World Health Organization (WHO) defined Induced second trimester abortion is pregnancy loss between 13 and 28 weeks of gestational age. It was reported that the prevalence of women were 10–15% of all induced abortions have to be made in the second trimester period though the foremost rate of abortions are performed in the first trimester abortion in worldwide 1. Termination of pregnancy is the most debatable issue and a distressing experience that affects the mother in a variety of ways by influencing on emotional status that can finally result in psychological disorders such as depression 2. On average, 73.3 million induced abortions appeared in the world each year between 2015 and 2019, which resembled to the worldwide annual rate of 39 abortions per 1000 women aged between 15–49 years 3. An estimated 22 million abortions continue to be performed unsafely each year, resulting in the death of an estimated 47,000 women and disabilities for an additional 5 million women 4. The impact of Second trimester abortion is different across countries in Africa such as, Kenya, Nigeria and Ethiopia and had association with utmost maternal complications 5–7. Furthermore, in developing countries termination of pregnancy enforce high financial effect on the limited healthcare resources for post abortion care 8. In Ethiopia, Abortion law declared which used to save women where the health or life of the woman or the child have threatened due to continuation of the pregnancy or birth, it does not deal about financial burden and social problem 9.
A previous Study done in southwest Ethiopia suggested that women who gain safe second trimester medical abortion were 154 (76.6%) with complete abortion without any complication while the remaining 47 (23.4%) had incomplete abortion with one or more complication 10. The second trimester complication of abortion is significantly different across category of gestational age as reported by study conducted in Bangladesh 11 that indicated 17.5% women existing in 13–16 weeks, 55% were in 17–20 weeks and 27.5% of women were in 21–24 weeks of gestational ages. Another studies 49.8% in 12–18 weeks, 43.8% in 18.1–24 weeks and 6.5% in 24.1–28 weeks gestational ages in Ethiopia 10. In Zambia, more of women had second trimester abortion at 14 weeks of pregnancy which is 21.4% 12.
The prevalence of second term-induced abortion was different among the countries in Africa. The point prevalence of second trimester abortion was 15.3% in Lusaka Zambia 12. Another studies convinced with the prevalence of induced second trimester abortion was 19.2% in Ahmara Ethiopia 13, 29.6% in Debre markos town of Ahmara Ethiopia 14, 31.3% in Northwest Ethiopia, 7, 10% in Nigeria 6 and 34% in Kenya 5. In Ethiopia, unwanted pregnancy is huge problem among abortion patients 15. The cross-sectional study done in Harari region, from March 25 to April 25, 2019 suggested that the main reasons for the unwanted pregnancy of women were that 32.23% partner pressure and 31.40% forget to take contraceptives carefully 16. The study conducted by 14 in Debre Markos showed that 75% of the women who occurred for abortion care services had induced second trimester abortions. Another study by 15 revealed that about 64% of women experienced first trimester abortion and 41% of women experienced second trimester abortion.
Several studies revealed that Induced abortions had maternal and child mortality in addition to psychological, mental and physical health conditions. In confirmation to this in Ethiopia the annual abortion was 23 per thousand women, abortion ratio to live births was 13 per 100 women and the case fatality rate of women who seek post abortion care in Ethiopia was 628 per 100,000 for those in the reproductive age 17,18. In the area, including the current study area, Social Stigmatization and psychological impose an result misfortune that disturb the normal life of the entire family, depression and grief for women needs to terminate their pregnancy 19. Another study conducted by 20 indicated that “Depression” (60.5%), “worry about not being able to conceive” (53.6%) and “eating disorder” (48.7%) were the main psychological consequences of women with abortion complication while “Decreased self-esteem” (43.7%), “nightmare” (39.5%), “guilt” (37.5%), and “regret” (33.3%) have been lower status of psychological cause of abortion, respectively. The cultural practice of community considered children as an asset and belief that using contraceptive for family planning services was against religion since terminating a pregnancy is considered to be killing a baby 21. Due to this women were fear to use contraceptive which reduce the risk of abortion and not interested in discussing this issue either with family member or any other close friends that elongated the time of abortion to second trimester where the risk is higher. However, Non-use of contraception is found to increase the risk of abortion by twofold 22.
Early management of induced second trimester abortion is very crucial to prevent further complications of second trimester termination of pregnancy. Women with such complication, needs more facility services, antenatal care visits and training regarding their reluctance to visit healthcare providers. Delay in making decision in first trimester due to either family/partner pressure or conflicting feeling about the pregnancy, lack of information about where to obtain an abortion, delay in testing and appointments, abortion related social stigma, the need to travel far from their home, and evidence of fetal anomalies or threats to health of mother were contributor to second trimester abortion 23–25. Hence, to save mothers life from abortion correlate mortality and planning strategy for interventions the abortion complication problem it is better to know the prevalence rate and potential determinants. Current study revealed that determining potential factors associated to second trimester termination of pregnancy and percentage of prevalence for women in reproductive age at Jugel Hospital in Harari Region, Eastern Ethiopia.