for medication abortion and to make second-trimester abortion services more available (Holcombe et al., 2015). Even with numerous initiatives and attempts to increase access to safe abortion facilities, nearly six out of ten abortions in Ethiopia are still conducted in a risky manner (Moore et al. 2016). Despite the problem's significance, little is known about the factors that lead to women terminating their pregnancies. A further enhancement is still needed; so assessing its risk factors is important for tracking progress toward sustainable development goals.

Therefore, in Nigeria where the research was carried out, the activities that was conducted is to know the Causes and Effects of Abortion among Women of Reproductive Age.

1.3 Statement of Problems

Investigation revealed that abortion is highly stigmatized and is widely interpreted as being illegal in the country, though it is legally permitted in a wide variety of cases (Aniteye, 2002). Despite the liberal nature of the abortion law, most women seeking abortion still seek clandestine abortions which are usually unsafe (Lithur, 2004). Some studies have looked at the epidemiological and socio-economic characteristics of women undergoing abortion) and the methods used to induce abortion (Turpin, Danso, Odoi & 2000; Ahiadeke, 2001). However, no known study has been done to assess the perceived reasons why women conduct illegal abortions in Nigeria. Understanding of these issues is an important step in understanding what needs to be done to prevent unsafe abortion in Nigeria.

1.4 Aim and Objectives of Study

The aim of the study is to identify the Causes and Effects of Abortion among Women of Reproductive Age. In achieving this aim, the following specific objectives were laid out as follows:

1. To identify the factors that causes and contributes to women engagement in abortion.
2. To determine possible effects of abortion among women of reproductive age.
3. To ascertain whether abortion causes reproductive health complication.

1.5 Research Questions

The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:

• Does abortion causes reproductive health complication?
• What are possible effects of abortion among women?
• What are the factors which causes and contribute to women engagement in abortion?

1.6 Research Hypothesis

In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.

Hypothesis One

• H0: There is no significant factor that causes and contributes to women engagement in abortion
• H1: There is a significant factor that causes and contributes to women engagement in abortion

1.7 Significance of Study

This study will be beneficial to the society as the results of this study will reveal the dangers of abortion, and the effect of abortion on the sexual practices among reproductive aged women (15-49) thereby encouraging parents and guardians to take actions and decisions that will better educate their youths on abortion and its accompanying dangers.

Additionally, subsequent researchers will use it as literature review. This means that, other students who may decide to conduct studies in this area will have the opportunity to use this study as available literature that can be subjected to critical review. Invariably, the result of the study contributes immensely to the body of academic knowledge with regards to the causes and effect of abortion among women of reproductive age.

1.8 Scope of the Study

The scope of the research is focused on the Causes and Effects of Abortion among Women of Reproductive Age in Nigeria.

1.9 Limitations of the Study

During the course of this study, many things militated against its completion, some of which are:

1. Time Constraint:The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
2. Research Material: availability of research material is a major setback to the scope of the study.
3. Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

1.10 Definition of Terms

Abortion:

It is the termination of the pregnancy of a woman before it reaches full term.

Mortality:

It refers to the loss of life on a large scale.

Sexual Activities:

Human sexual activity, human sexual practice or human sexual behaviour is the manner in which humans experience and express their sexuality. People engage in a variety of sexual acts, ranging from activities done alone to acts with another person in varying patterns of frequency, for a wide variety of reasons.