Table 1 depicts (44.2%) and (55.8%) of the respondents were males and females, respectively, involved in the study. The majority of the respondents’ age group was found to be from 35-45(46.1%) and the mean age of respondents’ was 41.33. Majority of respondents (67.7%) were married followed by (23.5%) unmarried. With respect to religious affiliation (72.9%), Orthodox Christians followed by Islam (21.9%) and the remaining 4.2 % and 1 % were Protestantism and Catholic, respectively. Concerning the household family size, the majority was found to be under the category of 3-4 (41%). Majority of the respondents were educated where (28.1%) were diploma holders, (23.5%) degree and above, (22.3%) secondary school completed. Finally, trade was the main livelihood strategy for most respondents followed by government employment.
Table 1: Socio- Demographic Characteristics of Respondents
Characteristics
|
Responses
|
(N=310)
|
Percent
|
Sex of respondents
|
Male
|
137
|
44.2
|
Female
|
173
|
55.8
|
Age of respondents
|
24-34
|
75
|
24.2
|
35-45
|
143
|
46.1
|
46-56
|
75
|
24.2
|
57-67
|
12
|
3.9
|
68 and above
|
5
|
1.6
|
Marital status
|
Married
|
210
|
67.7
|
Unmarried
|
73
|
23.5
|
Divorced
|
20
|
6.5
|
Widowed
|
7
|
2.3
|
Religious Affiliation
|
Orthodox Christian
|
226
|
72.9
|
Islam
|
68
|
21.9
|
Catholic
|
3
|
1.0
|
Protestant
|
13
|
4.2
|
Household family size
|
1-2
|
87
|
28.1
|
3-4
|
127
|
41.0
|
5-6
|
73
|
23.5
|
7 and above
|
23
|
7.4
|
Educational level
|
unable to read and write
|
11
|
3.5
|
read and write
|
41
|
13.2
|
primary completed
|
29
|
9.4
|
secondary completed
|
69
|
22.3
|
Diploma
|
87
|
28.1
|
degree and above
|
73
|
23.5
|
Main source of income/livelihood
|
Trade
|
132
|
42.6
|
Government employee
|
113
|
36.5
|
daily laborer
|
15
|
4.8
|
Remittance
|
22
|
7.1
|
NGO/private employed
|
24
|
7.7
|
Others
|
4
|
1.3
|
Respondents’ Knowledge and Awareness of Abortion
Table 2 presents majority of the respondents, 181 (58.4%), knew about safe abortion practices performed in healthcare centers compared to unsafe abortion practices and spontaneous abortion which accounted for 101 (32.6 %) and 28 (9%) respectively at the time of the survey. Regarding knowledge of the respondents about the institutional preference of women in terminating pregnancy, the majority of the respondents currently said that most women preferred private clinics (50.8%), NGOs (33.7%), government hospitals (34%) and government health posts (24.3%). Yet, 35.3% of respondents said that still a large number of women resorted to unsafe abortion practices for terminating pregnancy. Respondents were asked the reasons of pregnancy termination. The results showed that 52.8% of them thought the people terminated pregnancy due to fear of societal stigma/judgment/ 49% for economic reasons, 39.5% for fetal abnormality, and 37.5% for a health threat to mother. One of my FGD discussants narrated:
There is a strong reaction by the community against induced abortion. They label women as ‘dikkalawolaj’ in local language [giving birth illegitimately] if they bear a child before wedlock and outside of marriage]. Besides, most women terminate their pregnancy due to economic reasons. Imagine that a lot of babies were born and thrown in the back streets (ditches) mainly due to the fear of societal reactions and economic reasons (FGD, Male).
While performing induced abortion, 66% and 54.5% of the respondents thought women faced health-related risks and problems including death, respectively. The remaining 27.1 % said women encountered societal stigma, stereotype, and labeling after practicing induced abortion. A woman who experienced an induced abortion narrated societal reactions as follows:
There are bad words from my neighbors and my work place. They insulted me as an arrogant, killer and murderer. I always felt embarrassed and sometimes I cry. Only God knows my situation. I am a housemaid (domestic worker). Life is miserable and I may not be married in the future because the community sees me in a bad manner (Unmarried, age 24).
Table 2: Respondents’ knowledge and awareness of abortion practices
Variables
|
Responses
|
F
|
%
|
F(multiple response)
|
What kind of pregnancy termination do you know currently in the area?
|
Safe
|
181
|
58.4
|
|
Unsafe
|
101
|
32.6
|
|
Spontaneous
|
28
|
9.0
|
|
Total
|
310
|
100.0
|
|
In which place do women terminate unwanted pregnancy? (Multiple response is possible)
|
|
Frequency (N=310)
|
Percent of responses
|
Percent of cases
|
government hospital
|
105
|
19.1%
|
34.0%
|
government health post
|
75
|
13.6%
|
24.3%
|
NGO health centers
|
104
|
18.9%
|
33.7%
|
private health clinic
|
157
|
28.5%
|
50.8%
|
traditional practitioner
|
109
|
19.8%
|
35.3%
|
Total
|
550
|
100.0%
|
178.0%
|
What do you think that the reasons why women terminate pregnancy? (multiple response is allowed)
|
|
Frequency (N=310)
|
Percent of Responses
|
Percent of cases
|
Economic reason
|
154
|
27.7%
|
49.8%
|
Health threat to mother
|
116
|
20.9%
|
37.5%
|
Fetal abnormality
|
122
|
22.0%
|
39.5%
|
fear of societal reaction/stigma
|
163
|
29.4%
|
52.8%
|
Total
|
555
|
100.0%
|
179.6%
|
What problems do you think that women face after terminating pregnancy? (Multiple responses is possible)
|
|
Frequency (N=310)
|
Percent of responses
|
Percent of cases
|
Health Problems
|
205
|
42.5%
|
66.1%
|
Death
|
169
|
35.1%
|
54.5%
|
Societal Stigma/ Reaction
|
84
|
17.4%
|
27.1%
|
I Do not know
|
24
|
5.0%
|
7.7%
|
Total
|
482
|
100.0%
|
155.5%
|
In table 3 respondents were directly asked whether they had information about the revised abortion law of Ethiopia; nevertheless, only 141(45.5 %) knew about it. Put differently, more than half of the respondents (54.5%) did not have any sort of information regarding abortion law. Most of the participants in the FGD did not have any idea what the abortion law is and what it actually says. Here, out of 141 who said they know about the abortion law, 67(48%) believed that it is sufficient, 23 (16%) said it violates the norms of the society, and 51 (36 %) said insufficient/does not consider all social factors. However, table 4 depicts regarding the legalization of abortion, 183 (59%) believed abortion should be legalized only under the conditions of preventing maternal death (48.4%), rape when it is legally reported (31.3%), minor age when approved by recognized officials (35.2%) and upon the desire and request of women (18.1%). On the contrary, except Muslim and Christian religious leaders, who had fierce resistance towards the legalization of abortion, most FGD discussants and some key informants such as lawyers, recommended that abortion should be legalized and permitted upon the request of a women who live under commercial sex work, women with poor economy and other victims which are being clandestinely practiced and ultimately led to maternal mortality. For example, an elderly key informant narrated her opinion about the legalization of abortion as follows:
I personally believe that abortion should be legalized since unsafe abortions can be performed at any time. For example, there are situations other than rape and incest that compels women to perform abortions due to economic and social/psychological reasons. At this time, legal abortion should be allowed; otherwise most women will be vulnerable to various unwanted life experiences such as death, health risks, and societal discrimination (Female, age 68).
Table 3: Respondents’ Knowledge related to the abortion Law in Ethiopia
Variables
|
Responses
|
Frequency
|
Percent
|
Multiple response(F)
|
Do you have information about Ethiopian 2005(1997 E.C)) revised abortion law?
|
Yes
|
141
|
45.5
|
|
No
|
169
|
54.5
|
|
Total
|
310
|
100.0
|
|
What is your opinion about the revised abortion law if yes?
|
I believe it is sufficient
|
67
|
48
|
|
I oppose as it violates norm of the society
|
23
|
16
|
|
I think it is insufficient/does not considers all social factors
|
51
|
36
|
|
Total
|
141
|
100
|
|
Table 4 Respondents’ Opinion about Legalization of Abortion
Do you believe that abortion should be legalized?
|
Yes
|
183
|
59
|
|
No
|
127
|
41
|
|
Total
|
310
|
100
|
|
Under what conditions do you think that abortion should be justified? Multiple response is possible
|
In case of rape that is legally approved and reported
|
57
|
21.8%
|
31.3%
|
to prevent maternal death
|
88
|
33.7%
|
48.4%
|
if a pregnant is a minor approved by recognized officials
|
64
|
24.5%
|
35.2%
|
up on the desire and request of a woman
|
33
|
12.6%
|
18.1%
|
I am not quite sure
|
17
|
6.5%
|
9.3%
|
other justifications
|
2
|
0.8%
|
1.1%
|
Total
|
261
|
100.0%
|
143.4%
|
The practice of abortion and Contextual factors
Findings on contextual factors on abortion decisions showed that 120 (38.7%) of respondents thought that religion and morality affected abortion decisions in the community. About 97 (31.3%) of the respondents said societal stigma and stereotypes, 69 (22.3%) gender roles, and the remaining 24 (7.7%) said legality issues. A 22 -year-old woman having induced an abortion narrated in an in-depth interview how her religion impacts on her abortion decision as follows:
I was in tension in deciding to end my pregnancy when the pregnancy test was positive. Above all else, my religion and morality of killing a baby worried me greatly [enklfnesagn]. Because I frequently attended church programs that made me more worried; because religious leaders frequently taught us about the sin of killing a baby and the dignity of celibacy. Moreover, both giving birth before wedlock and abortion are socially undesirable; I was stressed because I may be also socially neglected and isolated.
Hence, the finding agrees with Reardon (2003) and Kimport et al. (2011) which says abortion decision is not an easy process and requires several steps to reach a decision as the decision affects women’s social, cultural, emotional, and spiritual and even physical and economic life.
In a similar fashion, gender roles played a decisive role in abortion decisions. To this end, majority of the respondents 211(68.1%) said that women have no right regarding abortion decisions and practices; rather only 99(31.9%) of the respondents said that women have the right to decide on matters of abortion and unwanted pregnancy. The reason women could not influence men in performing induced abortion was due to the fact that 113 (53.3 %) believed that abortion is believed to be a sign of illicit sexuality (pregnancy outside of marriage) by women followed by 101(47.6%) male dominancy system (men’s power to decide over women). The remaining 74(34.9%) and 5(2.4%) thought that women are perceived as not leaders in the community and other factors, respectively. One of the key informants working in the women and children office of North Wollo Zone explained as follows:
Gender and gender roles are reflections of the wider society. Still, male dominancy is reflected. Men are dominating women in many aspects such as in abortion decision, especially in married couples. Women are subordinate to men; hence, women are ashamed of influencing men in the abortion decisions and consider themselves as inferior. As a result, the burden is usually on women having less voice than men (male, age 38).
There were various constraining factors which influence safe abortion practice. In doing so, 100 (32.5%) of the respondents said that the clandestine nature of unsafe abortion practices, 132 (42.9%) stringent values and norms of the society which stigmatize and discriminate women having induced abortions and 80(26%) costs of abortion fees, 63(20.5%) conscientious objection of doctors (incompatibility of healthcare providers’ moral, religious and ethical perspectives), 57 (18.5%) confidentiality problems of healthcare providers to their clients privacy as barriers of safe abortion practice in the study community.
Table5: Contextual Factors in Abortion Decision and Practice
Items /variables
|
Responses
|
Frequency
|
Percent
|
Multiple response
|
Which factor mainly influence abortion decisions in your community?
|
religion and morality
gender norms and relations/roles
Legality
societal stigma
Total
|
120
69
24
97
310
|
38.7
22.3
7.7
31.3
100.0
|
|
What are the barriers in practicing, safe abortion? (multiple response is possible )
|
|
Frequency (N=310)
|
Percent of responses
|
Percent of cases
|
Conscientious objection of doctors
|
63
|
14.5%
|
20.5%
|
availability of TBAs(abortionists)
|
100
|
23.0%
|
32.5%
|
Lack of confidentiality of healthcare providers
|
57
|
13.1%
|
18.5%
|
Stringent values and norms of the society
|
132
|
30.4%
|
42.9%
|
cost of abortion fee
|
80
|
18.4%
|
26.0%
|
other barriers
|
2
|
0.5%
|
0.6%
|
Total
|
434
|
100.0%
|
140.9%
|
Do you think that females have the right to terminate pregnancy by their own?
|
|
Frequency
|
Percent
|
|
Yes
|
99
|
31.9
|
|
No
|
211
|
68.1
|
|
Total
|
310
|
100.0
|
|
|
|
Frequency (N=211)
|
Percent of responses
|
Percent of cases
|
What would be the possible reasons why women do not influence men in abortion decisions?(Multiple response is possible)
|
Male dominance system
|
101
|
34.5%
|
47.6%
|
women are perceived as not leaders in the community
|
74
|
25.3%
|
34.9%
|
abortion is a sign of illicit sexuality
|
113
|
38.6%
|
53.3%
|
other factors
|
5
|
1.7%
|
2.4%
|
Total
|
293
|
100.0%
|
138.2%
|
Community’s Experience towards Abortion Practice
Respondents were asked regarding the community’s response towards induced abortion. Accordingly, 56(18.1%) respondents anticipated that the community had a positive or favorable responses, 120 (38.7%) said moderate/medium reactions, and 134(43.2%) negative or unfavorable reactions towards abortion. During an in-depth interview, a 34 year-old woman having induced abortion also strengthened the negative reaction of the community as follows: “I have faced negative reactions from my neighbors. They labeled me as ‘shermuta’ [a promiscuous and immoral woman] and they do not respect me as the previous one and now I got divorced”.
Respondents were asked a straight forward question about their willingness to give social support after a woman performed an induced abortion. Accordingly, 219(70.6%) responded that they would be voluntary to help a woman who experienced abortion, while the remaining 91(29.4%) would not be willing to support because they believe that such a woman is adulteress 15(16.5%), murderers 54(59.3%), violator of cultural values 14(15.4%) and inciter of others to do the same 37 (40.7 %). The remaining 1(1.1%) identified other reasons. However, respondents were asked what could be done if an unwanted pregnancy occurred in their family members. Accordingly, the majority of the respondents 155 (50%) would decide to raise, 114 (36.8%) terminate safely, 39(12.6 %) did not know what to do, and 2(0.6%) expelled from the family if one who experienced abortion. Moreover, the respondents were also asked whether they would share the problem of unwanted pregnancy and abortion experience to someone else. The responses were 219(70.6%) would share if they experienced the case, among whom 123(58.3%) of the respondents said they would share with their family members, 98(46.4. %) to their peers /closest friends, 61(28.7%) to their religious leaders, and 3(1.4%) to others, while the remaining 91(29.4%) would not be willing to share with someone else if they experience/encounter/ unwanted pregnancy or abortion due to 42(46%) responded that due to fear of societal stigma/reaction/, 36(39%) fear of expose to others, and 14(15%) fear family reaction. For instance, during the in-depth interview, a woman having induced abortion narrated the experience of telling to others as follows:
While I was working as a house maid, I was raped by someone and got pregnant. I did not have any information about how and where to terminate. I do not want to tell the case to someone else either. Later, I went to my parents and told to my mother. Then my mother told the case to someone else to get money. Then, we went to a private clinic and paid 1500 birr. The pregnancy was 5 months. It was very painful. Now everybody insults me; no one gives me any respect. Had I not been poor and found difficult to get money, I would not have disclosed the case to others. Now I am stigmatized by those who know my history (uneducated, unmarried, age 24).
Table 6: Experience of the Community towards Abortion Practice
Variables
|
Responses
|
F
|
%
|
How do you evaluate the response of the community towards pregnancy termination/induced abortion?
|
positive reaction(favorable)
moderate reaction/medium /
negative stereotype and discrimination
Total
|
56
120
134
310
|
18.1
38.7
43.2
100.0
|
Will you voluntary if a woman asks you any support after experiencing an abortion?
|
Yes
No
Total
|
219
91
310
|
70.6
29.4
100.0
|
What would be your reason/s/ not to support?(Multiple response is possible)
|
Responses
|
F (N=91)
|
% responses
|
%of cases
|
I consider her as adulteress
she is a murder
she violates cultural values
she may encourage other women
other reasons not to support
Total
|
15
54
14
37
1
121
|
12.4%
44.6%
11.6%
30.6%
0.8%
100.0%
|
16.5%
59.3%
15.4%
40.7%
1.1%
133.0%
|
What if one of your family members experiences unwanted /unplanned pregnancy?
|
Responses
|
F
|
%
|
she should terminate safely
she has to raise it
I just go out her from home
I don’t know how could she do
Total
|
114
155
2
39
310
|
36.8
50.0
.6
12.6
100.0
|
Will you share the problem to someone else if an unwanted pregnancy occurred in your family?
|
Yes
No
Total
|
219
91
310
|
70.6
29.4
100.0
|
To whom you may share the problem you face?
|
Responses
|
F(N=219)
|
% of responses
|
% of cases
|
Family members
my friends
for religious leader
I am uncertain
Others
Total
|
123
98
61
7
3
292
|
42.1%
33.6%
20.9%
2.4%
1.0%
100.0%
|
58.3%
46.4%
28.9%
3.3%
1.4%
138.4%
|
What is the main reason behind not to share your problems with others?
|
Responses
|
F
|
%
|
Fear of social stigma
It may be disclosed to others
family reaction
Total
|
42
36
14
91
|
46
39
15
100
|
The Influence of Socio-Cultural Discourses on the Attitude of Community towards Abortion practices
The results of multiple regression analysis showed that those stigmatizing attitudes, beliefs and actions, moral and religious discourse, and medico-legal discourse were significant at p < 0.05, where stigmatizing attitudes, beliefs and actions were significant at p=.032, moral and religious discourse statistically significant at p=0.000 and medico-legal discourses at p=0.035. Moreover, F ratio in ANOVA, table below shows that the independent variables statistically significantly predict the dependent variable, F (3, 306) =53.049, p < 0.05, R2= .342).Therefore, the aforementioned discourses were found to be important variables that influence the attitude of the respondents towards abortion practice and had a cumulative effect of 34.2 % upon it. One professional in Women and Children office explained its impact upon the lives of women and the attitude of the community towards abortion as follows:
Pregnancy may occur in one way or another; the same is true for pregnancy termination. This is due to the fact that the existing socio-cultural structures and community values, discourses, and expressions have their own impact on women’s reproductive rights and community attitudes towards abortion. Among other things, in religion, abortion is intolerable, immoral, and sinful act or against the law of God and condemnation of spiritual fathers by their followers. In fact, gender norms (male dominancy), societal stigma, social exclusion and bad words and the like determined people’s attitude towards abortion practices. Besides, unwillingness and lack of confidentiality of doctors are also great problems in practicing abortion (male key informant, age38).
Table 7: The Impact of socio-cultural discourses on respondents’ attitude towards abortion practice
ANOVAa
|
Model
|
Sum of Squares
|
Df
|
Mean Square
|
F
|
Sig.
|
1
|
Regression
|
4671.317
|
3
|
1557.106
|
53.049
|
.000b
|
Residual
|
8981.780
|
306
|
29.352
|
|
|
Total
|
13653.097
|
309
|
|
|
|
a. Dependent Variable: community attitude towards abortion practice
b. Predictors: (Constant), medico-legal discourse, moral and religious discourse, stigmatizing attitudes, beliefs and actions
|
Coefficients a
|
Model
|
Unstandardized Coefficients
|
Standardized Coefficients
|
T
|
Sig.
|
95.0% Confidence Interval for B
|
B
|
Std. Error
|
Beta
|
Lower Bound
|
Upper Bound
|
1
|
(Constant)
|
5.231
|
2.427
|
|
2.155
|
.032*
|
.455
|
10.007
|
stigmatizing attitudes, beliefs and actions
|
.194
|
.062
|
.159
|
3.145
|
.002*
|
.072
|
.315
|
moral and religious discourses
|
.607
|
.063
|
.477
|
9.662
|
.000*
|
.484
|
.731
|
legal and medical discourses
|
.123
|
.058
|
.104
|
2.119
|
.035*
|
.009
|
.238
|
a. Dependent Variable: community attitude towards abortion practice
|
b. Predictors: (Constant), stigmatizing attitudes, beliefs and actions, moral and religious, and medico-legal discourses
Abortion Practices and Public Attitude
About 227(73.2%) of the respondents reported that they had an unfavorable attitudes, while 11(3.5%) and 72(23.2%) had neutral and favorable attitudes towards abortion practice respectively.
Table 8: Respondents’ Attitude towards Abortion Practice
Valid
|
Cutoff point
|
Frequency
|
Percent
|
10-29
|
227
|
73.2
|
30
|
11
|
3.5
|
31-50
|
72
|
23.2
|
Total
|
310
|
100.0
|
Women’s negotiating strategies in performing induced abortion
During the in-depth interview, women who experienced induced abortion, identified strategies such as confessing to spiritual father, silence, perceived risks and benefits, and world view (openly discuss the issue, considering abortion as normal) were the main negotiating strategies in abortion decision and practice within the existing discourses by most women. A 19 year-old woman narrated her experience as follows:
When I faced an unwanted pregnancy, I was in a dilemma to terminate it because I feared my family, my religion, and societal stigma. Giving birth without wedlock in our community exposes to psychological and moral crisis and societal stigma. Besides, I feel like God will punish me by forbidding me another child. On the other hand, if I give birth, my life will be complicated and I want to finish my education. Finally, I decided to terminate and share the story with my mother. Besides, I thought that I should confess to my religious father.
On the contrary, unlike social factors, which are external to the individual, personal factors also play a greater role in abortion decisions. Hence, some view abortion as a relief so that they could easily decide to perform abortion despite external factors. A 22 -year-old and married woman, who participated in an in-depth interview, narrated her experience in an abortion decisions as follows:
Although to some extent my religion influenced my decision not to perform an abortion, as to me it was easy to decide because I know that the problem I would face otherwise was difficult. I am a high school student; and I married when I was at the age of 19 and I have one child. I got pregnant immediately after my first baby. My husband is working in a private organizations but his salary is not enough to raise our children, so it was me who should decide on the future life and living condition. However, after performing an abortion I got depressed and felt guilty.
Lived experience of Women practicing induced abortion: before, during, and after
While women practicing abortion, they faced various types of life challenges such as regret, fear of dying and health threat relief, fear of punishment from God, psychological and emotional impacts, and fear of being blamed by others were the common problems repeatedly narrated by most of the women during the in-depth interview. Before performing induced abortion, various personal and structural level factors such as results of pregnancy tests, fear of dying and health threats, gossips, stigma and shame, source of information about legality, service availability, cost, quality and preference of health centers and social networking (to whom shall I share or be secret), feeling of depression made women in trouble and dilemma to decide and perform abortion. Unlike those who performed surgical abortion, most women experience a good feeling in medical abortion where they simply took misoprostol to end pregnancy. However, there was a significant change after performing induced abortion compared to pre-abortion. In other words, most women experienced a feeling of regret, distress, severe health complications such as nausea, bleeding (hemorrhage), abdominal pain, and the like after performing abortion. Above all else, societal reactions such as stereotypes and gossip, and even bad words such as ‘newregna’( deviant from the norm) and ‘nefsegeday’ (killer or murderer) were frequently narrated. However, despite the various challenges faced by women after induced abortion, they employed various resilience mechanisms such as effective family planning, social connections such as sharing the problem to others, consulting health professionals which are related to health risks, confessing to the spiritual fathers , praying and developing self-confidence[I can principle] among others. Jemila speaks as follows:
I have no words to speak. I passed a miserable life. I lost many things including my home (marriage). I did a sinful act condemned by Allah [God]. It was haram. I had no futurity; it was dark. However, now I always pray. I hope Allah will forgive me. I tried to make things secret but not as expected. Now I have convinced myself to ask my husband’s forgiveness to live together and raise our children (Jemila, 34)