Research design
A cross-sectional “research design was used to guide the study among female students in public universities in Eastern Cape Province, South Africa. A cross-sectional research design was used because the design allows studies to collect data to make inferences about a population of interest at one point in time (4). A cross-sectional research design makes snapshots of the populations about which they gather data. Besides, this design was chosen because it allows studies to collect data from many different individuals at a single point in time. In this case, data were collected from four different public universities” in Eastern Cape.
Research approach
The study used “quantitative research approach which is the process of collecting and analysing numerical data (4). Quantitative research approach can be used to find patterns and averages, make predictions, test causal relationships, and generalise results to wider populations. Quantitative research methodology in this study is used to quantify the knowledge, attitude, and predictors of safe abortion among female students using numerical data that is transformed into statistics. These statistics helped to understand the research problem under study. Quantitative research methodology was also used because many researchers agree that quantitative methodology is the best when it comes to measuring opinions, views, behaviours, attitudes, practices, and other measurable variables (21). Evidence shows that quantitative research methodology is effective in uncovering and formulating facts (4). This study employed quantitative methodology to measure knowledge, attitude, and predictors of safe abortion among female students. The method was also used because it is helpful in conducting structured studies and collecting information that is” generalisable.
Sampling technique
The study “used multi-stage sampling method to select respondents. In the first stage, all universities in Eastern Cape namely Nelson Mandela University (NMU), University of Fort Hare (UFH), Rhodes University (RU) and Walter Sisulu University were selected using census sampling technique. Second stage, from each University, faculties and colleges were categorised as faculties/colleges of humanities, agriculture, engineering and science, health sciences and law and management studies. Third stage, the list of female students was generated from students' register in each faculty/college using proportional sampling technique distributed based on female students’ level of study. This was followed by the application of simple random sampling technique to select the sample for the study from six thousand female students. One thousand two hundred sixty six (1266) students successfully” completed the questionnaire.
Data collection instruments
Data were “collected using a questionnaire. To achieve the aim of the study and high response rate, six thousand female students in the first, second, third-and fourth-year level of study were invited to complete the questionnaire through their respective university communication systems. The survey used a questionnaire with several items including demographics, knowledge, and attitude towards safe abortion. The questionnaire was reviewed by” experts in survey research for face validity.
A pilot sample (n=10) was “used to improve the wording and clarity of expression of the survey items. Data from the pilot sample was not used in any further analysis. The final version of the questionnaire required an estimated time of 5-15 minutes to complete. The questionnaire was posted online together with the consent form describing the purpose of the study in detail. One thousand two hundred sixty six questionnaires were collected. The total number of female students expected to complete the survey was 6 000. Using the confidence level 95%, population size 6 000 and margin of error 5% the ideal sample size is 365 but this study generated 1266 questionnaires expressing more than one hundred per cent response rate. It was easy to conduct the study because the researcher was a senior lecturer at one of the universities under study and has expertise in health communication and research methodology studies. The researcher’s experience in health communication and research methodology span more than twelve years. All completed questionnaires were checked” for completeness by the investigator.
Variables and measurements
The “study investigated into the knowledge, attitude, and predictors of safe abortion among female students. Knowledge of students on safe abortion was assessed using eight questions that generated a high internal consistency namely Cronbach’s alpha = 0.712. Each of the correct responses was given one point while zero was given for the incorrect response based on students’ responses. Students who scored less than 60% in the knowledge questions were reported as having poor knowledge and students who scored higher than or equal to 60% were reported as having good” knowledge.
Students’ attitude “towards safe abortion was calculated out of eleven questions that generated a high internal consistency namely Cronbach’s alpha = 0.706. The study employed a five-point Likert scale: 1 = strongly disagree; 2 = disagree; 3 = neutral; 4 = agree; and 5 = strongly agree; and then categorised as “agree” (strongly agree and agree) and “disagree” (strongly disagree, disagree, and neutral). All students who scored less than the mean score were reported as having unfavourable attitudes and all students who scored greater than or equal to the mean were reported as possessing favourable attitudes towards safe abortion. Independent variables in the study were sex, age, marital relationship, place of resident, financial support from the family, and year” of study.
Ethical considerations
With adequate “knowledge of the study, female students were asked to sign the consent form by ticking on the right side of the questionnaire if they wanted to participate. Students were informed that participation in the study was voluntary and were at liberty to withdraw from the study anytime without any consequences. Confidentiality, privacy, and anonymity were upheld. The contact details for Nelson Mandela University Research Office were provided in case students had questions. The four universities under study provided gatekeepers’ letters and Nelson Mandela University provided ethical clearance. The questionnaire ran” online from July 2021 to August 2021.
Data analysis
Data were “analysed using descriptive statistics that included the computing of percentages and frequencies. Bivariate and multivariable logistic regression analyses were performed, and adjusted odds ratios (AORs) calculated with 95% confidence interval to determine the associations between safe abortion and independent variables. All variables with a p=value <.25 in the bivariate analysis were considered for the final multivariable analysis while variables with a p=value <.05 were considered in the final multivariable logistic regression model to determine significance of the association with the outcome variable” safe abortion.
Demographic characteristics of the respondents
The “study involved 1266 respondents with a response rate of more than hundred per cent. The study’s average age was 21.8 years (SD ± 2.98). Findings indicate that 778 (61.5%) of students were single, and 676 (53.4%) had parents who were both illiterate. The study found that 990 (78.3%) of the students lived in urban areas before they joined the university” as shown in Table 1.
Table 1: Socio-demographics characteristics of students
Items
|
Frequency
|
Per centage
|
|
Age group
|
18 years to 19 years
|
176
|
11.7
|
20 years to 24 years
|
820
|
65.9
|
≥25 years
|
270
|
22.4
|
|
|
Relationship status
|
Never been in a relationship
|
778
|
61.6
|
Not in a relationship at the moment
|
162
|
12.9
|
In a relationship but not married
|
160
|
12.7
|
Married
|
166
|
13.2
|
|
Family education
|
They are both illiterate
|
676
|
53.5
|
One of my parents is literate and the other one illiterate
|
428
|
33.9
|
They are both literate
|
162
|
12.9
|
|
Area of residence
|
Urban
|
376
|
21.9
|
Rural
|
990
|
78.2
|
|
University
|
Nelson Mandela University
|
424
|
33.6
|
University of Fort Hare
|
286
|
22.7
|
Rhodes University
|
276
|
21.9
|
Walter Sisulu University
|
280
|
22.2
|
|
Year of study
|
First year
|
286
|
22.7
|
Second year
|
414
|
32.8
|
Third year and above
|
566
|
44.8
|
|
Monthly stipend from family
|
<R500
|
906
|
71.7
|
R501-R1000
|
286
|
22.7
|
>R1001
|
74
|
5.9
|
Students’ knowledge of safe abortion
Results show “that 866 (68. 5%) of the students in this study had knowledge on safe abortion. Most of the students 1218 (96.3%) had heard about safe abortion out of which 966 (79.4%) heard about safe abortion from health institutions. Results indicate that 1196 (80.4%) of the students reported unsafe abortion as a major health problem, and 904 (71.5%) reported that South Africa has laws on abortion. The study found that 630 (49.9%) of the students reported hospitals as places they knew performing safe abortion. Results indicate that 752 (59.5%) of all students in the study reported that safe abortion should be carried out up to three months of the pregnancy” as presented in Table 2.
Table 2: Students’ knowledge of on safe abortion
Items
|
Frequency
|
Per centage
|
|
Have you ever come across information on methods of abortion?
|
Yes
|
1218
|
96.3
|
No
|
48
|
3.8
|
|
What is the source of your information on safe abortion?
|
Health institution
|
966
|
79.4
|
Mass media
|
826
|
67.9
|
Parents
|
432
|
35.6
|
Other
|
84
|
6.9
|
|
Where are safe abortions performed?
|
Health centre
|
246
|
22.7
|
Home
|
106
|
8.5
|
Hospital
|
620
|
49.9
|
Private clinic
|
222
|
17.6
|
|
Can safe abortion services help to reduce reproductive health problem women face?
|
Yes
|
426
|
33.7
|
No
|
568
|
44.9
|
I do not know
|
272
|
21.6
|
|
When is it suitable time to perform safe abortion?
|
Any time during pregnancy
|
514
|
40.7
|
Before pregnancy clocks three months
|
752
|
59.5
|
|
Do you think unsafe abortion is a major health issue in South Africa?
|
Yes
|
1016
|
80.4
|
No
|
250
|
19.8
|
|
Is abortion legal in South Africa?
|
Yes
|
904
|
71.5
|
No
|
362
|
28.7
|
|
What is the reason abortion is legal in South Africa?
|
If a woman has physical/mental disabilities
|
718
|
56.8
|
If a woman is physically psychologically not ready
|
910
|
71.9
|
If one is not financially able to rise the child
|
984
|
77.8
|
If pregnancy endangers life of the woman or foetus
|
528
|
41.8
|
If pregnancy is due to rape or incest
|
652
|
51.5
|
If the pregnancy is extra-marital
|
1032
|
81.6
|
Not allowed for any reason in South Africa
|
408
|
32.3
|
Students’ attitudes towards safe abortion
The results “indicate that 722 (57%) of students in the study reported a positive attitude towards safe abortion while 1062 (83.9%) disagreed to the view that elective abortion should be accessible and legal. Most of the students 922 (72.9%) disagreed to the view on the legalisation of safe and voluntary abortion, 870 (68.8%) agreed to the statement that abortion services should be available at health institutions, and 812 (64.2%) of the students agreed to the statement that men should play a role in the decision” of abortion as demonstrated in Table 3.
Table 3: Students’ attitude towards safe abortion
Items
|
Disagree
|
Agree
|
N (%)
|
N (%)
|
Safe and voluntary abortion should be legal and accessible
|
922 (72.8)
|
344 (27.3)
|
Elective abortion should be legal and accessible under any circumstance
|
1062 (83.9)
|
204 (16.2)
|
A woman under 18 asking for safe abortion service should be allowed to have the service
|
852 (67.3)
|
514(32.8)
|
Safe abortion is acceptable if a person has no resources to rise the child
|
852 (68.1)
|
404 (31.9)
|
Safe abortion is acceptable to prevent mother’s life or foetal anomaly
|
722 (57.0)
|
554 (43.1)
|
It is acceptable for a woman to choose safe abortion because of rape or incest
|
616 (48.7)
|
650 (51.4)
|
Provision of safe abortion after unwanted pregnancy can save mothers’ life
|
542 (42.8)
|
724 (57.3)
|
Males partners have influence in the decision to have an abortion
|
454 (35.9)
|
812 (64.2)
|
Health centres and hospitals should provide safe abortion services
|
396 (31.3)
|
870 (68.8)
|
A woman has the right to terminate her pregnancy
|
580 (45.8)
|
686 (54.3)
|
Adolescent students use induced abortions to terminate pregnancies
|
570 (45.0)
|
776 (55.1)
|
|
Factors affecting students’ knowledge towards safe abortion
The “bivariate analysis found students’ marital status, family education, year of study, residence, age, and hearing about abortion to be associated with students’ knowledge of safe abortion. The multivariate analysis found residence, family education, age, and hearing about abortion to be associated with students’ knowledge” of safe abortion.
Students aged 25 “and above were reported to be 2.79 times more likely to have good knowledge of safe abortion than students aged between 18 and 19 (AOR 2.78, 95% CI: 1.17, 7.28). Students from urban areas were 2.42 times more knowledgeable than students from rural areas (AOR 2.43, 95% CI: 1.27, 4.36), and students who had heard about safe abortion were 4.36 times more likely to have good knowledge than their counterparts (AOR 4.37, 95% CI: 1.89, 10.84). Students living with both parent who were literate were 3.18 times more likely to have good knowledge of safe abortion than their” counterparts (AOR 3.19, 95% CI: 1.33, 7.07) as shown in Table 4.
Table 4: Predictors of students’ knowledge of safe abortion
Items
|
Knowledge
|
COR (95% CI)
|
AOR (95% CI)
|
Good
|
Poor
|
|
Age group
|
18 to 19
|
126
|
50
|
1
|
1
|
20 to 24
|
572
|
248
|
1.10 (0.87, 1.49)
|
1.12 (0.95, 2.37)
|
≥25
|
168
|
102
|
1.54 (1.07, 2.15)
|
2.79 (1.17, 7.29)
|
|
Relationship status
|
Never been in a relationship
|
548
|
230
|
1
|
1
|
Not in a relationship at the moment
|
122
|
40
|
0.79 (0.46, 1.36)
|
0.75 (0.49, 1.39)
|
In a relationship but not married
|
90
|
70
|
1.86 (1.14, 3.04)
|
1.88 (0.95, 3.23)
|
Married
|
106
|
60
|
1.36 (0.83, 2.23)
|
1.69 (0.83, 2.46)
|
|
Family education
|
Both parents are illiterate
|
443
|
230
|
1
|
1
|
One of my parents is literate and the other one illiterate
|
298
|
130
|
0.86 (0.59, 1.23)
|
0.92 (0.69, 1.29)
|
Both of my parents are literate
|
122
|
40
|
1.65 (1.11, 3.28)
|
3.19 (1.33, 7.07)
|
|
Residence
|
Rural
|
684
|
306
|
1
|
1
|
Urban
|
182
|
94
|
1.16 (0.78, 1.73)
|
2.43 (1.27, 4.36)
|
|
Year of study
|
First year
|
198
|
88
|
1
|
1
|
Second year
|
186
|
224
|
2.77 (1.58, 4.15)
|
0.69 (0.39, 1.28)
|
Third year and above
|
482
|
86
|
0.39 (0.25, 0.65)
|
1.29 (0.83, 2.04)
|
|
Having ever heard about abortion
|
Yes
|
848
|
370
|
3.83 (1.65, 8.89)
|
4.37 (1.89, 10.84)
|
No
|
18
|
30
|
1
|
1
|
|
Monthly stipend from family
|
<R500
|
602
|
304
|
1
|
1
|
R501–R1000
|
206
|
80
|
0.72 (0.52, 1.17)
|
0.94 (0.43, 2.42)
|
>R1001
|
58
|
16
|
0.62 (0.25, 1.23)
|
0.97 (0.89, 4.29)
|
|
Factors affecting students’ attitude towards safe abortion
Findings in the “bivariate analysis show that marital status, family education, age, religion and residence were associated with students’ attitude towards safe abortion. The multivariate logistic regression included all explanatory variables that were considered in the bivariate analyses. Results show that students’ place of residence and age remained significantly associated with students’ attitude of safe abortion. Results indicate that students coming from urban residents were 1.51 more likely to have a favourable attitude of safe abortion than their counterparts (AOR 1.52, 95% CI: 1.09, 2.22), and students aged between 25 and above were 6.58 times more likely to have a favourable attitude of safe abortion than students” aged between 18-19 (AOR 6.59, 95% CI: 2.72, 11.22) as presented in Table 5.
Table 5: Predictors of students’ attitude towards safe abortion
Items
|
Attitude
|
COR (95% CI)
|
AOR (95% CI)
|
Favourable
|
Unfavourable
|
|
Age
|
18 to 19
|
156
|
20
|
1
|
1
|
20 to 24
|
438
|
382
|
6.81 (1.44, 10.48)
|
4.69 (0.97, 9.85)
|
>25
|
128
|
142
|
8.66 (2.14, 12.46)
|
6.59 (2.72, 11.22)
|
|
Relationship status
|
Never been in a relationship
|
396
|
382
|
1
|
1
|
Not in a relationship at the moment
|
126
|
36
|
0.29 (0.18, 1.04)
|
2.49 (0.75, 4.31)
|
In a relationship but not married
|
88
|
72
|
0.86 (0.53, 1.39)
|
0.79 (0.38, 1.65)
|
Married
|
112
|
54
|
0.51 (0.32, 0.83)
|
1.59 (0.82, 3.15)
|
|
Family education
|
Both illiterate
|
368
|
308
|
1
|
1
|
One literate, one illiterate
|
252
|
176
|
0.84 (0.59, 1.19)
|
0.95 (0.56, 1.62)
|
Both parents are literate
|
102
|
60
|
0.71 (0.44, 1.17)
|
1.04 (0.59, 1.82)
|
|
Residence
|
Rural
|
578
|
412
|
1
|
1
|
Urban
|
144
|
132
|
1.29 (0.89, 1.89)
|
1.52 (1.10, 2.22)
|