DETERMINANTS OF INDUCED ABORTION AMONG REPRODUCTIVE AGE WOMEN ATTENDING PUBLIC HEALTH FACILITIES IN DIRE DAWA ADMINSTRATION, EASTERN ETHIOPIA

Abstract

Background Induced abortion remains a significant public health issue globally, with an estimated 73 million procedures occurring annually, accounting for 29% of all pregnancies. Nearly 45% of these abortions are unsafe and disproportionately affect women in low- and middle-income countries where healthcare access is limited. Unsafe abortion contributes to 4.7–13.2% of maternal deaths worldwide, and approximately 7 million women are hospitalized each year due to complications such as sepsis, hemorrhage, and trauma. The burden is particularly severe in sub Saharan Africa and South Asia. In Ethiopia, although abortion law was liberalized in 2005 to permit the procedure under specific circumstances, many women continue to resort to unsafe methods due to cultural stigma, limited awareness of legal provisions, and inadequate access to quality reproductive health services. Evidence suggests that unintended pregnancies, low contraceptive use, and socio-economic disparities are major drivers of induced abortion in the country. Dire Dawa, characterized by its diverse socio-cultural composition and mixed urban–rural population, presents unique reproductive health challenges. Understanding the factors influencing induced abortion in this setting is essential for informing targeted interventions aimed at reducing unsafe abortion and improving maternal health outcomes. This study examines the socio demographic, reproductive, and healthcare-related determinants of induced abortion among women of reproductive age attending public health facilities in Dire Dawa. The findings will contribute to evidence-based strategies to address unsafe abortion and advance progress toward national and global maternal health goals. Objective: To Identify determinants of Induced abortion among women of reproductive age G.C Method: Unmatched case-control study had been done. A total of 194 cases and 390 controls were included in the study. The Kobo server data were downloaded as an excel file and exported to SPSS V.25 for cleaning, coding, ensuring completeness and accuracy, and then to Stata V.14 software for further analysis. Bivariate and multivariate logistic regression analysis with 95% confidence interval was done. Results: A total of 194 cases and 390 controls completed the interview with response rate of 95% and 94.9% for cases and controls. Divorced or separated women had significantly reduced odds of abortion (AOR = 0.192, 95% CI: 0.051–0.725, p = 0.015), whereas married and single women also demonstrated lower odds but without statistical signific Stigma from health professionals was vii not significantly associated with the abortion outcome. Short waiting times were linked to lower odds of abortion (AOR = 0.357, 95% CI: 0.115–1.106), although this relationship was borderline non-significant. Women who perceived abortion services as unaffordable had markedly reduced odds of obtaining an abortion (AOR = 0.108, 95% CI: 0.034–0.345, p < 0.001), highlighting financial constraints as a critical limitation to access. Conclusion: This study found that religion, marital status, knowledge of safe abortion, and service affordability significantly influenced induced abortion among women in Dire Dawa. Muslim and Orthodox Christian women, as well as divorced or separated women, were less likely to seek abortion. Limited knowledge of safe abortion and financial barriers further reduced access to care. These findings underscore the need to increase awareness of legal abortion services, improve affordability, strengthen counseling, expand contraceptive education, and reduce stigma to enhance safe abortion care and prevent unintended pregnancies.