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ORIGINAL ARTICLE
Year : 2023 | Volume
: 30
| Issue : 1 | Page : 40-45
Legalisation of abortion in a poor-resource setting: nigerian undergraduates' perspectives
Funmito Omolola Fehintola1, Idowu Ajibola2, Samuel Anu Olowookere1, Yemisi Roseline Akande3, Tolulope Komolafe1, Emmanuel Eledah1, Eniola Faneye1, Seun Oyewale1
1 Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun, Nigeria
2 Department of Community Medicine, Bowen University Teaching Hospital, Ogbomosho, Nigeria
3 Department of Community Medicine, Ladoke Akintola University, Ogbomosho, Nigeria
Correspondence Address:
Funmito Omolola Fehintola
Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun
Nigeria
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/npmj.npmj_254_22
Background: Abortion is one of the leading causes of morbidity and mortality amongst Nigerian women in a country with restrictive abortion laws. Despite being illegal, abortions are still performed, and about 50% of abortions are performed by untrained persons in unhygienic conditions. This study assessed the determinants of attitude of undergraduates to legalisation of safe abortion in Nigeria. Methods: It is a descriptive cross-sectional study. We used a three-stage sampling technique to select 423 undergraduates using a pre-tested questionnaire. The predictors of attitude towards abortion and its legalisation were identified during multivariate analysis. Results: Good knowledge of abortion and its sequelae was found in about two-thirds (62.2%) of the participants, while over half (56.3%) had a negative perspective to abortion legalisation in Nigeria. Older participants were more likely to have positive perspectives to legalisation of abortion compared to their younger counterparts (odds ratio [OR] = 4.72, confidence interval [CI]: 2.61–8.55). Furthermore, respondents from upper social class and those with good knowledge were more likely to have positive perspectives to legalisation of abortion compared to their counterparts (OR = 5.63, CI: 3.12–10.16 and OR = 4.50, CI: 2.89–7.01). Conclusion: The study showed that respondents' knowledge of abortion was relatively low amongst the study population, and more than half of the respondents did not want abortion to be legalised. Increasing awareness on the importance of abortion and its complications in Nigeria will curb the menace of death due to abortion now and in the future.
Keywords: Abortion, attitude, knowledge, legalisation, undergraduates
Abortion is 'the termination of pregnancy before 20 weeks or when a foetus is <500 g'.[1] Similarly, unsafe abortion has been defined as the 'process of ending undesired pregnancy done by incompetent individual, or under a circumstance deficient of required medical regulations, or both'.[1] One-hundred and twelve million unintended pregnancies occurred in the last 7 years amongst women of reproductive age group.[2]
Ninety-three per cent of women aged 15–49 years live in African countries with prohibitive laws against safe abortion.[3],[4] The modern contraceptive prevalence rate is equally low amongst African women resulting in several unwanted/unplanned pregnancies. Most of these pregnancies are covertly aborted with attendant complications and death from unsafe procedures. Induced abortion has been increasing globally with higher rate of increase observed in African countries as a result of increase in the population of women in the age group of 15–49 years.[5],[6] Furthermore, there are a higher percentage of deaths occurring in Africa from abortion.[7]
The rate of abortion doubled the 1996 rate and one out of every seven pregnancies ended in induced abortion in 2012.[8],[9],[10] The rate of abortion varies by zones in Nigeria with the highest rate seen in North East and South-South zones.[11],[12]
Abortion and its Legalisation have always been debatable in Nigeria, as in many developing nations. It is illegal and associated with penalty of 14-year imprisonment if violated.[9],[13] Abortion is a delicate and controversial issue with reverent, noble and societal perspectives.[14],[15] Despite these prohibitive laws, it is still commonly done by untrained persons unhygienically in Nigeria.[16] Because of these opposing laws in Nigeria, most abortions are considered illegal.
Abortion carried out under unclean condition claims the life of women globally every year.[17],[18],[19],[20 Even though there is a decline from figures reported in the previous DHS, the Nigerian maternal mortality rate is still one of the highest in the world.[19] Annually, over 3000 women die due to unsafe abortion in Nigeria and 85% were <25 years.[21]
Previous studies revealed that people have different attitudes towards the legalisation of abortion. A survey by Folasade on adolescents' perspectives towards the legalisation of abortion showed that adolescents have a negative perspective towards the legalisation of abortion.[22] A study done in Enugu on the legalisation of abortion showed the public's negative attitude towards abortion.[23] However, a study done in Mizan Aman revealed that mothers have a positive perspective towards the legalisation of abortion.[24]
Findings have shown that predictors of stance to legalisation of abortion include being married, educational status as well as knowledge.[25] Furthermore, knowledge was identified as one of the predictors of legalisation of abortion in a study carried out by Adera et al. in Ethiopia.[26] The finding was similar to that of a study done in Harari and Zambia, where determinants of attitude include age, sect and marriage.[27] These studies were done amongst women of the reproductive age group who were mostly married. Hence, the need to understand factors that predicts legalisation of abortion among unmarried undergraduates for appropriate interventions to be carried out amongst them.
There has been a lot of argument in the healthcare system on the issue of abortion.[28],[29] Research on abortion and its legalisation will help inform policymakers in Nigeria. It is, therefore, imperative to carry out this study amongst undergraduates who may have challenges of unintended pregnancy. Furthermore, the previous studies failed to include the opinions of males.[25],[30] The decision to engage in abortion can stem from the influence of either party. This study provides information to bridge this knowledge gap regarding the opinions of Nigerian undergraduates on abortion legalisation. This study identified the determinants of the attitude of undergraduates towards the legalisation of abortion in Nigeria.
MethodsStudy area
The study was carried out between May 2021 and November 2021 at the Obafemi Awolowo University, Ile-Ife, Osun State, South-West Nigeria. This Federal Government-owned university is situated on a vast expanse of about 11,681 hectares. It is located on the GPS coordinates of 7°31'14.7612” North and 4°31'49.1. The population of Ile-Ife is currently 397,000 at a growth rate of 3.12%.[31] It is the source of Yoruba ethnicity and the dominant language is Yoruba. It also has several cooperative banks, healthcare facilities and universities. The accommodation for students comprises eight undergraduate halls and a post-graduate hall of residence, which are located on campus. There are about six off-campus halls of residence. There are five male halls, three female halls (the female halls are bigger in capacity than the male halls) and one post-graduate hall of residence at the university. About 18,928 out of over 35,000 students of Obafemi Awolowo University, Ile-Ife, reside off-campus.[31] The number of blocks varies per residence hall, ranging from 8 to 15 blocks. Each hall has six to ten rooms per block. Blocks are the buildings in the residence hall; they can be storey buildings or bungalows, and rooms are within the blocks. The university currently has 13 faculties, 82 departments and 2 colleges. It is a community of students with diverse tribes and backgrounds with varying life exposure and perspectives, in which the students have a voice of their own.
Sample size determination and selection
The study employed a descriptive cross-sectional design. Undergraduates between the ages of 18 to 35 years were included in the study. Leslie Kish sample size formula was used.[32] A prevalence of 56% (percentage of respondents that support abortion and its legalisation) was used.[25] A 10% non-response rate was anticipated; therefore, the adjusted sample size is 417. It was increased to 423 to allow for robust analysis. Four hundred and twenty-three respondents were selected using a multistage sampling technique. In Stage 1, the existing eight undergraduate halls in the university were stratified into male and female. One female and two male undergraduate halls were selected. In Obafemi Awolowo University, there are more male halls of residence compared to females, hence the reason for choosing one female and two male halls of residence. For off-campus halls (about six were functional at the time of the study), one female and two combined halls were chosen. Thus, a total of 6 hostels were used for the study. In Stage 2, two blocks were selected out of the total blocks in each hall; each hall had an average of 7 blocks. In Stage 3, each block has an average of 8 rooms, and each room has an average of four occupants. Eligible respondents were selected from alternate rooms on each selected block. For rooms with more than one eligible respondent, a simple random sampling technique by balloting was used to pick one eligible respondent.
Data collection tools and techniques
A semi-structured, self-administered questionnaire was used to gather information from the students. The questionnaire has four sections, A to D. Section A provides information on sociodemographics; Section B, knowledge of abortion, its complications and indications; Section C, attitude to abortion and its legalisation; and Section D assessed how the government could help in solving the problem of abortion in Nigeria. The questionnaire was developed and adapted from previously standardised questionnaires to assess undergraduates' perspectives to abortion and its legalisation.[23],[25],[33] Before the study, the questionnaire was pre-tested amongst undergraduates between the ages of 18 and 35 years of Oduduwa University Ipetumodu to ensure the validity and reliability of the instrument and correct any ambiguous questions before use. Five medical students were trained in communication, technical and interviewing skills for 2 days.
Data analysis
IBM SPSS Statistics for Windows, Version 20.0. (Armonk, NY: IBM Corp.) was used for data analysis. Respondents were asked six questions based on knowledge of abortion and its complications. The correct answer attracted 2 points, and it was scored over 12; those who had at least 6 points were grouped as having good knowledge, while those who had <6 points were grouped as having poor knowledge. Six questions were used to grade respondents' perspectives to legalisation of abortion; the answer to each question was rated using a Likert scale ranging from 'strongly agree' to 'strongly disagree'. Each respondent scored over 30 points; those who had <15 points were grouped as having a negative attitude towards legalisation of abortion.
Socioeconomic status was determined using the approach by Oyedeji.[34] The adolescents' mother and father were awarded a mark based on their occupation and education, and this was used to classify the adolescent into socioeconomic class. Chi-square test was used to assess the association between undergraduates' attitude and sociodemographics. A stepwise binary logistic regression was used to determine the predictors of their perspectives.
Ethical consideration
We obtained ethical clearance from the Ethics Committee of the Institute of Public Health (IPH), OAU, Ile-Ife (IPH/OAU/12/1608). Written consent was obtained from the respondents during the filling of the questionnaire. Participation was entirely voluntary and confidentiality was ensured.
ResultsFour hundred and twenty-three undergraduates filled out questionnaires, of which 49.9% were male and 50.1% were female. Majority of the undergraduates (79.9%) fell within the age group of 19–23 years. Most were Christians (84.2%) and of Yoruba ethnicity (87.7%). About 28.1% of the respondents were in their 4th year. The mean age of respondents is 21.5(±2.3) years [Table 1].
[Table 2] shows that most (96.9%) of the respondents have heard about abortion, out of which (90.3%) could correctly define abortion. A third (36.6%) of the respondents listened to the information from the seminar and lectures. The method of abortion most known amongst respondents is abortion pills (42.1%). Out of all the respondents, 96.9% were aware that abortion could be associated with complications, while 13 (3.1%) were unaware. Two hundred and sixty-three (62.2%) respondents had good knowledge, while 160 (37.8%) had poor knowledge.
Table 2: Knowledge of respondents about abortion, its complication and indication[Table 3] reveals that 29.8% of respondents strongly disagreed that government should legalise abortion, 21.5% disagreed, 16.3% were neutral, 18.4% agreed and 13.9% strongly agreed. About 36.2% of the study participants strongly disagreed that they would use the service if abortion should legally be allowed, 21.0% disagreed, 24.8% were neutral, 11.8% agreed and 6.6% strongly agreed. About 56 (56.3%) undergraduates had a negative attitude towards abortion legalisation, while 43.7% had a positive attitude.
Logistic regression analysis revealed that respondents aged 27–35 years were five times more likely to have a positive attitude towards the legalisation of abortion compared to their counterparts who are 18–26 years of age (odds ratio [OR] = 4.72, confidence interval [CI]: 2.61–8.55). Additionally, male respondents were 67% less likely to have a positive attitude towards the legalisation of abortion than their female counterparts (OR = 0.33, CI: 0.21–0.47). Respondents who were non-Yorubas were 96% less likely to have a positive attitude towards the legalisation of abortion than their Yoruba counterparts (OR = 0.04, CI: 0.01–0.11). Respondents of high social class were seven times more likely to have a positive attitude towards the legalisation of abortion than those of lower socioeconomic class (OR = 5.63, CI: 3.12–10.16). Respondents with good knowledge of abortion were five times more likely to have a positive attitude towards the legalisation of abortion than their counterparts with poor knowledge (OR = 4.50, CI: 2.89–7.01) [Table 4].
DiscussionSixty-two per cent (62.2%) of respondents have good knowledge of abortion. A survey done by Paluku et al. in 2013 in Kampala, Uganda, has the same findings.[35] It documented that 72.4% of participants had good knowledge. Previous studies in Ibadan and Nepal, which placed good knowledge of abortion amongst undergraduates at 83.3% and 94.4%, respectively, have higher knowledge score.[36],[37] Studies at Mekelle University, Northern Ethiopia;[38] Wolaita Sodo University, Southwest Ethiopia;[39] and Puducherry, India,[40] showed lower knowledge score than that of this present study, 44.1%, 38.8% and 36%, respectively. These contrary findings might be due to different study participants and their access to health information in various locations.
Less than half (43.7%) of the undergraduates had positive perspectives to the legalisation of abortion in Nigeria. A study in Nepal shows that two thirds of the participants had a positive attitude to abortion and its legalisation.[37] This finding was somewhat higher than that of studies done in Debre Markos and Armenia Hospital, which was 23% and 30%, respectively.[26],[41] These contrasting figures may be due to difference in geographical location or cultural differences.
Although the negative attitude towards abortion is above average in this study, it is lower than the results of a survey done at a university in 2003 in Nigeria, which placed the negative attitude towards abortion at 77.3%.[42] The lower value in this study might be due to a change in the trend towards accepting abortion in this environment. It may suggest a gradual change in the mindset of Nigerian youths towards the legalisation of abortion. After about two decades, due to Westernisation, children nowadays are more open-minded and liberal in their way of thinking.
The percentage of the respondents in this study who were ready to support abortion in some given conditions was higher than the findings of a previous study done in 2016.[33] The study shows that majority said that under no situation should it be carried out, and few said that it could be carried out only if the woman's life is in danger and when the pregnancy is undesired. It also reiterates a gradual shift in the attitude of undergraduates in Nigeria towards the legalisation of abortion.[33]
According to this study, older undergraduates have favourable perspectives to abortion than those younger. Studies carried out amongst students in Ethiopia and South Africa supported this result.[43],[44],[45] It might suggest that the older people become, the more likely they will be aware of the dangers of unsafe abortion. Hence, they need for them to want abortion to be legalised to prevent complications and deaths associated with it.
The study showed that good knowledge about abortion and its complications is associated with positive perspectives to legalisation of abortion. Previous studies done in Zambia and Yirgalem and Ethiopia reveal similar findings.[27],[46]
In this study, female respondents are more liberal with regard to their attitude towards legalisation of abortion compared to their male counterparts. This is similar to the report of the World Value Survey where studies from sub-Saharan Africa showed that males are less favourably disposed towards legalisation abortion than their female counterparts. Male negative attitudes can hinder access to safe abortion and post-abortion care.[47]
The findings of this study corroborate that of other studies on abortion in developing countries, which revealed that respondents have good knowledge of abortion and its complication.[34],[44] The positive attitude of the respondents towards the legalisation of abortion in this study was contrary to the study conducted in other studies.[26],[48] It was, however, slightly higher than the findings of a previous study done in the same environment about two decades ago.[42] It might be a pointer to the gradual overcoming of cultural and religious barriers to the legalisation of abortion in this environment.
Limitation
As with all cross-sectional surveys, this study is subject to response bias and social desirability bias, though respondents were assured confidentiality of any answer given.
ConclusionThe study indicated that respondents' knowledge of abortion was relatively low amongst the study population, and more than half of the respondents did not want abortion to be legalised. Health promotion on abortion in Nigeria may help curb the menace of its complications and death.
Acknowledgements
The authors thank the participants for their cooperation and support.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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