Study design and period
An institutional based quantitative cross sectional study was conducted from October 1 to November 30, 2017GC at health facilities of Debre Markos town, Amhara region, Ethiopia.
Source and study population
All reproductive aged women who seek abortion care services at health institutions of Debre Markos town were the study population, and those who seek the service at the selected health institutions of the town, during the study period, were the study population. Women on therapeutic abortion or those who had spontaneous abortion and came to the institution for PAC service were assumed to be excluded from the study.
Sample size and sampling procedure
The final sample size, 567, was calculated using single population proportion formula with the assumptions of 95% confidence interval, 5% margin of error, 33.6% magnitude of RIA in Addis Ababa from a previous study(9), 10 % non-response and a design effect of 1.5. Multi stage sampling was the technique used to select the study participants. First, by using cluster sampling technique, health facilities with safe abortion service were clustered based on facility ownership as public, non-governmental and private facilities. There were five public health facilities (four public health centers and one public referral hospital), two facilities owned by Non-Governmental Organizations (NGO) and six private clinics in the town. By simple random sampling technique, two public, one NGO and four private health facilities were selected from each cluster. After allocating proportional sample for each cluster, based on their average monthly abortion service, systematic random sampling technique was finally employed to select the study participants from each health institution. The sampling interval K was calculated by using the formula K = N/n, and every second women was selected from each facility.
Data collection tool and procedures
The data was collected using an interviewer-administered questionnaire. It was conducted by eight diploma midwifes and supervised by four first degree holder midwifes. Prior to the data collection, proper training about the instrument and how to get consent for interview was given to the data collectors and supervisors for three days. The data collection tool was prepared from literatures, and first it was translated from English to the native language of the region (Amharic), and then re-translated to English language to ensure consistency. Moreover, pretest was conducted on 28 women who came for safe abortion service at University of Gondar referral hospital, Gondar town. Thereby, relevant modification was done to ensure the relevancy of the instrument before the actual data collection. The questionnaire contains; Part I-socio-demographic characteristics, Part II - sexual and reproductive health history, Part III –FP use and fertility intentions, Part IV -substance exposure status and Part V -gender based violence.
Repeat induced abortion – refers for the women who is having pregnancy termination for more than one time, without any medical or surgical indication.
First, the data was coded, entered and cleaned using Epi info statistical software version 7. Then, it was exported to SPSS statistical software version 20 for analysis. Descriptive statistical analysis such as simple frequencies, measures of central tendency and measures of variability were used to describe the characteristics of participants. To see the association between each independent variable with the outcome variable, bivariate logistic regression was used, and variables with a p-value <0.2 were selected for multivariable logistic regression. Independent predictors of RIA were determined by Multivariable logistic regression, and crude and adjusted odds ratios (COR & AOR) together with their corresponding 95% confidence intervals were computed to see the strength of association. Finally, level of statistical significance was declared at p-value < 0.05.