Geleto and Markos Reproductive Health (2015) 12:19

DOI 10.1186/s12978-015-0006-y

RESEARCH Open Access

Awareness of female students attending higher

educational institutions toward legalization of
safe abortion and associated factors, Harari
Region, Eastern Ethiopia: a cross sectional study
Ayele Geleto1* and Jote Markos2

Abstract
Background: Unsafe abortion has been recognized as an important public health problem in the world. It accounts for
14% of all maternal deaths in sub-Saharan African countries. In Ethiopia, 32% of all maternal deaths are accounted to
unsafe abortion. Taking the problem of unsafe abortion into consideration, the penal code of Ethiopia was amended in
2005, to permit safe abortion under a set of circumstances. However, lack of awareness on the revised penal code is a
major barrier that hinders women to seek safe abortion. The aim of this study is to assess awareness of female students
attending higher educational institutions toward legalization of safe abortion and associated factors in Harari region,
eastern Ethiopia.
Methods: Institution-based descriptive cross sectional study was conducted among 762 female students who are
attending five higher educational institutions in Harari Region. Systematic sampling method was used to identify study
participants from randomly selected colleges. Self administered structured questionnaire was used to collect data. Data
were entered in to Epi Info version 6.04 and analyzed by SPSS version 17.0 statistical packages. Frequency, percentage
and ratio were used to describe variables. Multivariable logistic regression analysis was done to control confounders and
odds ratio with 95% confidence interval was used to identify factors associated with awareness of female students to
legalization of abortion.
Results: 762 study participants completed the survey questionnaire making the response rate 90.2%. Only 272 (35.7%)
of the respondents reported that they have good awareness about legalization of safe abortion. Studying other fields
than health and medicine [AOR 0.48; 95%CI (0.23, 0.85)], being the only child for their family [AOR 0.28; 95%CI (0.13,
0.86)], having no boy friend [AOR 0.34; 95%CI (0.12, 0.74)], using family planning [AOR 0.50; 95%CI (0.13 and 0.86)],
being 25 years or older [AOR 1.64; 95%CI (1.33, 2.80)] were significantly associated with awareness of female students
to legalization of safe abortion.
Conclusions: Only slightly more than a third of the study participants, 35.7% have good awareness of legalization of
safe abortion. Strengthening information dissemination regarding legalization of safe abortion is required for female
reproductive age group in general and higher institution female students in particular.
Keywords: Safe abortion, Legalization, Awareness, Penal code, Female college student

* Correspondence: [email protected]
1
Department of Public Health, College of Health and Medical Science,
Haramaya University, Haramaya, Ethiopia
Full list of author information is available at the end of the article

© 2015 Geleto and Markos; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article,
unless otherwise stated.
Geleto and Markos Reproductive Health (2015) 12:19 Page 2 of 9

Introduction pregnancy [9]. But limited awareness on the revised 2005

Abortion is the termination of pregnancy by removal or penal code of the Federal Democratic Republic of Ethiopia
expulsion of a conception tissue (fetus, fetal membranes (FDRE) is one of the major obstacles that hinder women
and placenta) from the uterus. Abortion can occur either from obtaining Comprehensive Abortion Care (CAC).
spontaneously, due to complications during pregnancy Therefore, the main aim of this research is to assess the
or could be induced [1]. Safe abortion can be defined as level of awareness of female students learning at higher
providing services for termination of a viable early preg- educational institutions to legalized safe abortion in Harari
nancy as well as managing other clinical types of abor- regional state, eastern Ethiopia.
tion. The World Health Organization (WHO) defines
unsafe abortion as a procedure for terminating un- Methods
wanted pregnancy performed by persons lacking the ne- Study Design and setting
cessary skills or in an environment not in conformity Institution-based quantitative cross-sectional study de-
with minimal medical standards, or both [2]. sign was conducted among 762 female students attend-
Unsafe abortion is a significant cause of maternal mor- ing higher educational institutions in Harari regional
tality and morbidity in the world. 95% of unsafe abortion state. Harar is the capital city of Harari region, and is
takes place in developing countries. Globally, each year, 526 km far from Addis Ababa, the capital city of
unsafe abortion claims the lives of about 68,000 women; Ethiopia, to the east. The region has nine woreda admin-
43% of these women were from Africa. Unsafe abortion istration structures. Three of the weredas are rural and
accounts for an estimated 14% of maternal death in Af- six are urban. The urban woredas are sub- divided in to
rica [2] and 32% in Ethiopia [3]. Despite the global effort nineteen kebeles, whereas the rural woredas are sub di-
to improve post abortion care, rising contraceptive use vided in to seventeen peasant associations. The total
and easing abortion restrictions, unsafe abortion con- population of the region was 205,000 from which 54.8%
tinues to be common in Africa [4,5]. In Ethiopian society were urban dwellers. Females in reproductive age group
as premarital sex is taboo, unmarried adolescents are were 43,050. There are three public and five private
discouraged from using any kind of contraceptives. This higher educational institutions in Harari Region. Public
socio-cultural barrier to use contraceptives could result colleges include College of Health and Medical Science
in unwanted teenage pregnancy. Lack of awareness to of Haramaya University, Harar Teacher’s Training Col-
legalization of safe abortion forces unmarried adoles- lege and Harar College of Health Sciences. The private
cents to seek unsafe abortion in a secret place [6]. higher educational institutions are Rift Valley University
In Ethiopia, before 2005, abortion was permitted only to College, Afran Qallo College, Lucy College, Horn inter-
save the life of a pregnant woman. The woman seeking national College and East Africa College of health sci-
abortion service needs to be diagnosed by an obstetrician/ ences. The study was conducted from January to March
gynecologist to have a life threat grave danger. In 2005, the 2012 among female students attending two public and
penal code was amended to permit abortion under a much three private higher educational institutions found in the
broader set of circumstances. These amendments include region.
i) if the pregnancy is a result of rape or incest, ii) if con-
tinuation of the pregnancy endangers the life of the Study participants
mother, iii) if the fetus has an incurable and serious de- Randomly selected day time female students attending
formity, iv) if the pregnant woman, owing to a physical or higher educational institutions in Harari Region were in-
mental deficiency she suffers from, or she is physically as cluded in the study. The data were collected from volun-
well as mentally unfit to bring up the child, v) in the case tary female college students. Students with mental
of life threat grave and imminent danger which can be problem and seriously ill who cannot provide appropri-
averted only by an immediate intervention, an act of ter- ate information were excluded from the study.
minating pregnancy is not punishable [7].
In most of developing countries including Ethiopia, ac- Sampling method
cess to safe abortion continues to depend on women’s To calculate the sample size a single population proportion
awareness of the legal background of safe abortion. Al- formula, [n = (Z α/2)2 p (1-p) / d2], was used. Since the
though the new 2005 Ethiopian abortion law is relatively proportion of awareness of female students to legalization
liberal, due to lack of knowledge of legal rights among of safe abortion in Ethiopia is not yet known, P = 50% was
most women, shortage of safe abortion services provision used to obtain maximum sample size. In addition, 95%
and significant amount of socio-cultural pressures, women confidence level 5% margin of error (d = 0.05), design effect
still seek unsafe abortion services [8]. In Ethiopia, cur- of 2 and non-response rate of 10% were considered. There-
rently both medical abortion (Mifepristone/Misoprostol) fore, the final sample size was calculated to be 845. To col-
and surgical abortion (MVA) are used to safely end a lect sample from each college, the colleges were stratified
Geleto and Markos Reproductive Health (2015) 12:19 Page 3 of 9

into governmental and private higher educational institu- calculated and taken as a cut point value to determine
tions. Then two governmental educational institutions whether female students have good or poor awareness
(College of health and Medical Science of Haramaya Uni- about legalization of safe abortion. Thus, female students
versity and Harar Teacher’s Training College) and three for whom score was below mean (490 female students)
private colleges (Rift Valley University College, Afran Qallo were considered as having poor awareness and those with
College and Horn International College) were randomly mean and above score (272 female students) were
selected to be included in the study. The sample size was regarded as having good awareness. Socio-demographic
proportionally allocated to all the departments based on variables including participants’ age, marital status, reli-
the number of female students in each department. Female gion, year of study, department of study, and previous sex-
students from all study years were included. The study par- ual exposure were independent variables. Female students
ticipants were identified from all departments of selected who had boy friend and whether they were learning col-
colleges by systematic sampling method from the list of fe- leges were also independent variables in the study.
male students found in each department.
Data quality control
Data collection The questionnaire was pre-tested and feedback was
A self administered pre tested structured questionnaire used to make modifications to the questionnaires.
was used for data collection. Close ended questionnaire Members of field staff (data collectors and supervisors)
was developed in English language and translated to local were selected according to their qualifications, work ex-
languages: Amharic and Afaan Oromoo for data collec- perience in the field of data collection and experience in
tion. After completion of data collection the questionnaire carrying out surveys. They were given extensive training
was retranslated to English language for analysis. These before data collection was commenced. During training,
questionnaires were developed after completion of a litera- the objective of the study, method of data collection and
ture review and pretested on 40 female college students supervision were discussed. Furthermore, each question
(5% of sample size) attending colleges other than the sam- included in the questionnaire was discussed in detail.
pled colleges. Feedback obtained from pretest was incor- Field practice (pre-test) was undertaken to check the
porated and the survey tool was revised and finalized after practicality and applicability of the questionnaire. Each
pretest. Data collectors were selected from health profes- day, collected data were checked for its completeness
sionals those teaching at College of Health and Medical and consistence by supervisors and principal investiga-
Science, Haramaya University. They were given training tor. Data were also cleaned and rechecked after double
before data collection was commenced. Completed ques- data entry was performed.
tionnaires were checked every day by investigators and
supervisors. Ethical consideration
The study was approved by Institutional Research
Data analysis Ethics Review Committee (IRERC) of College of
Data were entered into Epi Info Version 6.04 and were an- Health and Medical Science, Haramaya University.
alyzed by SPSS version 17 statistical packages for window. Official letters of co-operation were written to all
Descriptive statistics was used to summarize the data and participant higher educational institutions by College
the results were presented using frequency tables and per- of Health and Medical Science, Haramaya University.
centages. A multivariate logistic regression analysis was A letter explaining about the purpose, method and
employed to control confounders between variables. anticipated benefit and risk of the study was attached
Crude Odds ratio with 95%CI was used to determine pres- to each questionnaire. It was explained for the
ence of association between explanatory variables and respondents that participation in this study was
level of awareness of respondents to legalization of safe voluntary and private information would be protected.
abortion. The degree of association between dependent Written informed consent was obtained from each
and independent variables was measured using adjusted participant. In order to protect confidentiality,
odds ratio with 95% confidence interval at significance participants’ names and ID numbers were not included
level of ≤ 0.05. in the questionnaire.

Measurements Result
Dependent variable for this study is level of awareness of Socio-demographic characteristics of the respondents
female students attending higher educational institutions A total of 762 respondents completed the survey ques-
toward legalization of safe abortion. To measure level of tionnaires from the proposed 845 study participants,
awareness, the mean values of the respondents to the five making response rate of 90.2%. Majority of the respon-
criteria under which safe abortion is legally allowed was dents (72%) were aged between 20–25 years. Amhara
Geleto and Markos Reproductive Health (2015) 12:19 Page 4 of 9

ethnic group accounted for nearly half of the study par- Reproductive health of the respondents
ticipants (47.2%). Majority of the respondents, 71.1% Nearly two fifth, (42.9%) of the respondents in the study
were Christian by religion and about four fifth of the re- had a boyfriend and 184 (24.1%) of the study participants
spondents were single. More than two fifth, 43.2% of the responded that they had ever performed sexual inter-
respondents were middle child in their birth order while course. Among those who had sexual intercourse, 17% of
2.8% were the only child to their family. For about them had sex before the age of 15 years. And majority
76.8% of the respondents, their father and mother are of them 75.3% had sex by the age of 18 years. 533 (69.9%)
alive and only 1.7% of them have lost both of their par- of the study respondents knew about emergency contra-
ents (Table 1). ception. Only 68 study participants had a pregnancy from

Table 1 Socio-demographic characteristics of respondents

Table 2 Reproductive health of the respondents, Harari
(n = 762), Harari Region, Eastern Ethiopia, 2012
Region, Eastern Ethiopia 2012
Characteristics Frequency Percent
Characteristics Frequency Percent
Age
Have boy friend (n = 762)
25 years and less 682 89.5
Yes 327 42.9
More than 25 years 80 10.5
No 435 57.1
Ethnicity
Ever had sexual intercourse (n = 762)
Oromo 272 35.7
Yes 184 24.1
Amhara 360 47.2
No 578 75.9
Others 130 17.1
Age at first sexual intercourse (n = 184)
Religion
<15 32 17.4
Christian 542 71.1
15-20 137 74.4
Muslim 220 28.9
>20 15 8.2
Marital status
Family planning use (n = 184)
Single 620 81.4
Yes 152 82.6
Married 142 18.6
No 32 17.4
Resident of respondent's family
Type of family planning used (n = 152)
Urban 606 79.4
Artificial contraceptives 138 90.7
Rural 156 20.6
Natural family planning methods 14 9.3
Respondent's resident
Knowledge of emergency
In the campus 279 36.6 contraceptive (n = 762)
Out of the campus 483 63.4 Yes 533 69.9
Department of the respondent No 229 30.1
Health and medicine 563 73.8 Have ever got pregnant (n = 184)
Other field of study 199 26.2 Yes 68 36.9
Year of study of the respondents No 116 63.1
Two years and less 319 41.8 Outcome of the pregnancy (n = 68)
More than two years 443 58.2 Aborted 18 26.5
Birth order Delivered 47 69.1
First 270 35.4 Know pregnant 3 4.4
Middle 329 43.2 History of rape victim (n = 762)
Last 142 18.6 Yes 29 3.8
The only child 21 2.8 No 733 96.2
Life status of respondents’ family Result of rape victim (n = 29)
Both are alive 585 76.8 Got pregnant 9 31
Only mother alive 146 19.2 Develop genital swelling 2 6.9
Only father alive 18 2.4 Develop genital ulcer 3 10.3
Both are died 13 1.7 Develop vaginal discharge 15 51.8
Geleto and Markos Reproductive Health (2015) 12:19 Page 5 of 9

which only three were pregnant at the time of data collec- continuation of the pregnancy endangers the life of the
tion. Forty seven of the pregnancies resulted in a live birth mother or the child or the health of the mother or where
while eighteen were terminated by abortion. Twelve of the the birth of the child is a risk to the life or health of the
abortions were unsafe (induced by traditional practitioner) mother. Only 27% had awareness that safe abortion is le-
and only six abortions had been conducted in health insti- gally allowed if the fetus has an incurable and serious de-
tutions, both public and private, where it was assumed to formity. About a fifth of study participants responded that
be conducted under safe condition by trained health pro- safe abortion is legally allowed if the pregnant woman,
fessionals. To induce abortion, five of the respondents re- owing to a physical or mental deficiency she suffers from,
ported that they were given traditional leafs and roots to or if she is physically as well as mentally unfit to bring up
drink. Among study participants for whom abortion was the child (Table 3). Twenty five percent of the respondents
performed, seven of them were provided unknown tablet have received information about criteria, under which
to swallow to induce abortion. For six of them, traditional abortion is legally allowed, from health workers while only
practitioners inserted plastic material into their cervix to 4% reported their family as a source of information
induce abortion. Twenty nine of the respondents reported (Figure 2).
that they had rape history and nine of them had got preg-
nancy as a result of rape victim (Table 2). Factors associated with awareness of legalization of safe
Amongst the adolescents who reported to had sex, 82.6% abortion
used a contraceptive method to prevent pregnancy. About Multivariate logistic regression analysis showed that age,
30.9% of them used Depo-Provera while only 9.2% of the birth order, having boy friend, field of study and years of
respondents used natural family planning method. study were some of the factors that were significantly asso-
(Figure 1) From 138 artificial family planning users 64 ciated with awareness of female students to legalization of
(46.4%) of them got the method from public health institu- safe abortion after possible confounders were controlled.
tions. Twenty six percent got the method from private Female students learning another field of study than
pharmacies while 23.2% and 4.4% get family planning health and medical science [AOR 0.48; 95%CI (0.23, 0.85)]
methods from private clinics and shops respectively. and those who were the only child for their family than
the first child [AOR 0.28; 95%CI (0.13, 0.86)] were less
Awareness of respondents about legalization of safe likely to have good awareness about legalization of safe
abortion abortion. Those who had no boyfriends [AOR 0.34; 95%CI
Only 272 (35.7%) of the respondents have good awareness (0.12, 0.74)] and who used family planning method during
about legal background of safe abortion. Nearly 13% of the sexual intercourse [AOR 0.50; 95%CI (0.13, 0.86)] were
study participants responded that safe abortion is legally less likely to have good awareness about legalization of
allowed for all types of pregnancy. Slightly more than half, safe abortion. Those female students who were aged
52% of the respondents reported that safe abortion is le- 25 years or above were 1.6 times more likely to have good
gally allowed if the pregnancy is the result of incest and awareness about legalization of safe abortion with the ref-
49.1% responded safe abortion is legally allowed if the erence to younger than 25 years, [AOR 1.64; 95%CI
pregnancy is the result of rape. Four hundred thirteen (1.33,2.80)]. Married students [AOR 1.82; 95%CI91.12,
(54.2%) reported that safe abortion is legally allowed if the 3.52)], those studied for more than two years [AOR 2.34;

Figure 1 Types of family planning methods utilized by participants, Harari Region, Eastern Ethiopia 2012.
Geleto and Markos Reproductive Health (2015) 12:19 Page 6 of 9

Table 3 Level of awareness of the respondents to the 95%CI (1.18, 5.97)] and those who had lost both of their
criteria under which safe abortion is legally allowed in parents [AOR 1.70; 95%CI (91.23, 5.66)] were more likely
Ethiopia, Harari Region, Eastern Ethiopia 2012 to have good awareness about legalization of safe abortion
Characteristics Frequency Percent than single female students, those studied for two years or
Safe abortion is legally allowed less and whose both families were alive (Table 4).
for all type of pregnancy
Yes 97 12.7 Discussion
No 665 87.3 The findings of our study have shown that fewer than half,
Safe abortion is allowed 35.7% of the respondents, had good awareness about legal
if pregnancy is the result background of safe abortion in Ethiopia. A similar finding
of incest was reported in the study conducted in Nepal. The base-
Yes 396 52.0 line survey conducted in Nepal in 2003 showed that only
No 366 48.0 15% of the 1,100 rural married women of reproductive age
Safe abortion is allowed if (MWRA) interviewed were aware of the new abortion
pregnancy is the result of rape law, and 56 percent still believed that abortion was illegal
Yes 374 49.1 in the country [10]. However, a study conducted in Latin
No 388 50.9 America found over 60 percent of all women surveyed
was aware of medications to induce abortion [11]. It is also
Safe abortion is allowed if the
continuation of the pregnancy consistent with the study findings in South Africa where
endangers the life of the mother only 264(32%) of 831 study participants did not know that
or the child the law in South Africa allowed for legal abortion [3].
Yes 413 54.2 Similar finding was reported from study conducted in
No 349 45.8 Ethiopia where 552(67.9%) of college students have aware-
Safe abortion is allowed if the ness of legal abortion [12]. Lower awareness of students
fetus has an incurable and toward legalization of safe abortion in Ethiopia could be
serious deformity due to poor information dissemination to the target popu-
Yes 206 27.0 lation and poor information seeking of adolescents about
No 556 73.0 their reproductive health as compared to the case of devel-
Safe abortion is allowed if the oped country. Therefore, policy alone does only have a
pregnant woman has physical limited effect on the health and lives of women. Accessing
or mental deficiency or she is to safe abortion service and improving women’s awareness
physically and mentally unfit to
bring up the child are crucial to reduce mortality and morbidity related to
Ye 150 19.7
unsafe abortion.
Abortion has been legalized in Ethiopia since 2005
No 612 80.3
under some circumstances. But 67% of the abortions per-
Average formed in our study were unsafe (performed by traditional
Yes 272 35.7 method outside of health institutions). The result of this
No 490 64.3 study is consistent with the findings in India where nearly
40 years after India legalized abortion Indian women

From reading
materials
25% 18% From radio

From television
13%
From friend
19% 10% From family
4% 11% From teacher

From health worker

Figure 2 Sources of information about the criteria under which safe abortion is legally allowed among female students of higher
educational institutions, Harari region, eastern Ethiopia, 2012.
Geleto and Markos Reproductive Health (2015) 12:19 Page 7 of 9

Table 4 Association of respondents’ characteristics with level of awareness to legalization of safe abortion, Harari
Region, Eastern Ethiopia 2012
Characteristics Awareness to legal abortion COR (95%CI) AOR (95%CI)
Good Poor
Age N (%) N (%)
25 years and less 252 430 1.00 1.00
More than 25 years 20 60 1.75 (1.25,2.61)* 1.64 (1.33,2.80)*
Ethnicity
Oromo 91 181 1.00 1.00
Amhara 124 236 0.95 (0.66,1.92) 0.42 (0.12,1.81)
Others 57 73 0.64 (0.31,1.12) 0.67 (0.22,0.99)
Religion
Christian 219 323 1.00 1.00
Muslim 53 167 2.13 (1.29,4.58)* 1.46 (0.98,5.80)
Marital status
Single 225 395 1.00 1.00
Married 47 95 1.15 (1.04,3.21)* 1.82(1.12,3.52)*
Resident of respondent's family
Urban 172 434 1.00 1.00
Rural 100 56 0.22 (0.15,0.68)* 0.53 (0.11,1.10)
Respondent's resident
In the campus 137 142 1.00 1.00
Out of the campus 135 348 2.48 (1.28,4.77)* 1.88(0.73,3.42)
Department of the respondent
Health and medicine 137 426 1.00 1.00
Other field of study 135 64 0.15 (0.10,0.73)* 0.48 (0.23,0.85)*
Year of study of the respondents
Two years and less 121 198 1.00 1.00
More than two years 151 292 1.18 (0.98,2.91) 2.34 (1.18,5.97)*
Birth order
First 99 171 1.00 1.00
Middle 139 190 0.79 (0.52,1.73) 0.43 (0.11,1.23)
Last 18 124 3.98 (1.62,8.10)* 1.18 (0.99,6.21)
The only child 16 5 0.18 (0.10,0.88)* 0.28 (0.13,0.86)*
Life status of respondents’ family
Both are alive 212 373 1.00 1.00
Only mother alive 48 98 1.16 (0.87,3.97) 1.19 (0.78,5.44)
Only father alive 8 10 0.71 (0.75,2.31) 0.79 (0.56,2.65)
Both are died 4 9 1.27 (1.04,3.84)* 1.7 (1.23,5.66)*
Have boy friend (n = 762)
Yes 101 226 1.00 1.00
No 171 264 0.68 (0.14,0.89)* 0.34 (0.12,0.74)*
Ever had sexual intercourse (n = 762)
Yes 61 123 1.00 1.00
No 211 367 0.86 (0.23,1.02) 1.83 (0.76,3.57)
Family planning use (n = 184)
Geleto and Markos Reproductive Health (2015) 12:19 Page 8 of 9

Table 4 Association of respondents’ characteristics with level of awareness to legalization of safe abortion, Harari
Region, Eastern Ethiopia 2012 (Continued)
Yes 38 114 1.00 1.00
No 234 376 0.53 (0.13,0.82)* 0.50 (0.13,0.86)*
Have ever got pregnant (n = 184)
Yes 26 42 1.00 1.00
No 246 448 1.12 (0.59,2.01) 0.36 (0.19,0.86)*
*= p ≤ 0.05.

continue to be unaware that safe abortion service was Limitation of the study
available or were unable to access it. Although abortion The study suffered from the usual limitation of a cross
has been legal in India for decades, unsafe abortions were sectional study. The study also did not discover informa-
estimated to be 90 percent [8]. Our findings were also tion about uneducated adolescents living both in urban
similar to the case of Africa where about 5.5 million and rural areas of the region. So the finding of this study
African women undergo unsafe abortions each year. East could only be generalized for educated adolescents in
Africa in particular has one of the world’s highest rates of the region. Moreover, the nature of the sensitivity of the
maternal deaths linked to complications from unsafe abor- abortion might result in information bias and past his-
tions. Over 50% of all women seeking abortions in tory on abortion might be affected by recall bias. Limited
Ethiopia do so outside the reach of trained medical profes- numbers of similar studies were conducted in Ethiopia
sionals and outside of health facilities even after to compare our findings with.
legalization of safe abortion services [5]. Nearly two-third
of the abortions in our study was unsafe. This might be Conclusion
due to stigma and the erroneous belief of the community The study disclosed that there was high proportion of fe-
toward abortion which enforces adolescent women to male college students with poor knowledge of legalization
choose secrecy over safety. of safe abortion in the study area. Moreover, this poor
The findings of our study indicated that, to induce knowledge urges women to practice unsafe abortion
abortion traditional methods were used in majority of which in turn leads to maternal mortality and morbidity.
the case. Among the study participants for whom abor- Much more effort should be done on information educa-
tion was performed, five of them were given leaves and tion and communication of awareness creation on legal
roots to drink. An unknown tablet was given to swallow background of safe abortion. Furthermore, researches
for seven of them and plastic material was inserted into should be conducted to assess the awareness of rural and
their cervix for six to induce abortion. This finding was less educated adolescents toward legalization of safe abor-
consistent with the result of the study conducted in tion. Studies exploring the attitude-practice gap should be
northwest Ethiopia where plastic tube was inserted in to done on women of abortion and early initiation of sexual
the cervix of 54.7% participants and different oral drugs intercourse to see the cause and effect relationship clearly.
were given for 35.9% to induce the abortion [8]. The
Abbreviations
possible reason for using such traditional method of in- AOR: Adjusted Odds Ratio; CAC: Comprehensive Abortion Care; COR: Crude
ducing abortion is that most of the traditional practi- Odds Ratio; EDHS: Ethiopian Demographic and Health Survey; FDRE: Federal
tioners have no training on medical profession. They Democratic Republic of Ethiopia; IRERC: Institutional Research and Ethical
Review Committee; MVA: Manual Vacuum Aspiration; WHO: World Health
didn’t understand the health adverse effect of using such Organization.
leaves, roots and plastic tubes.
In our study, age of respondents, birth order, place of Competing interests
The authors declare that they have no competing interests.
residence, contraceptive use, and type of education, years of
study were some of the factors that were significantly asso- Authors’ contributions
ciated with awareness of female students to legalization of AG have made substantial contributions from inception of the research idea to
proposal development, data collection, analysis and interpretation of data and
safe abortion. Similar factors were reported in a study done preparation of the manuscript. JM has participated in data collection, analysis of
in northwestern Ethiopia where place of residence, marital data, and preparation of the manuscript for publication. Both authors read and
status, contraceptive use, number of pregnancies and level approved the final version of the manuscript.
of education attained by the women were reported as de- Authors’ information
terminant factors of unsafe abortion [8]. Another study AG has Master of Public Health and currently working in College of Health
conducted in Ethiopia also reported that field of study and and Medical Science, Department Of Public Health, Haramaya University as
a lecturer. JM has Master of Science in Maternal and Reproductive Health
having had sexual intercourse are associated to attitude of and currently working in College of Health and Medical Science, School of
female students toward legalization of safe abortion [12]. Nursing and Midwifery, Haramaya University as a lecturer.
Geleto and Markos Reproductive Health (2015) 12:19 Page 9 of 9

Acknowledgments
We would like to express our deepest gratitude to Haramaya University
for financial support. We would also like to express our appreciation to
all individuals who supported and encouraged us during this research
work. Last but not least, we would like to extend our appreciation to all
individuals who reviewed and gave us technical support to the successful
completion of this research.

Author details
1
Department of Public Health, College of Health and Medical Science,
Haramaya University, Haramaya, Ethiopia. 2School of Nursing and Midwifery,
College of Health and Medical Science, Haramaya University, Haramaya,
Ethiopia.

Received: 3 February 2014 Accepted: 24 February 2015

References
1. World Health Organization (WHO). Unsafe Abortion: Global and Regional Unsafe
abortion: global and regional estimates of incidence of unsafe abortion and
associated mortality in 2003. 5th ed. Geneva: WHO; 2007. http://whqlibdoc.who.
int/publications/2007/9789241596121_eng.pdf.
2. From concept to measurement: operationalizing WHO’s definition of unsafe
abortion. 2014. Bull World Health Organ 2014;92:155. www.who.int/bulletin/
volumes/92/3/14-136333.pdf
3. Chelsea M, Landon M, Kemilembe T. Knowledge of the abortion legislation
among South African women: a cross-sectional study. Reprod Health.
2006;3:7. doi:10.1186/1742-4755-3-7.
4. Singh S, Fetters T, Gebreselassie H, Abdella A, Gebrehiwot Y, Kumbi S, et al.
The estimated incidence of induced abortion in Ethiopia.
Int Perspect Sex Reprod Health. 2010;36(1):16–25.
5. Hailemichael G, Tamara F, Susheela S. Caring for Women with Abortion
Complications in Ethiopia: National Estimates and Future Implications, Addis
Ababa, Ethiopia. Int Perspect Sex Reprod Health. 2010;36(1):6–15.
6. Berer M. Making abortions safe: a matter of good public health policy and
practice, Geneva. Bull World Health Organ. 2000;78(5):Print version ISSN
0042–9686.
7. Ethiopian Ministry of Health. Technical and Procedural Guidelines for Safe
Abortion Services in Ethiopia. Addis Ababa, Ethiopia: Federal Ministry of
Health; 2005. www.phe-ethiopia.org/resadmin/index.php?attachment=90.
8. Elias S, Getu A, Nuru A, Hailu Y. Prevalence and associated risk factors of
Induced Abortion in northwest Ethiopia. Ethiopian J Health Dev.
2005;19(1):37–44.
9. IPAS Ethiopia, Abortion in Ethiopia: Fast Facts, Downloaded from
http://www.ipas.org/~/media/Files/Not%20Yet%20Rain%20Factsheets/NYR%
20Ethiopia%20Facts.pdf.ashx. Accessed on June 2011.
10. Ojha N, Sharma S, Paudel J. Post legalisation challenge: minimizing
complications of abortion, Nepal. Kathmandu Univ Med J. 2003;2(2):131–6.
Issue 6.
11. IPAS, Protecting Women’s Health, Advancing women’s Reproductive Right,
Profile of Medical Abortion utilization 2006.
12. Worku A, Binyam B. Awareness and Attitude to Liberalized Safe Abortion Services
among Female Students in University and Colleges of Arba Minch Town,
Ethiopia. Sci J Public Health. 2014;2(5):440–6. doi:10.11648/j.sjph.20140205.20.

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