International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Kasso T et al. Int J Reprod Contracept Obstet Gynecol. 2022 Jul;11(7):1854-1860

www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789

DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20221659
Original Research Article

The knowledge and prevalence of induced abortion among

female undergraduates at a tertiary institution
in Port Harcourt, Southern Nigeria
Terhemen Kasso1*, Elizabeth N. Obidinnu2

1
Department of Obstetrics and Gynaecology, University of Port Harcourt and University of Port Harcourt Teaching
Hospital, Port Harcourt, Nigeria
2
Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

Received: 12 May 2022

Accepted: 02 June 2022

*Correspondence:
Dr. Terhemen Kasso,
E-mail: terhemen.kasso@uniport.edu.ng

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Abortion is a sensitive and contentious issue with religious, moral, cultural, and political dimensions.
Induced abortion especially when unsafe can endanger a woman’s reproductive health and lead to serious life-
threatening complications and even death. This study was aimed at determining the knowledge and prevalence of
induced abortion amongst female undergraduates at a tertiary institution in Port Harcourt, Nigeria.
Methods: This was a descriptive cross-sectional study carried out on 303 female undergraduate students at the
University of Port Harcort in November 2019. Data was collected using structured self-administered questionnaires
and the information obtained was analysed with Statistical Package for Social Sciences (SPSS) version 23.0.
Results: Majority of the respondents (93.1%) had good knowledge of abortion and most of them (96.4%) knew
abortion as termination of pregnancy while 84.8% knew it to be illegal. Also, 25.7% had previously been pregnant
with 79.5% of such pregnancies ending in induced abortion. This study noted that the age, level of study, religion,
residence and family status of the respondents significantly influenced the practice of induced abortion (p<0.05).
Conclusions: There was good knowledge of abortion and the complications of unsafe abortion among the
respondents; however, many of them who had previously been pregnant had unsafe abortions. More awareness
creation on the dangers of unsafe abortion and use of contraceptives especially the barrier methods among young
people will significantly reduce the menace of unsafe abortion with its attendant complications.

Keywords: Undergraduates, Induced abortion, Complications

INTRODUCTION illegal in Nigeria and carries a jail sentence of up to

14years except when it is performed to save a woman’s
Induced abortion is the deliberate removal or expulsion of life.2 Also, the Rex V. Bourne holding is applied in the
a fetus from the uterus before it attains the age of fetal southern Nigeria; it allows abortions for physical and
viability (in our environment 28 weeks of gestation). mental health reasons and induced abortion is prohibited
When the pregnancy ends spontaneously, the word for incest, rape, fetal impairment, economic and social
miscarriage is usually used in place of abortion. Abortion reasons.3 Due to these restrictive laws and the socio-
is a sensitive and contentious issue with religious, moral, cultural and religious beliefs in the African societies that
cultural, and political dimensions.1 Induced abortion is induced abortion is an act of murder, majority of

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abortions are very often performed in secret by unskilled self-administered questionnaires by simple random
persons, quacks in very poor environments, thus making it sampling of the female students from 100 level to 600
unsafe. Unsafe abortion according to the world health level using balloting. The questionnaires consisted of
organisation (WHO), is the termination of an unwanted three sections; Section A contained questions on
pregnancy either by persons lacking the necessary skill or sociodemographic characteristics such as age, marital
in an environment lacking minimal medical standard or status and religion. Section B had questions that assessed
both.4 It is further classified as less safe when it is the knowledge of the respondents on abortion and section
performed by a trained provider using an unsafe or C had questions related to the practice of abortion.
outdated method (e.g. sharp curettage) or by an untrained
person using a safe method (e.g. misoprostol). 4 The data were analyzed with SPSS version 23.0.
Worldwide, it is estimated that 56 million induced Percentages and standard deviation were computed for
abortions occurred each year from 2010-2014. The baseline characteristics of the participants. The purpose
estimated global abortion rate is 35 per 1000 for married of the study was explained to each respondent and their
women and 26 per 1000 for unmarried women. 5 Women consent obtained. The names of the participants were not
in developing regions have a higher likelihood of having requested and no form of identification was requested on
an abortion than those in developed regions, 36 vs. 27 per the questionnaire to maintain confidentiality.
1000.5,6 About 9.2 million pregnancies in Nigeria are
unintended and 56% of these ended in an induced RESULTS
abortion, while 750,000 of these were unsafe with up to
40% of maternal deaths in Nigeria due to induced Table 1: Socio-demographic characteristics (n=303).
abortion.7-11 The causes of induced abortion are varied but
generally stem from an unwanted or unplanned pregnancy Variables N %
and probably due to the low prevalence of contraceptive Age (years)
use by women in the reproductive age group. Other <20 125 41.3
reasons cited by women are to postpone or stop 20-24 142 46.9
childbearing, socioeconomic concerns like disruption of ≥25 36 11.9
education or employment, lack of support from the Marital status
partner, poverty and unemployment. In addition, Single 242 79.9
relationship problems with a partner or husband and a Cohabiting 8 2.6
woman’s perception that she is too young have also been Married 53 17.5
cited. Induced abortion especially when unsafe, can Level of study
endanger a woman’s reproductive health and can lead to
100 66 21.8
serious, life-threatening complications including, retained
200 76 25.1
products of conception, bleeding, fever, sepsis, injury
300 69 22.8
from instruments, pelvic infections and in the long-term
ectopic pregnancy, secondary infertility and even death. 400 52 17.2
Also, the cost of post abortal care in Nigeria is estimated 500 35 11.6
at US$103/patient and about 3000 women die annually in 600 5 1.7
Nigeria from complications resulting from unsafe Ethnic group
abortion.12,13 The morbidities and mortalities from Hausa 25 8.3
induced abortion are enormous and thus place a huge Igbo 116 38.3
burden on the family, the society and women’s Yoruba 68 22.4
reproductive health generally. Others 94 31.0
Religion
Aim and objectives Christianity 254 83.8
Islam 47 15.5
This aim and objective of current study was to determine Others 2 0.7
the knowledge and prevalence of induced abortion Residence
amongst undergraduate students at a tertiary institution in On-campus 167 55.1
Port Harcourt, Rivers state, Nigeria. Off-campus 136 44.9
Family status
METHODS Monogamy 240 79.2
Polygamy 48 15.8
It was a descriptive cross-sectional study, carried out at No response 15 5.0
the University of Port Harcourt in the month of
November, 2019. The study was conducted to assess the
Three hundred and fifteen (315) questionnaires were
knowledge and prevalence of unsafe abortion among
administered, however 303 were retrieved and analyzed,
female students of the University of Port Harcourt. Three
amounting to a response rate of 96.2%. The mean age
hunderd and fifteen (315) female students were recruited
range was 20-24 years. Most (25.1%) of the respondents
into the study. The data was collected with structured
were in the second year of their study, 79.9% were single,

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83.8% were Christians, and 38.3% were of Igbo tribe. A few (6.9%) of the respondents were not aware that
More than half (55.1%) of the respondents resided in the drugs could be used for abortion. Most of the respondents
hostel and 79.2% were from a monogamous family knew abortion can be complicated by bleeding (92.4%),
setting. (Table 1). infection (89.4%), infertility (95.0%) and even death
(96.7%) as shown in (Table 2).
Table 2: Knowledge about abortion (n=303).
Table 3: Association between socio-demographics and
Variables N % knowledge of abortion.
Abortion is termination of pregnancy
No 8 2.6 Knowledge of
Yes 292 96.4 abortion P
Variables χ2
I don’t know 3 1.0 Poor N Good N value
Abortion is illegal (%) (%)
No 40 13.2 Age (years)
Yes 257 84.8 <20 13 (10.4) 112 (89.6) 4.177
I don’t know 6 2.0 20-24 7 (4.9) 135 (95.1) 0.124
Drugs can be used to procure abortion ≥25 1 (2.8) 35 (97.2)
No 21 6.9 Marital status
Yes 279 92.1 Single 15 (6.2) 227 (93.8) 4.282
I don’t know 3 1.0 Cohabiting 2 (25.0) 6 (75.0) 0.118
Abortion can be performed through Married 4 (7.5) 49 (92.5)
operation Level of study
No 41 13.5 100 5 (7.6) 61 (92.4) 7.612
Yes 254 83.8 200 9 (11.8) 67 (88.2)
I don’t know 8 2.6 300 1 (1.4) 68 (98.6)
0.179
Pregnancy less than and above 3 months 400 3 (5.8) 49 (94.2)
can be aborted 500 2 (5.7) 33 (94.3)
No 29 9.6 600 1 (20.0) 4 (80.0)
Yes 263 86.8 Ethnic group
I don’t know 11 3.6 Hausa 5 (20.0) 20 (80.0) 10.611
Bleeding is a possible complication of Igbo 10 (8.6) 106 (91.4)
0.014
abortion Yoruba 4 (5.9) 64 (94.1)
No 18 5.9 Others 2 (2.1) 92 (97.9)
Yes 280 92.4 Religion
I don’t know 5 1.7 Christianity 13 (5.1) 241 (94.9) 11.665
Abortion can lead to infection Islam 7 (14.9) 40 (85.1) 0.003
No 21 6.9 Others 1 (50.0) 1 (50.0)
Yes 27 89.4 Residence
I don’t know 11 3.6 On-campus 9 (5.4) 158 (94.6) 1.371
0.242
There is possibility of contracting Off-campus 12 (8.8) 124 (91.2)
HIV/AIDS while procuring abortion Family status
No 83 27.4 Monogamy 10 (4.2) 230 (95.8) 14.191
Yes 210 69.3 Polygamy 9 (18.8) 39 (81.2) 0.001
I don’t know 10 3.3 No response 2 (13.2) 13 (86.7)
Abortion can lead to infertility
No 9 3.0 There was a statistically significant association between
Yes 288 95.0 ethnic group (p=0.014), religion (p=0.003) and the family
I don’t know 6 2.0 status (p=0.001) of the respondents and their knowledge
Abortion can lead to death of abortion (Table 3).
No 6 2.0
Yes 293 96.7 Prevalence of abortion
I don’t know 4 1.3
Overall knowledge Seventy-eight (25.7%) of the respondents had ever been
Poor knowledge (0-6 score) 282 93.1 pregnant with 79.5% of such pregnancies ending in an
Good knowledge (7-10 score) 21 6.9 induced abortion. Many (53.6%) had their first abortion
after 17 years of age. More than half (55.4%) had
Knowledge of abortion procured an abortion only once while 19.6% had more
than three induced abortions. Often times, the procedure
Most (93.1%) of the respondents had good knowledge of was done outside the hospital establishment (73.2%), by
abortion. Majority (96.4%) of them knew abortion as non-medical personnel (67.1%) and about two-thirds
termination of pregnancy and 84.8% knew it to be illegal.

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(73.2%) of the respondents had medical termination. Half of the respondents, p=0.043 and p=0.021 respectively,
(50.0%) of the respondents who were previously pregnant and their practice of abortion as shown in (Table 5).
and terminated the pregnancy said it was because they
were not yet ready to bear the responsibility of having DISCUSSION
and raising a child, while 16.7% said it was because their
parents disapproved of the pregnancy. The study assessed the knowledge and practice of
abortion among female undergraduate students at the
Table 4: Respondents’ practice of abortion. University of Port Harcourt. One hundred and forty-two
(46.9%) of the respondents were in the age group 20-24
Variables N % years. Majority of the respondents in the study who had
Ever been pregnant (n=303)
ever had an abortion were unmarried. This result is
No 220 72.6
similar to other studies done in Port Harcourt (Nigeria),
Yes 78 25.7
No response 5 1.7
Sri Lanka and Ethiopia which documented that majority
Ever had abortion of women who procure abortion were usually young and
Yes 241 79.5 unmarried, also, these studies were done among
No 56 18.5 secondary and university students.10,14,15 This
No response 6 2.0 corroborates the fact that the adolescent and early adults
Number of abortion(s) had (n=56) are the major age group at risk of induced abortion. The
One 31 55.4 world health organization has also revealed that the age
Two 14 25.0 group 15-24 years in African region accounted for more
Three or more 11 19.6 than 50% of the global abortion-related mortalities.3 This
Reason for abortion may be because most times they have poor knowledge of
Not ready for responsibility 27 50.0 the complications of induced abortion and limited access
Parental disapproval 9 16.7
to contraception leading to unplanned and unwanted
Health problems of mother 4 7.4
pregnancies. This calls for increased reproductive health
Father of baby not willing to accept 9 16.7
awareness on sex education. However, this procedure is
No excuse 5 9.3
Age at first abortion (years) not exclusively an unmarried/young women procedure, a
15 or less 8 14.3 significant number of older/married women in the
16 18 32.1 reproductive age group also sought abortion. This is
17 or more 30 53.6 consistent with a study done in Southwestern Nigeria.7
Where abortion was performed This result is a reflection of poor contraceptive use and
Chemist/pharmacy shop 19 33.9 the desire for child-spacing and limited family size.
Home 15 26.8
Hospital 15 26.8 Majority of the respondents in this study were Christians
School 7 12.5 and of Igbo tribe, this is not unexpected, since the study
Person who performed abortion was conducted in the South- South region of Nigeria
Doctor 18 32.1
which is largely occupied by Christians and people of
Chemist 10 17.9
Igbo tribe. The study revealed that 93.1% of the
Friend 5 8.9
Self 21 37.5 respondents had ‘good’ knowledge of induced abortion
Others 2 3.6 and majority (96.4%) knew the meaning of abortion. This
What was used to procure abortion is similar to the findings from a study carried out in
Drugs 41 73.2 Lagos among secondary school students in which 97.6%
Surgical procedure 15 26.8 knew the meaning of abortion.16 The result is however
Timing of abortion (weeks) higher than the result from a study done in Goma where
6-12 37 66.1 only 61.3% of respondents knew the meaning of
Over 12 19 33.9 abortion.17 This high level of awareness can be attributed
Experienced complication to the increase use of social network/media, which is one
No 26 46.4 of the main sources of information currently.
Yes 30 53.6
Type of complication experienced (n=30)
Bleeding 24 80.0
This study found that 84.8% of female undergraduates in
Infection 6 20.0 this university knew that abortion is not legally allowed
in Nigeria except to prevent death of a mother. Few of the
Only 26 (46.4%) of the respondents who procured respondents (15.2%) did not know it was illegal. This
abortion reported that they had no post abortal finding was similar to the study carried out in Goma
complications while 53.6% experienced complications where 82.6% knew abortion was illegal. The result from
with post abortal bleeding (80.0%) as the main Lagos was lower (57.3%) than in this study.16,17 The
complication (Table 4). There was a statistically prevalence of induced abortion in this study was 79.5%.
significant association between the age and level of study This prevalence was much higher than 51% reported by
Onebunne et al in a study done among female

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 Kasso T et al. Int J Reprod Contracept Obstet Gynecol. 2022 Jul;11(7):1854-1860

undergraduates in Ibadan.18 The prevalence is also much larger Sao Paulo, Brazil. Both studies were, however
higher than the 8.8% and 4.4% among ever pregnant community-based rather than a subset of female
women reported by Silva et al in Vila Mariana and the undergraduates in this study.19,20
Table 5: Association between socio-demographics and practice of abortion.

Experience of abortion χ2 P value

Variables
No (%) Yes (%)
Age (years)
<20 104 (85.2) 18 (14.8)
20-24 113 (81.3) 26 (18.7) 6.275 0.043
≥25 24 (66.7) 12 (33.3)
Marital status
Single 195 (82.3) 42 (17.7)
Cohabiting 6 (75.0) 2 (25.0) 1.002 0.606
Married 40 (76.9) 12 (23.1)
Level of study
100 54 (83.1) 11 (16.9)
200 62 (84.9) 11 (15.1)
300 52 (75.4) 17 (24.6)
13.256 0.021
400 40 (78.4) 11 (21.6)
500 32 (91.4) 3 (8.6)
600 1 (25.0) 3 (75.0)
Ethnic group
Hausa 17 (73.9) 6 (26.1)
Igbo 95 (82.6) 20 (17.4)
1.353 0.717
Yoruba 52 (78.8) 14 (21.2)
Others 77 (82.8) 16 (17.2)
Religion
Christianity 209 (83.6) 41 (16.4)
Islam 32 (71.1) 13 (28.9) 9.886 0.003
Others 0 (0.0) 2 (100.0)
Residence
On-campus 143 (87.7) 20 (12.3)
10.240 0.001
Off-campus 98 (73.1) 36 (26.9)
Family status
Monogamy 197 (83.5) 39 (16.5)
Polygamy 30 (65.2) 16 (34.5) 9.921 0.007
No response 14 (93.3) 1 (6.7)

Many (53.6%) of the respondents had their first abortion procedures result in damaging complications, due to the
at ≥17 years, 14.3% had their first abortion at ≤15 years, poor procedure, performed by unqualified persons
55.4% had had just one abortion each in the past, while clandestinely in an unhygienic environment.21,22 The
25% had two abortions in the past and 19.6% had had commonest reasons given by the respondents in this study
three or more. This is at variance from the result of the for terminating the unwanted pregnancy was
study done in Lagos where 1.5% and 0.5% of the unpreparedness for child bearing and parental disapproval
respondents had one and two abortions respectively, in (50% and 16.7% respectively). In many African societies,
the past.16 The report from the study done in Ibadan was single motherhood is frowned upon and in the event that
similar to the result of this study, 60.7% of the the father of the child is not willing to take up the
respondents had procured abortion once. 21 Majority responsibility for the child, the young female is more
(82%) of these abortions were done by unqualified often faced with the problems of dealing with the
persons. This can be compared to a previous report in pregnancy, and termination usually seems to be the
Nigeria, where 85% of the abortions among young people easiest way out. In other instances, adolescents terminate
were done in private clinics. These clinics and patent pregnancies for various reasons including fear of
medicine vendors from various reports have become the expulsion from school, denial by spouse and failed
haven for illegal induced abortions. These are avenues contraception.22
through which a lot of quack ‘doctors’ make easy money
in developing countries. They capitalize on the restrictive Most (53.6%) of the respondents in the study who had
laws to exploit their clients and most of the time, their ever had an abortion experienced complications and the

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commonest complication identified was bleeding. This is respondents may not be considered a reptesentation of the
similar to the report from the study done in Lagos in female undergraduates in Nigerian tertiary institutions.
which 81.6% of the respondents experienced bleeding as
the commonest complication.16 However, some other CONCLUSION
studies identified sepsis as the commonest post abortal
complication.22,23 This may be due to incomplete abortion The study yielded considerable insight into the
and trauma to genital tract or the uterine cavity during the knowledge and practice of induced abortion among
procedure. Many (69.3%) of the respondents in this study female undergraduates in the University of Port Harcourt.
knew that it was possible to contract human Majority of the respondents had good knowledge of the
immunodeficiency virus infection/acquired immune illegality of abortion in Nigeria, unsafe abortion and its
deficiency syndrome (HIV/AIDS) during abortion, complications. However, many of the respondents who
similar to studies done in Ibadan and Lagos where 79.1% had ever been pregnant had unsafe abortions despite the
and 54.8% respectively knew that unsafe abortion is knowledge of the possible complications.
associated with increased risk of contracting
HIV/AIDS.16,21 In this study, 95.0% of the respondents Recommendations
knew that abortion could lead to infertility, this is also
similar to the study at Ibadan in which 90.4% of the Health care workers should intensify awareness creation
respondents knew that infertility was a complication of on the use of contraceptives especially the barrier
abortion.21 A large proportion (96.7%) of the respondents methods among young people and the dangers of unsafe
in this study knew that abortion could lead to death, and abortion. This will significantly reduce the menace of
this is similar to the study carried out in Lagos where unsafe abortion with its attendant complications. Youth
96.6% knew death was a possible complication. friendly, including contraception and post-abortion
services should be made accessible to young people as
No statistical significance was found between the age of this will reduce the high rate of unwanted pregnancies
the respondents in this study and their knowledge. This is and unsafe abortions.
not in keeping with the studies in Lagos and Ibadan
where the knowledge of the respondents on induced Health care providers should be trained in providing good
abortion increased with increasing age.16,21 This study quality abortion care services which will prevent many of
however, showed a statistical significance between the the post-abortion complications.
ethnic group, religion and the family status of the
respondents and their knowledge of abortion. ACKNOWLEDGEMENTS
Respondents of the Igbo ethnic group and Christians had
more knowledge of abortion. This is not surprising as Authors would like to thank all the female undergraduate
they constituted the bulk of the population studied. This students at the university of Port Harcourt that consented
is also reflective of a previous study done in this region. 9 to participate in the study.
This study noted that the age, level of study, religion,
residence and family status of the respondents Funding: No funding sources
significantly influenced the practice of induced abortion Conflict of interest: None declared
(p<0.05). The respondents who were older, tend to Ethical approval: The study was approved by the
indulge more in abortion. This may have been due to Institutional Ethics Committee
interplay between experience and a sense of confidence
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International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 11 · Issue 7 Page 1860