TABLE OF CONTENTS
TITLE PAGE……………………………….…………………………………………i
CERTIFICATION.. iii
DEDICATION.. iv
ACKNOWLEDGEMENT. v
TABLE OF CONTENTS. v
LIST OF TABLES. ix
LIST OF FIGURES. x
LIST OF ABBREVIATIONS. xi
ABSTRACT. xii
CHAPTER ONE.. 1
INTRODUCTION.. 1
1.1 BACKGROUND TO THE STUDY.. 1
1.2 STATEMENT OF PROBLEM… 3
1.3 RESEARCH QUESTIONS. 4
1.4 OBJECTIVES OF THE STUDY.. 4
1.5 SIGNIFICANCE OF THE STUDY.. 5
1.6 SCOPE OF THE STUDY.. 5
1.7 OPERATIONAL DEFINITION OF TERMS. 6
CHAPTER TWO.. 7
LITERATURE REVIEW… 7
2.1 CONCEPTUAL REVIEW… 7
2.2 THEORECTICAL REVIEW… 16
2.3 EMPIRICAL REVIEW… 20
CHAPTER THREE.. 26
RESEARCH METHODOLOGY.. 26
3.1 RESEARCH DESIGN.. 26
3.2 TARGET POPULATION.. 27
3.3 SAMPLE SIZE.. 27
3.4 SAMPLING TECHNIQUE.. 28
3.5 INSTRUMENTS FOR DATA COLLECTION.. 29
3.6 VALIDITY OF THE RESEARCH INSTRUMENT. 29
3.7 RELIABILITY OF RESEARCH INSTRUMENT. 29
3.8 METHOD OF DATA COLLECTION.. 30
3.9 METHOD OF DATA ANALYSIS. 31
3.10 ETHICAL CONSIDERATION.. 32
CHAPTER FOUR.. 34
ANALYSIS OF DATA.. 34
4.1 QUANTITATIVE DATA.. 34
4.1.1 Demographic Data. 34
4.1.2 Sexual Reproductive Health Information. 36
4.1.3 Knowledge on Abortion. 39
4.1.4 Cross tabulations. 47
4.2 QUALITATIVE DATA.. 49
CHAPTER FIVE.. 56
DISCUSSION OF FINDING.. 56
5.1 DISCUSSION OF QUANTITATIVE AND QUALITATIVE FINDINGS…… 56
5.2 IMPLICATION TO NURSING.. 61
5.5 LIMITATIONS OF STUDY.. 62
5.6 SUMMARY.. 62
5.7 CONCLUSION.. 64
5.8 RECOMMENDATIONS. 65
5.9 SUGGESTIONS FOR FURTHER STUDY.. 65
REFERNCES. 66
APPENDIX.. 70
Table 1: Sociodemographic Characteristics of Students
Table 2: Exposure to sexual reproduction health information
Table 3: Respondents’ Exposure to Sex
Table 4: Knowledge on Abortion
Table 5: Respondents knowledge about consequences of unsafe abortion
Table 6: Source of information on abortion
Table 7: Perception of abortion
Table 8: Outcome of pregnancy
Table 9: Attitudes on abortion by respondents’ socio demographic characteristics
Table 10: Attitudes on abortion by respondents’ sexual reproduction characteristics
LIST OF FIGURES
Figure 1: Topics respondents discuss with peers and family
Figure 2: Respondents overall attitudes towards abortion
LIST OF ABBREVIATIONS
D & C – Dilation and Curettage
FGD – Focused Group Discussion
KAP – Knowledge, attitude and practice
UN – United Nations
WHO – World Health Organization
ABSTRACT
This study aimed to investigate unsafe abortion, which is more prevalent in most third world countries and contributes significantly to maternal morbidity and mortality. Majority of patients treated for induced abortion are young women. A cross sectional descriptive and explorative study with a mixed method approach was carried out among female students of Ambrose Alli University, Ekpoma. A sample of 340 students was subjected to a pre-tested self-administered questionnaire that captured data on attitudes towards unsafe abortion. For triangulation purposes, 16 students were purposively selected to participate in two sessions of focus group discussions. Pearson’s’ chi-square test was used to determine association between independent and dependent variables. Nvivo version 10 was used to assist the researcher in sorting and organizing the qualitative data. The mean age of the respondents was 22.1 years. 299(87.9%) of the respondents had experienced their sexual debut. Out of these, 76(25.5) have been pregnant of these 67(88.1) have carried out an abortion. The majority of respondents (92%) had negative attitudes towards abortion and 50.6% of the respondents had good knowledge on unsafe abortion. Factors associated with attitudes on abortion were age (P value>0.00) and ever had sex (p- value 0.02). Knowledge on unsafe abortion was associated with age (p-value 0.00), ever had sex (p- value 0.04) and ever used family planning (p-value 0.02). Qualitative findings showed that majority of the participants did not support abortion based on moral grounds. In conclusion, all governments and relevant intergovernmental and non-governmental organizations should strengthen their commitment to women’s health, to deal with the health aspect of unsafe abortion as a major public health concern. The study recommends public enlightenment on the menace of unsafe abortion.
Keywords: unsafe abortion, attitudes, female students
CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND TO THE STUDY
Abortion is a sensitive and frequently stigmatized topic, both politically and socially. The issue is frequently surrounded by secrecy, shame and misconceptions, which can lead to negative health and social consequences (Levandowski, Kalilani-Phiri, Kachale et al., 2012). Women are more likely to attempt a clandestine, unsafe procedure if they are unaware that they could legally visit a trained health provider to obtain a safe abortion (Banerjee, Andersen, & Warvadekar, 2012); and may well attempt an abortion regardless of the law. Knowledge of the legal framework, in addition to community attitudes and stigma, can pose important barriers to accessing reproductive health services. For women themselves, even an abortion taking place in a well-equipped facility with a trained provider may not be considered as ‘safe’ if she is at risk from negative social consequences due to the procedure (Izugbara, Egesa, Okelo, 2014).
Unsafe abortion accounts for a greater proportion of maternal deaths, yet it is often not adequately considered in discussions around reducing maternal mortality. The World Health Organization (WHO) estimates that an annual 22 million unsafe abortions occur globally, almost all of which take place in developing countries (WHO, 2012). Unsafe abortion mainly endangers women reproductive health in developing countries with restrictive abortion laws and in those where though legalized, safe abortion is not yet universally accessible (Ikeako, Onoh, Ezegwui, & Ezeonu, 2014). In Nigeria and most parts of Africa, abortion is highly restricted consequently, women sought for clandestine means of terminating an unintended pregnancy thereby posing a great threat to their reproductive health and life (Adinma, Adinma, Ugboaja, Iwuoha, Akiode, Oji, Okoh, 2011). Unsafe abortion accounts for a greater proportion of maternal deaths, yet it is often not adequately considered in discussions around reducing maternal mortality. Literally, more than one-third of the approximately 205 million pregnancies that occur world-wide annually are unintended and about 22% of all these pregnancies end in induced abortion (Ikeako, Onoh, Ezegwui, & Ezeonu,, 2014).
In the developing world, lack of access to family planning results in some 76 million unintended pregnancies, with 19% ending in induced abortion of which 11% are unsafe.
Unplanned and unwanted pregnancies are the major causes of unsafe abortions (Ikeako, Onoh, Ezegwui, & Ezeonu,, 2014). In the developing countries, these conditions may have been accentuated by the prevailing low contraceptive usage especially among sexually active young women (Tayo, Akinola, Babatunde, Adewunmi, Osinusi, Shittu, 2011).
Despite relatively liberal legal framework, social attitudes towards abortion remain conservative, and knowledge of safe abortion services remains poor, even contraceptive counseling to help women avoid a future unwanted pregnancy is often unavailable (Moore, Bankole, Awolude et al., 2015). The cost of unsafe abortion to society is enormous (Ikeako, Onoh, Ezegwui, & Ezeonu, 2014). This study therefore, is to assess the knowledge and attitudes surrounding unsafe abortions among Female Students of Ambrose Alli University, Ekpoma.
1.2 STATEMENT OF PROBLEM
Yearly, Nigerian women obtain approximately 760,000 abortions, a rate of 25 abortions/1000 women of reproductive age. Each year about 20,000 deaths from unsafe abortion occur in Nigeria (Okonofua, Hammed, Abass, Mairiga, Mohammed, Adewale, et al, 2011). In Nigeria, the rate of unsafe abortion is about 31/1000 women and abortion related deaths are responsible for 22-30% of all maternal deaths, in comparison to the world-wide estimate of 13% (WHO, 2011). In West African countries complications of induced abortion was responsible for nearly a third of maternal deaths (WHO, 2011).
Apart from maternal deaths, between 2 million and 7 million women who survive unsafe abortion each year sustain long-term morbidity, chronic disabilities and reproductive health problems (Ikeako, Onoh, Ezegwui, & Ezeonu, 2014).
It is beyond all reasonable doubt that women often resort to unsafe methods in order to terminate an unwanted pregnancy. Due to the fact that unsafe abortion is major contributor to maternal deaths its practice is a problem that needs attention. It is for this reason that the study focused on determining the level of knowledge and attitudes on unsafe abortion among students.
1.3 RESEARCH QUESTIONS
- What is the level of exposure to sex and reproductive health information among female students of Ambrose Alli University Ekpoma?
- What are the attitudes of female students of Ambrose Alli University Ekpoma on abortion?
- Does attitudes play a role on the practice of unsafe abortions among female students of Ambrose Alli University Ekpoma.
1.4 OBJECTIVES OF THE STUDY
To assess the level of knowledge and attitudes on unsafe abortions among students of Ambrose Alli University Ekpoma.
Specific Objectives
- To explore exposure to sex and reproductive health information among female students of Ambrose Alli University Ekpoma.
- To determine the attitudes on abortion among female students of Ambrose Alli University Ekpoma.
- To determine the role of attitudes on the practice of unsafe abortions among female students of Ambrose Alli University Ekpoma.
- To estimate the prevalence of abortion among female students of Ambrose Alli University Ekpoma.
1.5 SIGNIFICANCE OF THE STUDY
The necessity to give students more attention and advocacy is obvious, therefore information from this study will be used by the policy makers and program managers in addressing the needs of young people today and come up with effective interventions to help in the reduction of unwanted pregnancies and induced abortion among young women and hence lead to reduction of maternal mortality and morbidity in the long run. Findings of the study will also help focus attention on appropriate interventions responsive to the reproductive needs of students by strengthening youth friendly health services and promoting a safe and supportive social environment in which they can thrive. This is very important because the actions of young people today will shape the size, health, and prosperity of the world’s future population.
1.6 SCOPE OF THE STUDY
The study will be delimited to assess the knowledge and attitudes of students of Ambrose Alli University Ekpoma on unsafe and unsafe abortions.
1.7 OPERATIONAL DEFINITION OF TERMS
Abortion: Ending of a pregnancy by removing a fetus or embryo before it can survive outside the uterus i.e. the premature ending of a pregnancy either through surgical intervention or medications that cause the contents of the uterus to be expelled.
Knowledge. Facts, information and skills about reproductive health information, practice of abortion, its legality and methods of carrying out abortion
Attitude: Perception, with the practice of unsafe abortion and its related consequences.
Students: Female students of Ambrose Alli University Ekpoma
Unsafe abortion. Termination of a pregnancy by people lacking necessary skills, or in an environment lacking minimal medical standards, or both.
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