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| ORIGINAL RESEARCH REPORT |
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| Year : 2016 | Volume
: 13
| Issue : 2 | Page : 82-87 |
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Knowledge, attitude, and practice of abortion among female students of two public senior secondary schools in Lagos Mainland Local Government Area, Lagos State
Abdul-Hakeem O Abiola1, Oluwabunmi A Oke1, Mobolanle R Balogun1, Foluke A Olatona1, Maymunah A Adegbesan-Omilabu2
1 Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
2 Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
| Date of Web Publication | 4-Apr-2016 |
Correspondence Address:
Abdul-Hakeem O Abiola
Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos
Nigeria
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2408-7408.179682
Background: Unsafe abortion is a public health concern because of its dire reproductive health consequences and impact on maternal morbidity and mortality. Tackling this problem will go a long way toward achieving one of the Millennium Developmental Goals, which aim to reduce overall maternal mortality by two-thirds by the year 2015. The aim of this study was to determine the knowledge, attitude, and practice of abortion and the factors associated with it among female students of two public senior secondary schools in Mainland Local Government Area, Lagos state. Materials and Methods: This was designed as a cross-sectional, descriptive study. The multistage sampling method was used to select 210 respondents. Data were collected with self-administered questionnaires and analyzed using the EPI Info software. The questionnaire was divided into four sections: the sociodemographic characteristics of the respondents, knowledge about abortion, attitudes toward abortion, and the practice of abortion. The responses to the knowledge and attitude questions were scored and graded as good (≥50%) and poor (<50%). Results: The response rate was 98%. The mean age of the respondents was 15.6 1.3 years. The majority (83.3%) of the respondents had good knowledge of abortion; almost all (99.2%) demonstrated poor attitude toward abortion; and only a few (2%) had ever had an abortion. There was a statistically significant association between the ages of the respondents and their knowledge of abortion (P = 0.004) as well as their attitude toward abortion (P = 0.03). Conclusion: The respondents showed good knowledge of abortion, poor attitude toward abortion, and a low of practice of abortion. There is, therefore, a need to improve and sustain the existing knowledge and attitudes toward abortion so as to reduce the practice of abortion among students of the two schools. Keywords: Abortion, female, female students, secondary school, secondary school students
How to cite this article:
Abiola AHO, Oke OA, Balogun MR, Olatona FA, Adegbesan-Omilabu MA. Knowledge, attitude, and practice of abortion among female students of two public senior secondary schools in Lagos Mainland Local Government Area, Lagos State. J Clin Sci 2016;13:82-7 |
How to cite this URL:
Abiola AHO, Oke OA, Balogun MR, Olatona FA, Adegbesan-Omilabu MA. Knowledge, attitude, and practice of abortion among female students of two public senior secondary schools in Lagos Mainland Local Government Area, Lagos State. J Clin Sci [serial online] 2016 [cited 2023 Jun 2];13:82-7. Available from: https://www.jcsjournal.org/text.asp?2016/13/2/82/179682 |
| Introduction | |  |
Induced abortion is the intentional termination of a pregnancy before the fetus can live independently; it may be elective (based on a woman's personal choice) or therapeutic (to preserve the health or save the life of a pregnant woman). Unsafe abortion has been defined by the World Health Organization as a procedure for terminating unwanted pregnancy that is performed by someone lacking the necessary skills, or in an environment lacking minimal medical standards, or both. [1]
Exact information about the incidence of abortion has been very difficult to obtain, basically because of the fact that abortion is illegal in a lot of countries, especially developing countries. Abortion is a sensitive and contentious issue with religious, moral, cultural, and political dimensions. [2] Regardless of its legal status, abortion is still practiced and nearly half of all abortions are performed by unskilled practitioners, or in unsanitary conditions, or both. [2] Abortion in adolescents is an indicator of unplanned pregnancy. [3]
The practice of abortion performed under unsafe conditions claims the lives of tens of thousands of women around the world every year, leaving many women with chronic health problems that drain the resources of public health-care institutions. [3]
It has been estimated that about 46 million abortions are performed each year. [3] About one in five pregnancies worldwide end in abortion. [4] It has also been estimated that 60% of the cases of unintended pregnancies around the world are among adolescents. [5]
Abortion is illegal in Nigeria and it carries a heavy jail sentence of up to 14 years' imprisonment unless it is performed to save the life of the pregnant woman. [6] Most procedures are performed under unsafe, clandestine conditions. [6] Unsafe abortions are a major reason for Nigeria's high maternal mortality rate: At 575 deaths per 100,000 live births, it is one of the world's highest. According to conservative estimates, more than 3,000 women die annually in Nigeria as a result of unsafe abortion. Of the women obtaining abortion, 85% were younger than 25 years. [7]
In Nigeria, abortion is treated as that topic or issue that cannot and must not be discussed due to religious and moral reasons. Nigeria is predominantly made up of Christians and Muslims, whose doctrines frown at premarital sex and abortion. [7] This makes it even harder for adolescents who have procured abortion in the past to want to talk about it; those who want to procure it go to places where no one will recognize them, and want it done as quickly as possible to avoid stigmatization and mockery. [8]
The places where most of them end up going to in order to have the abortions are places that lack the skills to do a safe abortion and they later end up with a number of complications. [9] The high number of adolescents sexually exposed and low levels of contraceptive use, results in a high proportion of the students ending up with pregnancies, in which scenario they will have limited choices of where to terminate the pregnancy, in cases where they desire to terminate the pregnancy. [10] An unsafe abortion can endanger a woman's reproductive health and can lead to serious, life-threatening complications such as severe hemorrhage, sepsis, chronic pelvic inflammatory disease, ectopic pregnancy, secondary infertility, and even death. [9] Unsafe abortion is a public health concern because of its dire reproductive health consequences and impact on maternal morbidity and mortality. Tackling this problem will go a long way toward achieving one of the Millennium Developmental Goals, which aim to reduce overall maternal mortality by two-thirds by the year 2015. This study is, therefore, aimed at determining the knowledge, attitude, and practice surrounding abortion and the factors associated with it among female public senior secondary school students in Mainland Local Government Area (LGA) in Lagos state, Nigeria.
| Materials and methods | | |
Study location
This study was carried out in two of the nine public secondary schools in Mainland LGA.The schools were Wesley Girls' Senior Secondary School and Herbert Macaulay Girls' Senior High School, both in Mainland LGA of Lagos state in southwestern Nigeria. The numbers of students in the senior secondary school class 1 (SS1) and senior secondary school class 2 (SS2) classes of Wesley Girls' Senior Secondary School were 450 and 300 respectively; SS1 had five arms, while SS2 had four arms. The numbers of students in the SS1 and SS2 classes of Herbert Macaulay Girls' Senior High School were 250 and 160 respectively; SSI had 5 arms, while SS2 had 5 arms.
Methods
This was a cross-sectional, descriptive study by design. The study population consisted of female senior secondary school students. The level of significance and the degree of accuracy desired were each set at 5%. With the prevalence P of abortion from a previous study of 6.6%, [11] the minimum sample size of 83 was determined using the formula for a descriptive cross-sectional study where the target population is less than 10,000. However, 210 study subjects were selected using the multistage sampling method as follows: In stage one, two out of the nine public senior secondary schools in Mainland LGA (Herbert Macaulay Girls' Senior High School and Wesley Girls' Senior Secondary School) were selected by a simple random sampling method using the balloting procedure. In stage two, three arms were selected from the arms of the SS1 and SS2 classes of each selected school by a simple random sampling method using the balloting procedure. In stage three, the required numbers of students were selected in two equal groups from the selected arms of the two schools by a simple random sampling method using the balloting procedure.
Data collection was carried out using a pretested, structured, open- and close-ended, self-administered questionnaire. The questionnaire was divided into four sections to gather information on the following: Sociodemographic characteristics of the respondents, knowledge about abortion, attitude toward abortion, and practice of abortion.
Epi Info (TM) version 3.5.1 Database and statistics software for public health professionals developed by the Centers for Disease Control and Prevention (CDC) was used for data analysis. Every correct response to each of the 10 knowledge questions was given a score of one mark, and every incorrect and nonresponse scored zero; the maximum knowledge score was 10. Each of the eight attitude responses in support of abortion scored one mark, while each attitude response against abortion and each nonresponse scored zero; the maximum attitude score was 8. The total scores of each respondent for the knowledge and attitude questions were each converted to percentage and graded as good (≥50%) or poor (<50%).
Ethical approval for this study was obtained from the Health Research and Ethics Committee of Lagos University Teaching Hospital. Permission was obtained from the Principal of each selected school. Informed consent was obtained from each respondent, and all the students were assured of the confidential nature of the study.
| Results | | |
Out of the 210 questionnaires that were administered, 206 were retrieved and analyzed, amounting to a response rate of 98%.
Sociodemographic characteristics of the respondents
The age range and the mean age were 10-24 years and 15.6 ± 1.3 years respectively. A majority of the respondents were: In SS2 (59.7%), Christians (73.8%), single (99.5%), and from the Yoruba tribe (68.4%). A large percentage of the students (83.5%) indicated that they stayed with their parents [Table 1].
Knowledge of abortion
A total of 88.3% of the respondents had good knowledge of abortion, and the mean knowledge score (%) was 67.5 ± 17.3. The knowledge of the respondents about abortion was generally good, although only 38.8% of the respondents knew that any pregnancy can be aborted irrespective of the gestational age [Table 2]. The most common source of information about abortion was friends (52.4%), followed by mass media (18.4%), family (11.2%), other sources (8.7%), the church (5.3%), and lastly the Internet (3.9%). There was a statistically significant association (P = 0.004) between the ages of the respondents and their knowledge of abortion [Table 3]. | Table 3: Association between sociodemographics and knowledge of abortion
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Attitude toward abortion
The attitudes of the respondents which supported abortion were generally poor [Table 4]. Only 14 (6.8%) of the respondents had overall attitude score of at least 50% (graded as good) that supported abortion [Table 5]. There was also a statistically significant association (P = 0.03) between the ages of the respondents and their attitudes toward abortion [Table 5]. | Table 5: Association between sociodemographics and attitudes toward abortion
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Practice of abortion
A very small proportion of the respondents (2%) had ever been pregnant before, with 1% of the respondents having their first abortion at age 15 years and the remaining 1% having their first abortion at age 16 years. Only 0.5% of the respondents had any complications from abortions done: The only complication indicated was bleeding. All four of the respondents who had ever had an abortion indicated not being ready for responsibility, parental disapproval, and fear of discrimination as reasons for their first abortion. Two of the respondents had had their first abortion at home, one of the respondents had her abortion in school, and only one had her abortion in a hospital. Only one of the respondents had her abortion carried out with surgical instruments, while three of the respondents used drugs to induce their abortion [Table 6]. There was no statistically significant association (P > 0.05) between the sociodemographic characteristics of respondents and their experience of abortion [Table 7]. | Table 7: Association between sociodemographics and experience of abortion
Click here to view |
| Discussion | | |
This study revealed that the majority (84.5%) of the respondents were in the age group 15-19 years. This is similar to the findings of the studies done in Goma (Democratic Republic of Congo) and Brazil in which the majority of the respondents were 16-20 and 15-19 years old respectively. [3],[8] In this study, the vast majority of the proportion of the respondents (99.5%) were single. This is similar to the findings of the studies carried out in Ibadan (Nigeria) and Brazil in which 97.4% and 95.7% respectively of the respondents were single. [3],[11] A majority of the respondents in this study were from the Yoruba ethnic group (68.4%), followed by the Igbo ethnic group (27.7%). This is similar to the findings from a study carried out in Ibadan in which the majority of the respondents were also of the Yoruba ethnic group (75.1%), followed by the Igbo ethnic group (15.1%). [11] This is not surprising, as the study was carried out in southwestern Nigeria, which is dominated by the Yoruba ethnic group.
The great majority of the respondents (88.3%) had good knowledge of abortion. The majority of the respondents knew the meaning of abortion (97.6%); this result is higher than the result from a study done in Goma where only 61.3% of the respondents knew the meaning of abortion. [8] A majority of the respondents in this study first heard about abortion from their friends (52.4%), unlike the study in Goma where a majority of the respondents (66.2%) first heard about abortion from the radio. [8] The finding that 57.3% of the respondents in this study knew that abortion was illegal in Nigeria is lower than the finding of the study carried out in Goma where 82.9% knew abortion was illegal; this could be due to the fact that the respondents in this study first heard about abortion from their friends, a not-so-reliable or factual source of information about abortion, unlike with the study in Goma where the majority of the respondents first heard about abortion from the radio, which is a more authentic source of information. [8] The majority of the respondents (81.6%) knew that bleeding was a possible complication of abortion, which is very similar to a study done among university undergraduates in Ibadan where 81.2% knew that unsafe abortion could be associated with bleeding. [11] A little over half of the respondents (54.8%) in this study knew that it was possible to contract human immunodeficiency virus infection/acquired immune deficiency syndrome (HIV/AIDS) during abortion, while in the Ibadan study, 79.1% knew that unsafe abortion is associated with increased risk of contracting HIV/AIDS. [11] In this study, 77.2% of the respondents knew that abortion could lead to infertility, while in the Ibadan study 90.4% knew that infertility was a complication of abortion. [11] A very large proportion of the respondents (96.6%) in this study knew that abortion could lead to death, and this is higher than the finding of the study carried out in Ibadan where 85.4% knew death was a possible complication. [11]
A very small proportion (5.3%) of the respondents disagreed that abortion was a crime and 18.9% agreed with the statement that it should be legalized, which is similar to a study carried out among South African students where only 19.8% of the respondents agreed with the statement that abortion should be legalized [12] and also similar to the study in Goma where the majority of the participants (76.2%) were against illegal abortion. [8]
Only one of the respondents (0.5%) in this study disagreed with the statement that abortion was a sin against God. This might be due to the fact that Nigeria is a highly religious country, with the majority of the population being either Christians or Muslims-both doctrines do not agree with abortion.
Small proportions of the respondents agreed with the statement that abortion should be carried out in the case of pregnancies that are the result of rape (24.8%), incest (14.1%), and to save the life of the mother (23.3%). These results are in contrast to those from a study done on South African students, where endorsement was high for these "hard" reasons for abortion (i.e. in cases of rape, incest, and to preserve mothers' health). [12]
Only 2% of the respondents said that they had ever been pregnant, and only 2% of the respondents also said that they had ever had an abortion; this result is similar to results from other studies. A study was done in Brazil among female adolescents students, and the rates of those who had ever been pregnant and had procured an abortion were 7% and 5.7% respectively; [3] also a study carried out in Mexico City where only 3.5% had ever been pregnant, with 2% of them having ever had an abortion [6] and the one in Goma where only 9.8% of the girls had had an abortion before. [8] The reason for low pregnancy and abortion could be as a result of campaigns promoting abstinence and the use of condoms among adolescents, thereby lowering the incidence of pregnancy and thus the need to procure abortion.
Three of the respondents (1.5%) had had just one abortion each in the past, and one of the respondents (0.5%) had had two abortions in the past; this is at variance from the results of a study carried out at the University of Ibadan where a majority of the respondents (60.7%) had procured abortion only once. [11] In response to the question about who performed the abortion, one of the respondents (0.5%) said that hers had been performed by a doctor, one respondent (0.5%) mentioned a chemist, another (0.5%) said that it was done by friends, and yet another (0.5%) stated that it was done by family members. Taken together this is lower than the findings from the study carried out in Bangladesh where 43% of all abortions were conducted by health workers and 57% by traditional providers. [13]
There was a statistically significant association between the ages of the respondents and the knowledge of abortion (P = 0.004), as the higher the ages of the respondents, the more knowledge they had about abortion. A study was done on the knowledge and attitude of schoolgirls regarding illegal abortions in Goma, and significance was found between the knowledge of the complications (specifically, sterility and hemorrhage) and the ages of the respondents, as the higher the ages of the respondents, the more knowledge they had about the complications. [8]
There was found a statistically significant association between the ages of the respondents and their attitude toward abortion (P = 0.03), as the respondents who were older seemed to have a better attitude toward abortion. The older the respondents got, the more they began to understand and have unbiased opinions on abortion. This is similar to the study done on the knowledge and attitude of schoolgirls toward illegal abortions in Goma, among high school girls aged 16-20 years. While most of the participants (76.2%) were against illegal abortion, 23.8% supported it. The largest age group to support illegal abortion was the 18-year-old group (12.2%). [8]
There was no statistically significant association found in our study between knowledge of abortion and attitude toward abortion. The knowledge the respondents had had nothing to do with their attitude toward abortion, as there was overall good knowledge of abortion, yet an overall poor attitude toward abortion.
| Conclusion | | |
In conclusion, the majority of the respondents had good knowledge of abortion (83.3%) and poor attitude toward abortion (99.2%), and only 2% have ever procured abortion (98%). There was a statistically significant association between the ages of the respondents and their knowledge of abortion (P = 0.004) as well as their attitude toward abortion (P = 0.03).
There is, therefore, a need for the State Ministries of Education and Health to improve and sustain the existing knowledge and attitudes toward abortion so as to reduce the practice of procuring abortion among students of the two schools.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 7]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]
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